A Jamaican nurse who migrated to the United States in search of greener pastures continues to speak out about the plight of her colleagues, saying that it is necessary to acknowledge that their role as caregivers is leading to strain and burnout, necessitating therapeutic intervention.

But Dr Cheryl Morgan urged nurses not to use what she terms the “caregivers role strain” as excuse for lack of care, empathy or incompetence in the profession where patients are in dire need of their best selves.

“Caregivers role strain is an ancient nursing diagnosis. It is the physical, emotional, psychological and spiritual distress in nurses due to chronic exposure to caring for the sick and overexposure to long-term suffering and death,” she said in an article for the Jamaica Observer.

“Many nurses feel helpless in those situations and develop ineffective coping mechanisms that heighten their intolerance. This results in a nonchalant response to suffering as a result of the demand in the hospital. The public might interpret this behaviour as uncaring and lack of empathy.

“The nurses who display more empathy and caring are the ones who often experience burnout,” Dr Morgan believes, but urged them not to use it as an excuse for lack of care, empathy or incompetence in the profession.

Dr Morgan, who migrated in 2009 after leaving as a registered nurse from the University Hospital of the West Indies (UHWI) in St Andrew, went on to excel in her chosen profession, pursuing doctoral studies and becoming an author.

Reflecting on her time at the UHWI, she described her first few years of nursing as “dreadful”. She would be torn between being empathetic and being strong, unable to separate her personal emotion from her professional role.

“I became attached to patients easily, offering the most compassionate care; but I would cry at nights. My most challenging days were experienced while working on paediatric units. That was a character-building experience for me and the biggest test of my ability to be a caregiver.

“Working the paediatric floor will make or break you. If you survive it, you are ready for nursing. I drew strength from the parents of children who were dying. I convinced myself that if those mothers could walk on the floor with a smile, I also needed to radiate that smile for the children.

“While smiling, my heart was breaking inside when I thought of the inevitable prognosis. Many nurses suffer in silence without [a] therapeutic outlet. They vent to their colleagues, who in return vent about their nursing sorrows. There were no therapeutic outlets since both colleagues now resorted to trauma bonding by adding on more trauma after hearing each other’s stories.”

She said night-time would be her moment of solace.

“Sometimes I would wake up at nights and call the hospital floor to check on the patients. I would ice my eyes in the morning and walk onto the unit ready to care for the sick again. “Research has now shown that between 2023 and 2025, about 71 per cent of nurses were suffering from depression and anxiety and suicide rate is high in the profession, according to a 2021 National Library of Medicine study on nurse depression, anxiety, stress and workplace stressors in tertiary health-care settings, written by Kaushik et al.

“This was a hospital-based cross-sectional study that was conducted in two tertiary care hospitals, one of which was a government hospital and the other run by the private sector.

The stressors across subgroups of work areas were compared.

The result showed that 50.8 per cent of nurses had stress; 74 per cent had anxiety; 70.8 per cent had depression. and 79.1 per cent had at least one of them.

“Stressed, anxious or depressed nurses were more concerned about lack of job satisfaction and conflicts with supervisors. Workplace stressors varied with work areas: private hospital, no job satisfaction, conflicts with doctors and patients; government hospital, acquiring infectious diseases; ICUs, inadequate salary; non-ICUs, odour and sounds in workplace and conflicts with patients.

“It should be recognised at all levels of nursing that the profession is extremely demanding, with lack of flexibility and support to allow time away from work to recover. This is due to chronic understaffing issues. There will never be enough nurses in any health-care system. It is a profession with a high attrition rate.

“Nurses in Jamaica who work in very hostile environments usually adopt coping mechanisms to function in that environment, to match the energy of the patient population, similar to the police in their response to the Jamaican population.

“A visit to a hospital in Jamaica will reveal to the keen observer how uncaring, nonchalant and unperturbed the health-care staffs could be. Nurses often reach the point where they no longer saw patients as their job, but rather as their problems.

“Stress is very evident in American hospitals, much less in Jamaica. I arrive bright, delightful and chatty at 7:00 am. But as the day progresses and more emergencies and new orders were added, the day became more challenging and my smile slowly dissipated as my energy drained. Working long shifts in a poorly managed hospital system can be gruelling.

“One can survive in a hospital system by aligning oneself with good colleagues. When we are on shift together it made the work easier, more fun and the support is greater.

“To ease the nursing burden, the radical elimination of minuscule nursing tasks is imperative. Use time saved from minuscule tasks to build rapport with the patients and develop acquaintances. This will foster a better relationship in which the nurses get to know the person and not the sickness.

“Nursing was built on the principles of prioritisation and autonomy. To work in nursing doesn’t mean all tasks have to be completed. A nurse must prioritise the most important ones; especially those that will save or sustain the patient’s life.

“Hospitals need to hire more ancillary staffs to handle non-nursing tasks, to allow nurses to focus on important nursing tasks.

“Most hospitals I worked at in America have a certified nursing assistant (CNA) who performs hygiene care, feeding and other tasks that don’t require nursing expertise. The issue there is that they never hire enough. The hospital environment must be more cohesive to foster support and healing to both staff and patients if they practise safe nurse-patient and CNA-patient ratios.

“We now exist in a society with advanced technology, new diseases and treatments that require more intensive nursing expertise and procedures. Nursing is an art and a science and the roles today have become more demanding as the profession advances. It is a lot more than what the public is aware of.

“With all the advancement of the nursing profession, many will still visualise nursing as the lady in white giving a bed bath and the bedpan. If these are not done, the nurse is an abomination and a disgrace to the profession. Nurses have no time to educate the public about their role. As the current phrase today is: ‘If yu know yu know’.

“As much as nursing is demanding in America, the demand is higher in Jamaica because of the lack of resources. This demand can result in frustration that is perceived as poor nursing care.

No nurse wakes up and go to work planning to be a bad nurse.

“Coping mechanisms to function effectively in an uncertain, high demanding, high functioning and mentally draining environment is imperative to deliver excellent care. This cannot be stressed enough.

“Nursing is a very serious profession. It can mean life or death for patients and freedom or imprisonment for nurses. Nursing will never be normal. Nurses have to keep the reminder in the subconscious that the patients are their work and not their problems.

“Indeed, nursing is a calling; many are called, but only few are chosen.”

Dr Cheryl Morgan