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Darnetta Richardson, RN, kept going to work, caring for patients, handling her responsibilities, and keeping everything moving.
By that measure, she seemed to be doing fine.
She wasn’t.
In September 2022, Richardson’s Apple Watch alerted her to an abnormal heart rate. Her heart was racing, and she eventually went to the emergency room, where she had to confront how long she had been overlooking her own exhaustion.
“I realized I had been measuring how well I was doing by how much I could still accomplish,” Richardson said. “As long as I could get up, go to work, take care of my patients, handle my responsibilities, and keep everything moving, I told myself I was okay.”
For Richardson, a hospice RN case manager with 10 years in nursing, the experience exposed how difficult nurse burnout can be to recognize: A nurse can keep functioning long after she has stopped feeling well.
“After a while, you can become so accustomed to functioning while exhausted that you stop recognizing exhaustion as information,” she said. “You think, ‘This is just nursing. This is just life.’”
Richardson’s experience changed how she approached nursing and led her to begin working with other nurses through Perseverance With Poise, the identity and transformation coaching company she founded.
But she did not leave the bedside.
When Functioning Masks How Much a Nurse Is Carrying
Richardson said the warning signs had been there well before her emergency room visit, but exhaustion had begun to feel normal.
“The biggest warning sign wasn’t simply that I was tired,” she said. “It was that I had become disconnected from myself. I knew exactly what everybody else needed from me, but I had stopped asking what I needed or even who I was outside of all the roles I was carrying.”
Richardson believes nurses can become particularly adept at putting their own needs behind those of patients and families.
“We work in a profession where somebody else’s need is often more urgent than our own,” she said. “You may be hungry, but your patient needs medication. You may need to use the bathroom, but a family needs you. You may be emotionally exhausted, but another patient is waiting for you to walk through the door and be their nurse. You learn very quickly how to put yourself aside and keep going.”
That ability can be necessary during a shift, but Richardson said the problem comes when it becomes the way a nurse lives.
“Functioning and being well are not the same thing,” she said.
What a Day in Hospice Nursing Actually Requires
Richardson’s work as a hospice RN case manager illustrates the clinical and emotional demands that can unfold during a single day.
Her day typically begins by checking overnight triage notes for changes among her patients, including increased pain, breathing problems, falls, agitation, or calls from family members who sense something is different.
She then reviews charts for patterns that could indicate a patient’s condition is declining.
“Someone may be eating less, sleeping more, getting weaker, having more falls, needing more medication, or becoming less responsive,” Richardson said. “One change by itself may not tell me much, but when you know the patient and start putting those changes together, you can often see that they’re declining.”
In patients’ homes, she assesses symptoms, reviews medications, communicates with providers, orders medications or supplies when needed, and educates families, many of whom have never cared for someone who is dying.
Richardson said the clinical judgment required in hospice can be easy to underestimate. A restless patient may be experiencing pain, anxiety, urinary retention, constipation, medication effects, or disease progression. Shortness of breath requires assessment and symptom management. Some patients can no longer communicate what they are feeling.
“Sometimes the patient can’t tell me what hurts or what they’re feeling, so I have to know how to read the patient,” Richardson said.
Richardson may make those assessments in a patient’s home without a physician nearby or bedside monitoring.
“Your assessment skills matter,” she said.
The day’s schedule can also change quickly.
“I can have my entire day mapped out, and then I get a call that a patient has fallen or their pain is out of control,” Richardson said. “Someone who was talking yesterday may barely respond today. Sometimes a family calls and says, ‘Something is different.’ I’ve learned to pay attention to that because they know their loved one.”
Sometimes she enters a home knowing it may be the last time she sees the patient alive.
“So I start every morning with a plan,” she said. “But in hospice, the plan never matters more than the person who needs me.”
The Emotional Work Continues Between Patients
Clinical assessment is only part of hospice nursing.
Nurses may encounter family members who understand that a patient is dying alongside others who still expect recovery. They may have to explain why a dying patient has stopped eating, describe changes that can occur as death approaches, or prepare a family for a patient’s final hours.
Then they leave that home and go to the next patient.
“That part is rarely talked about,” Richardson said.
“You learn how to be fully present with one family during one of the hardest moments of their lives, then get back in your car, collect yourself, and walk into another home ready to be present for that family too.”
Richardson began her nursing career as an LPN before returning to school to become an RN while raising her son. She worked in several areas, including mental health, before finding hospice.
Her nursing education prepared her for assessment, medications, disease processes, and critical thinking. Some of the most difficult parts of hospice care, she said, could only be learned through experience.
“Nursing school did not teach me how to sit beside someone who knows they are dying,” Richardson said.
Over time, hospice changed her understanding of what nurses can provide when treatment can no longer change the outcome.
“There are times when there is nothing left to cure, but there is still so much care left to give,” she said. “You can manage someone’s pain. You can ease their breathing. You can prepare a frightened family for what is coming. You can protect someone’s dignity. You can listen.”
Staying at the Bedside Meant Changing How She Practiced
After confronting her own burnout, Richardson had to reconsider what being a good nurse required of her.
“The biggest thing I had to change was the belief that being a good nurse meant giving everything I had,” she said.
One distinction became particularly important.
“I had to learn that caring about my patients and carrying my patients are two different things,” Richardson said.
She became more intentional about boundaries, asking for help, using the team around her, and recognizing which responsibilities were actually hers to carry.
She also had to separate her identity from her profession.
“I’m still proud of it. I love being a nurse,” Richardson said. “But I had to understand that nursing is something I do and something I’m called to do. It is not the totality of who I am.”
She remains at the bedside today.
“I’m still at the bedside because I didn’t need to stop caring,” Richardson said. “I needed to change the way I was caring. I had to learn that I could be an excellent nurse without sacrificing myself to prove it.”
Burnout Can’t Be Placed Entirely on Nurses
Through Perseverance With Poise, Richardson now works with other nurses around burnout and identity.
One message she hears repeatedly is: “I’m tired, but I don’t know what to do about it.”
Behind that exhaustion, Richardson said, are often heavy workloads, staffing concerns, documentation, changing expectations, difficult patient and family situations, and the emotional responsibility that comes with caring for people during some of the hardest periods of their lives.
Some nurses begin questioning whether they want to remain in the profession.
“And sometimes when I dig deeper, they don’t necessarily hate nursing,” Richardson said. “They hate what their life has become around nursing. There is a difference.”
Richardson believes addressing that problem requires changes from both healthcare organizations and nurses.
“We talk a lot about resilience and self-care, but we have to be careful that those conversations don’t make the individual nurse responsible for solving problems that are also organizational,” she said. “You can teach a nurse breathing exercises, encourage her to take care of herself and offer wellness resources, but if she consistently works in an environment where she cannot take a break, the workload is unrealistic, or she does not feel supported, we have not addressed the entire problem.”
At the same time, Richardson said she had to examine her own boundaries and stop tying her worth to how much she could accomplish for others.
“That is why I believe the answer has to come from both directions,” she said.
For healthcare organizations, she believes a nurse’s continued ability to show up for work can obscure what is happening beneath the surface.
“Because if our only measure is whether a nurse continues showing up for her shift, we may not recognize how much we are losing until she finally decides she cannot do it anymore.”
For nurses, Richardson’s message is more personal and reflects what she learned after discovering that continuing to function was not proof that she was okay.
“Build a life nursing supports, not one it swallows,” Richardson said. “Being good at this work never meant you had to vanish inside it.”
