Teaching Empathy

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Some of the most troubling conversations I have with leaders today concern a growing number of nurses who seem to lack empathy. Caring for patients in a way that projects concern and empathy has always been a core value in nursing. Leaders see an increasing number of new graduates who view nursing as a potentially well-paying job rather than a passion or a calling. The challenge is that we depend on our staff to project empathy. Organizations may advertise that they are caring places, but this may differ from the patient’s experience. Consider the following story a nurse manager recently told me:

A patient talked with me on leadership rounds about one of my nurses who has repeatedly ignored requests like getting an extra blanket. The patient was blunt, saying that some of my staff are detached and more interested in their phones than their work. The nurse in question does not maintain eye contact with patients and seems uncomfortable conversing. I am not the only manager seeing this problem – it is coming up on our patient satisfaction surveys, where patients have raised the issue of a lack of empathy. Interestingly, it was not well received when I tried to coach this young nurse. She expressed concern that I cared about the patient but not her. I could not engender any empathy or concern about the patient’s perspective from her during this conversation. In some jobs, lack of empathy is not critical (think the tech bros my husband works with), but not in nursing. Can we hold nurses accountable for being empathetic, and how do we teach this?

Her question was such an important one. Perceptions about the level of empathy in the US today indicate that most feel that it has significantly declined. Unsurprisingly, our young workforce may exhibit less empathetic behaviors because this is what they are exposed to in society. In his book, The War for Kindness: Building Empathy in a Fractured World, Stanford professor Jamil Zaki notes that the modern world has made kindness harder. He also notes that people become less empathetic when exposed to the following challenges (all of which we see in healthcare today):

• Feeling isolated and less a part of a team or community
• Exposure to trauma such as COVID
• Tribalism and polarization in society
• Clinical depression
• Feelings of compassion fatigue
• Disengagement from work

The good news, reports Zaki, is that empathy is a learnable skill and can be thought of as a mindset. Only about 30% of empathy is genetically determined. You can choose to be empathetic and become more empathetic with effort and practice. There are three components to empathy:

• Cognitive: This is the ability to deliberately consider and perhaps understand the thoughts and feelings of other people. For instance, when we read about people starving in different parts of the world, we can feel pity for them.
• Emotional: This is the ability to share other people’s thoughts and feelings vicariously. Our brains have mirror neurons that allow us to feel what someone else is feeling. For instance, if a patient receives a terminal diagnosis, you are likely to react almost as if it had happened to you.
• Compassionate: This is the ability to sense what others need from you. For instance, you recognize that you can help a patient with their food tray when you see them struggling to cut their food.

So how do we teach nurses to be more empathetic? We must begin by being intentional and establishing empathy skills as just as important as clinical skills. Refrain from assuming new staff know how to be empathetic or decided to become a nurse when they were five years old because they were passionate about caring for others. That is not the reality of our society today. Nurses need classes on empathy that include developing it for themselves and others and how to project it. Some teaching strategies include the following:

1. Teach patient interviewing skills that are not simply focused on physical assessment but rather are designed to ask questions such as: What kind of work do you do or have you done? What are you struggling with during this hospitalization? As you look around this hospital room, are there things you are worried about, such as falling, getting to the restroom, or reaching for a tray? What should we know about you but may not know? 
2. Use simulation exercises such as having nurses spend 2-3 hours trying to navigate their facility in a wheelchair or using a walker.
3. Practice listening – hold a conversation with another person where you listen 80% of the time and talk only 20% of the time.
4. Use simulation exercises where nurses walk into a room where you are the patient and are looking at their phone, wearing Airpods and shutting you out of an interaction.
5. Role-play exercises about what to say to patients when your unit is short-staffed, and you can’t meet a request – then debrief.
6. Read a story as a group about a patient who has received a very challenging diagnosis – talk about how to converse with the patient and family.
7. Design an empathy bingo game where the team goes out and performs acts of empathy.
8. Have nurses share their experiences when they were not treated empathetically and how they responded.
9. Have nurses design service recovery responses when patients complain about the care that projects empathy.
10. Help nurses design their self-care plans – empathy starts with self-empathy.

In a world where empathy is in short supply, you need to see it to be it. We can all learn to become more empathetic.

Read to Lead

Zaki, J. (2019). The War for Kindness: Building Empathy in a Fractured World. New York: Broadway Press.

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