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Jump to Key Points Although it’s been more than two decades since Valerie Fuller, PhD, DNP, treated a patient who was diagnosed with melanoma, she has vivid memories of the case: He was young, newly married, and had just become a father; his wife noticed a mole on his back and encouraged him to have it checked.
The diagnosis was grim, Fuller recalled, “I remember almost not being able to breathe at that moment because this man was so young and he just had this baby…it may not be as acute or as dramatic as some of the stuff that I might see in the hospital…but I can remember his case like it was yesterday.”
It’s not uncommon for nurse practitioners (NPs) to think about their patients after their shifts ends. Delivering a difficult diagnosis, losing a patient, or treating patients with serious illnesses or injuries can linger long after clinical encounters are over.
Fuller, president of the American Association of Nurse Practitioners (AANP), believes the emotional connection that makes NPs effective caregivers can also make certain cases harder to leave at work.
- NPs often retain vivid memories of difficult cases long after shifts.
- Emotional connection can improve care but also increase after-hours distress.
- Reflection differs from rumination; rumination may ↑ burnout and turnover.
- NP burnout linked to ↑ medical errors, compromised safety, poorer care quality.
- Supportive debriefing, peer resources, therapy, and CE may reduce burnout risk.
“I think people go into this role because they do care so deeply for people and while that’s an enormous and great strength that we have, it also means that there are patients and experiences that stay with us,” she said. “I don’t think the goal would be not to think about your patients after you leave work.”
Cases That Come Home
When Jennifer Armendariz, RN, FNP-C, AOCNP, started caring for patients with cancer and hematologic conditions in El Paso, Texas, she discovered that it was hard not to bring work home.
“I thought I would be able to kind of leave work at the clinic,” Armendariz said. “I try to be very empathetic toward what my patients are going through because I really want them to feel that I am hearing them…the challenge is that I will bring that stress home.”
Patients dealing with severe mental health challenges or advanced cancer are the ones she thinks about most between appointments and after her shift ends.
While thinking about patients after work can have a useful role in clinical practice, Fuller noted that there is a difference between reflection and rumination. Rumination can make emotional distress more intense, contributing to high turnover rates and job dissatisfaction. These kinds of workforce challenges, coupled with the emotional demands of caring for patients, could also contribute to burnout.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, in Medscape’s 2026 Nurse Practitioner Burnout and Depression Report:
- More than half of NPs reported experiencing burnout, depression, or both.
- The percentage of NPs who attributed burnout to excessive work hours increased from 34% to 43% since the previous report.
- High caseloads and an ongoing sense of emotional responsibility for patients contributed to burnout.
Fuller pointed to emotional or physical exhaustion, losing enjoyment in work that was once rewarding, withdrawing or becoming detached or feeling overwhelmed by cases that previously would not have had the same effect as common signs of burnout.
“Caring is not a professional weakness,” Fuller added. “We have a workforce that needs to be protected. We don’t have enough healthcare providers and…we need to make sure that we’re creating environments where clinicians feel safe to talk about these things and want to keep doing the work they’re doing.”
Make Room to Process
Armendariz has developed strategies to process difficult encounters: She exercises, writes in a journal, meditates, and sees a therapist. When she anticipates a difficult diagnosis or patient conversation, she often talks it through with her husband the night before. Following up with patients who are referred to other clinics for treatment has also proven helpful.
“If I have a diagnosis of a cancer that can’t be treated [at our clinic]…I like to do a 6-week telephone follow-up,” she said. “I want to make sure that the patient got to the oncology center and find out what happened with that office visit. It helps to give me closure…and that actually has been very helpful for me.”
Fuller saw the value of structured support during her more than two decades working in acute care surgical settings.
After tough cases, the hospital established a process that let the team talk to a psychologist about what happened, their feelings, and whether anything could have changed the outcome before moving on to the next case.
“Just flipping into the next case, it was hard,” Fuller said. “It was a lot of weight to carry into another case.”
Among NPs, burnout is not just linked to poor mental health; it’s also associated with higher rates of medical errors, compromised patient safety, and poor quality of patient care.
For NPs, peers, and health system leaders, avoiding burnout means recognizing when reflecting on a case or patient after hours shifts from compassionate care to something more concerning, and fostering environments that provide resources and encourage asking for support. It’s a lesson that needs to start in nursing school, according to Armendariz.
“I’m precepting a nurse practitioner student, and I talk to her a lot about [being] mindful of how you process that stress,” she said. “When we’re younger, we think, ‘[n]othing will bother me,’ but it’s cumulative; it’s going to start to build up.”
AANP offers continuing education classes on burnout, mental health, and online communities for peer connection and support. Scheduling an appointment with a mental health provider is also an option.
“Don’t wait until you’re at a breaking point before you reach out for help,” Fuller warned. “It’s a strength when a person can ask for help.”
Armendariz has cried with patients after delivering difficult news and knows she’ll keep thinking about them after her shift ends.
“I don’t ever want to get to the point where I am so burnt out that I lose that empathy for a patient,” she said. “I think we just need to be more vocal about how we feel as healthcare providers and how taking care of our patients affects us too.”
The experts cited in this article reported having no financial disclosures.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
