This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Thursday, December 2, 2010

Managing your infertility treatment--understanding your relationship with your nurse

We often think of our reproductive endocrinologist as our primary treatment provider for infertility treatment. In fact we usually have much more frequent contact, and thus a more involved relationship, with the nurses responsible for the day-to-day monitoring of our care. I have always been impressed with how much responsibility and decision-making power that nurses working at infertility clinics often have. They can decide which of our questions and aspects of our clinical condition are brought to the RE's attention, and they often manage routine aspects of infertility treatment themselves. Thus, it pays to have a good relationship with your nurse--in which he or she is working with you to make sure you are getting the best medical supervision possible.

With a personal infertility career spanning the better part of a decade and a half-dozen clinics, and in hearing the stories of my clients, I have found the vast majority of nurses to be professional, competent, and kind. Many infertility nurses are truly exceptional--medically savvy, organized, and interpersonally sensitive--all traits that I believe can enhance your chances of treatment success. Occasionally, however, I have encountered some less than stellar nursing staff, and in these situations, I have witnessed the potential for negative outcomes.

To understand your relationship with your nurse, I think it is necessary to think a bit about the emotional situation involved in your nurse's job. First, she (or he, but I'm using she here because I've never actually come across a male infertility nurse, which in itself is interesting...) usually has a lot of patients to manage, all at different stages of treatment and with widely varying medical situations. She has to be on top of all the different steps each patient needs to take (imagine managing your own treatment plus 50-60 others at the same time!), as well as to be the liaison between the patient and the doctors. I think it's safe to say it's probably a fairly high stress job. In addition, the nurses, even more than the doctors, are privy to the emotional responses of patients to treatment failures and setbacks. Naturally, your nurse will have her own corresponding emotional reactions to patients' feelings (please see my blog entry on countertransference for a more thorough explanation of this phenomena). She must herself find a way to manage these emotional reactions--ideally remaining emotionally involved enough to be empathic, but with enough psychological boundaries that she does not become overwhelmed by her own feelings, so she is still able to be helpful. As you can imagine, managing these emotions isn't an easy task, and she is at constant risk of developing compassion fatigue, in which she becomes "burnt out", and may want to emotionally distance herself from her work. Add in to all this that infertility nurses are often of child-bearing age themselves, and there is a whole other set of feelings for them to manage. Perhaps they might worry that they too will struggle with infertility. Alternately, if they able to build their families easily, they may feel guilt that many of the couples with whom they work struggle and suffer so much in this area.

Warning signs

As you can see, being an infertility nurse involves juggling a great deal of emotions along with the ever-changing and fast-paced nature of the work. Despite the difficulty involved, I think that most nurses do a good job of remaining emotionally involved but still maintaining good boundaries. However, when things start going awry with a nurse, in my experience it is usually because she is struggling with this task. For example, I have sometimes observed that nurses can take an "us vs. them" attitude towards patients. This can come across as the nurse appearing impatient and irritated with patients when they have valid questions or concerns. It may seem that the nurse in question has a condescending attitude towards patients, in which she treats them as if they know nothing about the medicine involved, and that only she or the doctor are the experts. Because she is not listening to patients fully, or valuing the importance of what they say, she is at risk for missing important clinical information crucial to creating treatment success. And because she has reduced the level of patient trust and goodwill, she may not be getting this information in the first place.

At the crux of this "us vs. them" attitude, in my opinion, is that the nurse feels a strong need to disidentify with the patients with whom she works. In order to not feel overwhelmed by her own feelings regarding their situation, she must feel that they are entirely different from her, and is thus unable to emotionally understand their situation. In my field, we call this an "empathic break".

Although this situation is not common, it does occur, and it can really wreak havoc on an infertility treatment. In my own treatment, I once (and only once) had to fire a nurse off my case because repeatedly, she would not listen to me and refused to take my concerns seriously (which turned out, after speaking to other staff, to be entirely justified.) As I was rather far along on my own journey, I knew that this was not going to work for me--and that there were many other fantastic nurses with whom I could work-so I took the step of speaking to the clinic manager and requesting that we no longer work together. But I couldn't help but think that if I were new to the situation, and didn't know that things could be different, she could have really messed things up for me.

So my advice is, if you continually and repeatedly get the feeling that your nurse is not listening to you, is irritated with your worries, and is repeatedly unempathic to your feelings, you may need to consider talking to her or someone else about this situation. Of course, everyone, even nurses, can have a bad day, or even a bad week or month--but if it is never good, and talking about it doesn't improve the situation, you may need to consider making a switch.

Fortunately, as I mentioned earlier, this type of situation is not the norm. Most likely, you are already working with a good nurse. How can you make your relationship with her the best if can be? In my opinion, the most important facet of your relationship with your nurse is building good will between the two of you. If she can feel that you are a nice person, and someone with whom she can identify, she will be more positively emotionally involved in your case. She will want to help you succeed even more. She will be more likely to take your case to the doctor and think proactively about problems or issues which could occur. You will feel like she likes you, and you will be more open and forthcoming with her, which means she will have all of the necessary information to help the doctor make the best treatment plan. In my opinion, having a good treatment relationship with your nurse can be one of the major ingredients to treatment success.

Acknowledge her situation

As in any working relationship, if you can understand the needs and the situation of the other person, you will be better able to build good will and thus work collaboratively. For instance, if you can show your nurse that you are aware of how busy she is, and of the intellectual and emotional challenges of her job, she will be much more receptive to your needs. If most of the time, you only sound the alarm bell when it's necessary, you will be forgiven the occasional freak out or minor neurotic episode (all of which are inevitable in infertility treatment). Perhaps more importantly, though, you will build good will.

Be visible--but in a good way!

As a patient, one has to walk a fine line between being patient and trusting that the nurse or doctor will address your issues on their own, and being assertive and calling their attention to your concerns. If you simply trust that your nurse will take care of everything, you may be at risk for things being overlooked. If you are too aggressive or always making a big deal out everything, you are at risk for being seen as a "problem" patient. The key strategy here is to educate yourself about your own treatment plan and situation, and to bring up concerns as you have them--but in a polite and respectful way. Don't yell, and give the staff time to call you back or respond to your e-mail. If they don't respond, then you may have to be persistent--but again, in a calm and respectful manner. Remember, there's always time to yell at somebody about something later--but you can't take it back once it's done!

Apologize if necessary

Remember when I said that everyone is entitled to bad day or week every once in a while? This also applies to infertility patients. Given all of the hormones and emotional high stakes involved, it's not unexpected that you might not be at the top of your game, or at your most charming, during some contacts with your nurse. If you feel there are some situations you could have handled better, it might help to talk to her about it. In most cases, you will be greeted with an understanding and appreciative reception. Again, this will help rebuild the good will between the two of you--an ingredient helpful for treatment success.

Show your appreciation

Just as in our own lives, nurses appreciate being thanked for their hard work and efforts, especially if she has gone out of her way for you. If you feel she has done something truly exceptional, in addition to letting her know personally with a thank you card, kind e-mail, or occasional baked good, you could also let her office manager or supervising doctor know how much you appreciate her work and skills. These small gestures can help your nurse recognize the positive impact she is having on people's lives, and that can really get her through the difficult aspects of her day.

In sum, creating good will between you and your infertility nurse may help your treatment be successful, but even if it doesn't, it will at least make your treatment more pleasant. It may also provide you with another person who can understand your situation and offer emotional support.


  1. I like my nurse, but she's got a very cheery-sounding voice. Great when I'm just waiting for follicle growth, terrible when I'm having a m/c. But I think that's just her voice ;-)

    Also - there's a male IF nurse in the big office of my clinic! I've never had him (it's not my main office), so I'm not exactly sure what he does, but he exists!! lol

  2. This was extremely helpful - thank you. I have no idea why I didn't think about it more from what it's like from their perspective but I have a whole new appreciation for that now!

    Was also just curious about the link for countertranference that doesn't seem to be working anymore...

    Thanks again!

  3. Thanks for the comments. @myinfertilitywoes, I think I fixed the link. Thanks for bringing that to my attention...I'm a little bit of a techoidiot!:)