How nurses can process guilt and shame

Posted March 20, 2022

What is the difference between guilt and shame?

As a nurse, it is inevitable that at some stage you will make an error that could potentially contribute to someone deteriorating or even dying.

As a human being in general, you will also be prone to the kinds of mistakes we all make throughout life: saying something nasty to your child; parading your naked body around whilst drunk; accidentally leaking a friend’s secret.

It is part of the human condition to be imperfect and do things that elicit guilt and shame throughout life.

But what is the difference between guilt and shame?


Guilt is a feeling that signals we feel bad about the consequences of an action we have conducted on someone or something.

You might feel guilty because you got someone’s prescription wrong; you are concerned about the impact it has on them.

Guilt is the fallen tree in the forest of empathy: It cannot exist without our ability to reflect on and care about others.

When the conditions of empathy are present, guilt can feel like something crashing down inside of us.

If you are unable to experience empathy for others, it is highly unlikely you will experience guilt for your actions.

Think about something you have recently felt guilty about. Who or what would you have to not care about to not feel that emotion?

Thus, we go about life doing things that inevitably have an impact on others. And evolution equipped us with this fabulous prosocial ability to feel bad about it. Thanks, evolution!

When that tree in the forest falls, it can feel like you’ve done irreparable damage.

The good news is that through your empathy and ability to modify your future behaviour, you can plant a new sapling in the forest.

You can nurture yourself and others by examining the mistake and committing to growing from it.


Whilst guilt is the emotion tied to the effect of our actions on others, shame is all about the inadequacies we perceive in ourselves.

In simple terms,

Guilt = “I did something bad”

Shame = “There is something wrong/broken/deficient about me”

If guilt is the falling tree in the forest, shame is the dark, heavy cloud that obscures your whole emotional landscape and your ability to be logical.

The two emotions often go hand-in-hand, like sinister cousins.

You may have forgotten to provide an important piece of clinical information in your handover; the patient’s condition gets worse because something was missed.

You are left feeling the sinking, crushing feeling of guilt in your belly as you empathise with how unwell the patient must have felt and how it impacted your team.

In the same moment, the dark cloud of shame envelops you. Your mind says “you are not good enough” in some way or another. Maybe your mind tells you “you’re not cut out to be a nurse”.

Now it’s not just about the damage you’ve done, it’s become about how unworthy you feel as a nurse.

If guilt is the falling tree in the forest, shame is the dark, heavy cloud that obscures your whole emotional landscape and your ability to be logical.

Guilt and shame for all

Unless you are unfortunate enough to have certain personality disorders or a brain injury of some sort, then you will absolutely feel both guilt and shame. And your colleagues will too. 

Shame, in particular, is the emotion we hide.

Why would we want to share our inadequacies with others?

The culture and context is important here: if no one shares, everyone must be perfect, right? Wrong. A culture of perfectionism breeds shame.

There is a wonderful paradox with shame.

The shame cloud struggles to survive when it is expressed out in the real world to someone who you trust and will validate your experience.

The moment someone says “me too” it helps extinguish it.

Processing and dealing with guilt and shame

Here are some quick practical tools you can use to manage these emotions:

1) Reflect on something you feel bad about and write down what it was, how you feel about it and who you think it affected. Writing in itself often has a therapeutic quality to it.

2) Notice as you do this the kind of thoughts that surface that relate to YOU. In other words, does your mind tell you “you’re weak/bad” etc.

3) If that’s the case, label this feeling as shame and separate it from the guilt.

4) Ask yourself, “if my guilt/shame had a voice, what would it be trying to tell me?”

5) See if you can respond to this voice as if it were a small child in need of support. Maybe you need love, reassurance, a hug. Be creative in your mind about how you respond – use a soft tone of voice, imagine yourself hugging the pain or emotion, or place your arms around yourself compassionately.

6) If you feel guilty, write down how you can constructively move on from experiences by committing to changing your behaviour. Then, when your mind brings back images or thoughts of this event, remind yourself in a gentle way, “It’s okay, I’ve learned from this”.

7) If shame arises because your mind persistently tells you you’re not good enough, spend some time reflecting on the things that you have been working hard on. Remind yourself of the ways in which you have helped others. Be kind to yourself about your genuine intention to help people.

8) Find someone you trust enough to share your experience. Try to find someone you are confident won’t say “yes, that was bad, how could you do that?!”. Instead aim for someone who is more likely to say “that’s tough, I’m here for you. I’ve felt that way too.”

Safe sharing with others: Reflective practice

At Nurse Wellbeing we offer regular, free reflective practice sessions for nurses. It’s a place where strangers can come together and bond through shared experience, listen to each other’s stories in a psychologically safe and compassionate place. It’s not group therapy, but it has a therapeutic quality to it.

Our sessions are run by Nathan, Founder of NWP and Clinical Psychologist. If you’d like to melt away the burning sensation of guilt and shame arising from your nursing work, this might be the place for you to start that journey. Just sign up below to be a free NWP Community member and you can access reflective practice sessions for free straight away.

Article written by Nathan Illman. Nathan is a Clinical Psychologist. His mission is to give nurses access to high-quality psychological education and training to help them prepare for and heal from emotionally challenging work.

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