Are you at risk for compassion fatigue?
05.01.2012By Erica Sammartino
As a nurse, do you come home from a frantic 12-hour shift feeling helpless and frustrated? Is it impossible for you to set aside the stress and anxiety long enough to get a decent night’s sleep? Have you lost your smile? Do you dread the idea of going into work at all? If this rings a bell, you’re showing signs of compassion fatigue. Something must be done!
What is ‘compassion fatigue’?
Compassion fatigue is a term used to identify a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. Compassion fatigue is experienced primarily by individuals in caregiving roles, including cancer-care providers, emergency room personnel, and nurses. Compassion fatigue implies a state of “psychic exhaustion” and is associated with the “cost of caring” for individuals and refers to the strain that results.
Who is prone to compassion fatigue?
Healthcare professionals experience compassion fatigue when they have close contact with a suffering patient. Such contact can blur the caregiver’s emotional boundaries to the point that the caregiver unconsciously absorbs the distress experienced by the patient, resulting in feelings of self-blame, futility, or impotence.
Among healthcare professionals, nurses are especially vulnerable to compassion fatigue, as they enter the lives of patients at very critical times and become part of their healthcare journeys. In an interview with Ideastream, Dawn Filisky, a nurse in emergency care, relives the story of a family that had just received news of their children’s deaths: “You kind of just hear this wail that comes out of the room and you just know that it’s this very moment where their whole world has just kind of collapsed…Sometimes those sounds or those images kind of stick with you.” Empathetic interactions with patients coupled with their experience of cumulative grief puts acute care nurses at a particularly high risk due to the sadness and loss associated with compassion fatigue.
Compassion fatigue results from taking on the emotional burden of a patient’s agony, leading to feelings of stress and guilt. Nurses experiencing burnout gradually withdraw, but nurses experiencing compassion fatigue try harder to give even more to patients in need, spreading themselves too thin. Both compassion fatigue and burnout, however, are connected to a sense of depletion, a “running on empty” feeling that leads to frustration, powerlessness, and generally low morale.
Why is it important?
Nurses who had higher compassion satisfaction scores were more “fulfilled,” defined by scores of happiness. These nurses did not experience difficulty separating personal life and work, making them less likely to feel bogged down or “on the edge.”
A 2009 analysis linked compassion fatigue to decreased productivity, more sick days and higher turnover among cancer care providers. Another found about 12 percent of registered nurses in the U.S. weren’t working, of which more than 27 percent cited burnout or stressful work environments.
Compassion fatigue can lead nurses to feel sadness and despair that impair their health and well-being. Compassion fatigue can reduce a nurse’s empathy and lead them to dread or even avoid certain patients, increasing the risk of substandard care.  In reference to nursing and empathy, Dr. Kathy Clegg explains that “unless we sort of refill our tanks, we can run out of gas.” In an article in the Wall Street Journal, Patricia Potter explains that nurses exhibiting this behavior “don’t form the relationship necessary to truly understand the patient, identify their problems early, and adapt therapies to their needs,” adding that less observant nurses may be more error-prone.
How do you treat it?
The first step of treating compassion fatigue is recognizing the signs and the importance of taking care of your needs. Colleen Zahs, an MNA member and RN working in Oakland County, stresses the importance of making time for yourself: “Take one day at a time. Thinking too far ahead can create anxiety. Ask peers how they cope with it. Take a day off or a vacation, don't cancel scheduled time off. Listen to your favorite music when you get a chance to be by yourself.
“Pamper yourself with a trip to a salon. Don't be afraid to let someone know about your stress...keeping it bottled up can make you sick in many different ways. Cry when you need to, let it out. Plant a garden and watch it grow...living things are positive and inspirational. Attend spiritual classes/ services if you are religious. Stop and appreciate the small and big things. Make to-do lists to stay organized.”
|Activities such as gardening are recommended as ways to get away from the stress of constantly caring for others. Nurses are especially vulnerable to "compassion fatigue" and need to make time to take care of themselves.|
Colleen also points out that putting your needs first requires you to determine the cause of these feelings, and if in the case that it is a particular patient, she suggests that you “have a conference with your supervisor… this patient may have needs that go beyond the scope of nursing, and may involve social worker assistance, family counseling, palliative care/hospice intervention, or even up to an adult protective service referral.” Another important thing to ponder, Colleen says, is whether your own life history is influencing how you feel about someone else’s situation when you are caring for them. “Think that through very carefully,” she explains, “because perhaps something in your patient is bringing up old hurts, frustrations, and unresolved issues.”
Other coping strategies Colleen suggests include making a lateral or other job change, thereby giving yourself a break and some perspective on the situation, as well as more simple anecdotes such as getting enough rest to prevent physical fatigue.
Erica Sammartino is a student in James Madison College at Michigan State University and an intern in Government Relations and Outreach for the Michigan Nurses Association.
 Lombardo, Barbara. “Compassion Fatigue: A Nurse’s Primer.” OJIN: The Online Journal of Issues in Nursing. Vol. 16, No. 1, Manuscript 3. [http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/ Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html].
 Boyle, Deborah A. “Countering Compassion Fatigue: A Requisite Nursing Agenda.” OJIN: The Online Journal of Issues in Nursing. Vol. 16, No. 1, Manuscript 2. January 31, 2011. [http://www.nursingworld.org/MainMenuCategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Countering-Compassion-Fatigue.html].
 Edmunds, Marilyn W. “Caring Too Much: Compassion Fatigue in Nursing: Compassion Fatigue in Nurses.” Medscape News. WebMD, LLC. November 15, 2010. [http://www.medscape.com/viewarticle/732211].
 Landro, Laura. “When Nurses Catch Compassion Fatigue, Patients Suffer.” The Wall Street Journal Online. January 3, 2012. [http://online.wsj.com/article/SB1000142405297020 4720204577128882104188856.html].
 Landro, Laura. “Informed Patient: Helping Nurses Cope With Compassion Fatigue.” The Wall Street Journal Online: Health Blog. January 3, 2012. [http://blogs.wsj.com/health/2012/01/03/informed-patient-helping-nurses-cope-with-compassion-fatigue/].
 “Caregivers At Risk Of Burnout.” Ideastream. January 3, 2012. [http://www.ideastream.org/news/feature/44350].