Compassion Fatigue

  1. 1
    article from advance for nurses. how long before cf becomes a legit medical diagnosis?
    leslie :-D likes this.

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  3. 18 Comments...

  4. 19
    This is hard for me to admit.......but I've finally met the one patient for whom I cannot muster even a scintilla of compassion.

    He is a troll of a little man who is dx'ed with multiple psych disorders, and he has been making life hell for every staff member of my assisted-living community in the four months, nine days, and eight-and-a-half hours since he's been here. (But who's counting, right?)

    I've never been in this position before, didn't even think the person existed for whom I could feel nothing but revulsion. After all, I had plenty of compassion for the guy when he first moved in; I just figured he'd been dealt a bad hand in life, and all he needed was a little TLC and the right medications. But now that I've been dealing with this filthy, perverted, manipulative, disgusting pig of a man for what seems like an eternity, I have finally learned that even my compassion goes only so far, and because he has the luck of the Devil and I can't get him OUT of my building, I don't know how much longer I'll be able to be an effective nurse for the other residents of the community, who deserve my care and attention so much more than he does.

    I won't bore everyone with the details of this character's defective reasoning; suffice it to say that he is the first person I've ever met in whom I cannot find even one redeeming quality. He is whiney, selfish, vulgar, smelly, rude, crude, lewd, attention-seeking, disrespectful of the other residents and of personal boundaries, and he pretends to be crazier than he actually is. Nor are we the only facility that has been victimized by this pathetic excuse for a human being: in the past 11 years he's burned through every local resource there is.

    Not one single hospital from Portland to Ashland will admit him for psych reasons, not even when he's caught putting out cigarettes on his hand or slamming his fingers in his bathroom door for attention. He is SO far beyond the scope of assisted living---I don't think even the DSM-IV has a diagnosis that fits what this man is---and his doctors won't help, his case manager won't help, the police won't help, the mental-health people won't help.....they've all had enough and have washed their hands of him. I wish I could too.

    I have lost more hours of sleep than I care to count because of this piece of work. Some days he takes up fully 75% of my time on the job; the other 78 residents get only 25%. Staff call me frantically in the night because he's become "unresponsive" after being asked to get out of the employee break room where he's been stealing workers' cell phones. They call me because he is exposing himself in the dining room, trying to get into other residents' rooms @ 0200, smoking in the foyer, breaking into the kitchen, pouring bleach on the carpet, banging his head against the wall, saying sexually inappropriate things to the younger female aides......and then, when these actions don't get him the attention he thinks he deserves, he pretends to fall and knock himself out, or does his fainting-goat routine, or he just plain verbally abuses and threatens everyone within earshot.

    Yes, I've talked until I'm blue in the face, but my administrator will not give him a 30-day move-out notice "because he'll just end up on the street." Well, it's taken me almost 53 years to develop a layer of cynicism, but now I get that there are a few people who perhaps deserve to be on the street........or in a kennel of some sort, with others of their ilk, where their basic needs for food and shelter are met and they are just housed until they die.

    This is a horrible place for me to be, as I've always looked on the bright side and made a special point of searching for the good in people that others never took the time to find. But now that I've finally met my match, the term 'compassion fatigue' suddenly makes so much sense that it's frightening. I don't wish this feeling on anyone; I talk to God nearly every day on the way to work and ask Him to help me find a shred of humanity in this grotesque caricature of a man. But hope is fading fast, and guilt is taking its place.
    Last edit by VivaLasViejas on Aug 19, '11
    DeLanaHarvickWannabe, Dezy, Anisettes, and 16 others like this.
  5. 14
    We all hit the wall at some time, some place. It maybe that we're giving 100% on the job, 100% at home, 100% at church -- and we suddenly discover that no one's giving us even 10%. Then we stop giving 300%, trying to give ourselves a little of the love that no one else is, everyone starts talking bad about you, you withdraw more, and you end up the crazy lady living alone with all the cats...

    In all seriousness, I think "compassion fatigue" is actually a type of PTSD. To have a diagnosis of PTSD, the patient must have either experienced a life threatening event or perceived a situation as life threatening (life not meaning just a pulse, but loss of "life" in terms of work, family relationship, significant physical function, etc.). I think with all of the things we see, we have to develop a certain amount of distance -- you simply can't bleed for everything you see, or you'd go nuts. So you build up a wall that you can still get thru, but you keep out the sharp stuff that would cut up your psyche. So then you get one of those that you identify with for some reason...and you watch them die, or spend months uselessly on a vent, or watch the slow motion vivisection of cancer treatment....and the wall gets blown away, and you feel naked and exposed to everything, like all of your skin's raw and the world's made of salt. So you build the wall up again, this time higher and tougher. Someone blows a hole thru it again, so you build another wall, and this one's even bigger, and less painful stuff comes thru it, the every 3 week DKAs, the end of the month DTers, the sweet little demented man you discover abused and destroyed the lives of his children, the husband of a patient who decides that the day after a cath with stent placement is the time to ask for a divorce, the teenager who tried to chainsaw off his own head, and only managed to give himself a radical neck dissection, hypoxic brain damage, and a 50+ year sentence to a bed in a nursing home, the elderly psych patients who manipulate and drive you insane, and the families that are even worse. But each wall is also harder for you to reach thru to those who truly need you. Finally, you discover that protective wall hasn't locked the bad out, it's locked you in your own person prison, and you've concreted over the last door. And you're in trouble, and don't know what to do about it.

    I think that one thing that can help is cross training and what we called "assignment scheduling" -- you are cross trained into two separate areas of a corporation, and you have no longer than a 2 year assignment in any particular area. ICU and ER might cross train, and you would work no longer than 6 months at any position -- you break up the cycle of wall building.

    That's what I'm doing. Give it a try, it's really helped me from turning into Ice Station Nerd.
    aznurse1, LockportRN, Anisettes, and 11 others like this.
  6. 7
    These sociopathic psyche patients are too much for me too! I've had a bottle of urine thrown at me, he missed, but I was still forced to care for him on several admissions, a psychotic frequent flier who'd raise his fists at you, threaten to stab you. He was at death's door too many times and just wouldn't die! Finally he did die and I'm thankful I don't have to deal with him ever again. He was the stuff of nightmares!

    Unfortunately there are plenty of other psychotic creeps out there to take his place.
    I honestly don't know how nurses work in the psyche ward. I know the pay, benefits and overtime for govt psyche nursing is out of this world, but really how can stand to put up with this evil creeps. You could never pay me enough to put up with this voluntarily!

    My sympathy to you because at least in the hospital they LEAVE!
    Dezy, nurse0520, MassED, and 4 others like this.
  7. 5
    Folks, this is a very real and distressing phenomenon. Despite our most earnest and sincere efforts to provide good attentive care, there are people who are simply beyond redemption and situations which are simply unbearable. It can certainly take the starch out of your super nurse cape, when you find yourself dreading the interaction you will have with a patient of this variety.

    It's especially tough on very introspective sensitive nurses who tend to beat themselves up for not being able to "reach" that patient. So many times we see or want to see some untapped potential or shred of humanity in a patient, where it either doesn't exist or the patient doesn't have the capacity to let it exist.

    I think that perhaps somtimes it's just a part of maturing and learning to accept the things we can not change. Sometimes it means deciding to make a change yourself and finding another job. I think that as troubling as these patients are, they cross our paths for a reason. Sometimes it's not because they need our care. It may be that they are there because we need them. They can provoke change in lives and our ways of thinking. Being provoked to find a new job is sometimes the very best thing that can happen to you.
    Dezy, nurse0520, MassED, and 2 others like this.
  8. 14
    from the article:

    "Additional research suggests hospitals provide in-service education to raise awareness about compassion fatigue and provide life skills training."

    my contribution:

    decrease undoable nurse/pt ratios.
    more vacation/pto.
    stop making the nurses, the go-to people for anything that happens in the hospital.
    schedule unmanageable pts to nurses/aides, for half of a shift only, then switch as assigned.
    decrease undoable nurse/pt ratios.

    and finally:
    decrease undoable nurse/pt ratios.
    (except i'm not kidding.)

    it really galls me that hospitals provide these "compassion fatigue" survival skills, when it's the hospitals that create most of the burden.
    not helpful... not helpful at all.

    Last edit by leslie :-D on Aug 19, '11
    LockportRN, nurse0520, MassED, and 11 others like this.
  9. 5

    you'll just have to wait until that sick, sick man needs to be sent to the hospital.
    you don't have to take him back, putting the burden on the hospital.
    let their social services do what they can.
    your admin shouldn't have any problems w/that...i hope.

    nurse0520, MassED, VivaLasViejas, and 2 others like this.
  10. 8
    The Nurses' Serenity Prayer (adapted from the AA Serenity Prayer)
    God grant me the serenity to accept the patients that I cannot heal.
    Courage to heal the ones I can,
    and the wisdom to know the difference.

    When I read Viva's comment, I though of George Kostanza from that show Seinfeld, his arms in the air, yelling, "Serenity Now!", which made me think of the serenity prayer......
    Last edit by country mom on Aug 19, '11 : Reason: typo
    LockportRN, Dezy, nurse0520, and 5 others like this.
  11. 4
    Ms Marla ... PLEASE try not to feel guilty. The dude sounds possessed!

    I've dealt with a couple of these and the best thing that ever happened to me was a psych NP who told me that I have every right to feel how I was feeling. The trick was to be able to continue to meet my professional responsibilities to the patient ... professionalism became a shield rather than the wall described by another poster.

    I find it particularly troubling that your admin won't support you. I wonder what would happen if the admin got those trouble calls ...

    Another big help to me was reading People of the Lie: The Hope for Healing Human Evil by Scott Peck. If you follow the link and then click on "search inside this book" you can get an idea if it addresses your concerns. In particular, he addresses the problem of maintaining our "unconditional positive regard" in the face of the kind of deliberately chosen, abusive evil you're dealing with.

    I'm not gonna say to find another job ... you worked hard for this one and you've written about how much you like the job, the facility and the admin. It would be a shame if this person of the lie drove you away.

    You keep praying and I'll light a candle on this end ...
  12. 8
    Quote from leslie :-D

    you'll just have to wait until that sick, sick man needs to be sent to the hospital.
    you don't have to take him back, putting the burden on the hospital.
    let their social services do what they can.
    your admin shouldn't have any problems w/that...i hope.

    We've been there & done that before, and I have the battle scars to prove it. Both times he was in the hospital, we wound up taking him back because NO other place would have him.

    He is in the hospital now. Watch, they're going to want to send him back over the weekend, and so help me God, I am NOT wasting a minute of my weekend driving 60 miles round-trip to assess him for a return to the facility. I told the hospital social worker today that if they want to boot him out before Monday, they are going to have to park his sorry butt in a nursing home until we can get hold of his caseworker, because I am not going to have him come back without a HUGE fight.

    And FTR, my administrator is almost as sick of all this as the rest of us. He gets the calls too, and he actually deals with him one-on-one more often than I do. But for some reason, Bossman still has a bit of a soft spot for the guy, and he simply won't put anyone out on the street.....and I feel like the world's biggest jerk because I wouldn't spit on the dude if he were on fire. What that says about me worries me far more than what it says about him, and yet I have to say it or I'm gonna lose it.
    nurse0520, dudette10, MassED, and 5 others like this.

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