Compassion Fatigue: Patient Safety in Today's Healthcare Marketplace - A Four Part Series

[Damion Jenkins, MSN, RN]

According to a study published in The Online Journal of Issues in Nursing, compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. In a more recent study, compassion fatigue is defined as a cumulative and progressive absorption process of patient's pain and suffering formed from the caring interactions with patients and their families. The physical, emotional, spiritual, social and organizational consequences of compassion fatigue are so extensive that they threaten the existential integrity of the nurse. Such consequences include, but are not limited to: decreased level of job satisfaction, decreased productivity, increased rates of absenteeism, burnout, turnover, stress, insomnia, nightmares, headaches, gastrointestinal complaints, anxiety and depression.

What's the issue?

When healthcare providers such as nurses become depleted of their ability to effectively cope with the amount of stress that is placed upon them in their daily practice, patient care and safety decline dramatically. When a nurse suffers from compassion fatigue, it does not mean that they no longer want to care for others. Compassion fatigue is not simply a lack of willingness to care, but it is a major barrier to providing compassionate care.

Consider that you are a nurse on a busy acute care unit, and it is going on 4 o'clock in the afternoon. You have been at the hospital since 6:45 in the morning and you have not stopped patient care once to drink water, eat anything, or use the restroom. While your very own basic needs are not being met, you are doing your best to provide compassionate care to your patients and their family members. Some of your patients are easy going, and only need a few medications and treatments, while more than half of your patients are very sick, emotionally unstable, and require lots of your time. You have so many things to do - documentation, wound care, and discharge teaching, but you can't think straight. You're beginning to have an internal conflict, where you are trying to decide what's more important at this moment, drinking water so you don't pass out, or using the restroom so you don't have an accident. Now you're distracted. You are no longer focusing on the patient's status, as you are consumed by your own internal conflict. While you are deciding that using the restroom takes priority, your patient comes into the hallway and yells "NURSE! I need my pain medication!". Your colleagues look at you like you are crazy for not giving the patient their pain medication. Then suddenly you feel a little bit of urine trickle down your leg, and you think to yourself "I just can't even right now."

It is only a matter of time before situations like this will cause an extremely compassionate nurse to turn their backs on caring - and not caring is the most dangerous thing a nurse can do!

What can be done?

Although the risk of compassion fatigue is inherent in helping others who have experienced illness, loss & trauma, experts and research in this area provide some guidelines for managing the demands of the work while protecting ourselves.

Here are 5 strategies that we can safeguard ourselves against compassion fatigue:

Practice self-care.

Self-care includes activities, rituals and routines that help to promote individual holistic wellness. Some examples of self-care include:

• Getting plenty of rest and relaxation
• Getting plenty of exercise and physical activity
• Participating in prayer or spiritual ritual
• Consuming a healthy diet
• Surrounding yourself with people who love and support you

Set emotional boundaries.

Providing care for patients who are healing requires empathy and emotional involvement on the part of the caregiver. These qualities of care providers are what makes such interactions so supportive and meaningful, but they can also become overwhelming if we become too involved. It is essential to establish boundaries with our patients so that we do not assume their pain and experiences as our own. The challenge is to demonstrate compassion while being mindful that we are different people with different needs. This awareness can help to secure the space that exists between the care provider and the person receiving the care, which helps the provider to justify putting their basic needs and safety before that of the patient's.

Build a strong support network.

Research shows a strong correlation between high levels of work stress and the prevalence of compassion fatigue. As a result, It is vital to develop an organizational culture that normalizes grief and other reactions that we may experience while working with those who are ill, rather than assuming that negative reactions are a sign of individual weakness or an inability to fulfill the responsibilities of the caregiver role. Cultivating this kind of work environment can be very helpful in acclimating new staff as well as retaining and supporting existing staff.

Use active coping measures.

All of us have our usual ways of coping with stress or difficult situations. Which coping strategy we choose to utilize appears to make a huge difference in managing our stress levels. Studies have shown that using active coping strategies such as humor, social support, taking charge, and planning your time and schedule are more effective than negative or avoidant coping strategies. Choosing to cope by engaging in substance abuse, withdrawing from others and activities, or by using acts of aggression do nothing but exacerbate stress levels and can put your patients and your professional license in jeopardy.

Maintain a balance.

Managing the impact of caregiver role strain and stress requires a daily and ongoing commitment to self well-being. It is easy to remain in the tunnel vision of "caring for others", and I know it can feel impossible to take time out for ourselves so that we can be refueled and replenished. Just remember that holistic self-wellness is NEVER selfish. By upholding the commitment to care for ourselves first will provide us with a fresh perspective and restored energy. By taking care of ourselves as we care for others, we are protecting our valuable personal assets that support us in delivering high-quality care for our patients, their family, and our community.

Have you ever experienced compassion fatigue? Have you witnessed a colleague display behaviors that may suggest that they are struggling from compassion fatigue? If so, please feel free to share your experiences in the comments section below!

For articles in this series, go to:

• Inadequate Staffing: Patient Safety in Today's Healthcare Marketplace
• Inadequate Nursing: Patient Safety in Today's Healthcare Marketplace
• Alarm Fatigue: Patient Safety in Today's Healthcare Marketplace
• Compassion Fatigue: Patient Safety in Today's Healthcare Marketplace

[SisterofMary]

What a great article. It truly comes up at the best of times. I've been working just four months in an acute care med/surg unit and I feel, not necessarily compassion fatigue, but compassion overload. High stress in regards of giving the patients the best care, but juggling everything at the same time. Between admissions, frail patients, codes, and staffing minimums, I feel overwhelmed. Two hands are just not enough. Although I try self-care means, working nights just makes me that much more tired and low energy when I'm off. Thank you for this article because I've never heard of this before and I will keep such strategies in mind.

[Night__Owl, BSN, RN]

The root if this is nearly always staffing. When your facility staffs you with the bare minimum required not to kill someone, you don't have time to care about someone's tough life story, or their emotional wellbeing. Treating your pain patients is just another task you dont have time for. HCAHPS and numbers games push you to prioritize someone needing more ice water the same or more than someone who is seriously ill and teetering.

Compassion fatigue comes from nurses who are consistently denied the ability to get everything done, let alone go the extra mile the way most of us want to.

[BeenThere2012, ASN, RN]

This is timely as I am in the middle of battling compassion fatigue. I felt it coming, and then boom! I was in the middle of it. I've been a nurse for over 36 years now and I am aware of this problem. I ended up taking a few days off to rest and re-group. I felt better right away, and when I went back to work, I had a lot more patience and compassion again.

The problem is, like mostly every nurse I know, the conditions of where I work make it impossible to keep up with the pace and prevent this from creeping up again.

I have a very good personal life...caring friends and family, a loving home, and I take time for myself when I can. There is only so much a human who cares can do in the face of relentless demands from employers who refuse to provide adequate staffing, supplies, and other services needed to alleviate undue stress and frustration on the job. All this contributes greatly to compassion fatigue, burnout, or any other name you want to give this.

While at work I do deep breathing, crack jokes when appropriate, call a friend to vent while on break, think about how I would want to be treated if I were the patient, and remember the patients are ill and not in the best frame of mind for appropriate behavior also. A lot of my stress comes from patient abuse since I work in an acute psych facility.

It's just damned hard. Period.

[Katillac, RN]

Working under conditions in which management allows (and actually tacitly encourages) staff to work for a shift without eating, drinking, or going to the bathroom until they urinate in their pants is being abused. Coming up with a program to help the victims tolerate abuse isn't advocating self care, it's supporting, normalizing and enabling abuse.

The OP uses a definition of compassion fatigue focusing on "progressive absorption process of patient's pain and suffering" - a process under the control of the nurse and addressable by the pleasant sounding strategies the OP advances. But the OP muddies nurses' response to patients suffering with nurses struggling to work under crushing expectations in a race to failure environment. Optimal self care has little impact in the face of the learned helplessness caused by impossible performance standards.

As far as the OP's strategies are concerned, few nurses (in acute care at the least) have the luxury of "planning your time and schedule". Further, the OP seems to believe cultivating a workplace culture that prioritizes the mental health of care providers over meeting the expectations of satisfaction score driven management is somehow within the purview of staff nurses. Moreover, nowhere in the article does it suggest nurses organize and empower themselves to actually change the conditions - only passively respond to them.

I imagine the OP means well with these articles he writes, but I for one am so over the suggestions that nurses' burnout (not "compassion fatigue" wherein they got tired of caring) is the responsibility of the nurses to both prevent and manage when it's the abusive conditions under which they work that cause it in the first place.

[Daisy4RN]

Agree with Katillac, simply changing the terminology from burnout to passion fatigue does not do any good. And, in fact probably makes the situation worse by down playing the problem. Burnout needs to be addressed as a problem of the workplace, not the individual nurse. That being said, yes, we should all use positive coping measures that help us, physically, emotionally, and spiritually.

[Damion Jenkins, MSN, RN]

Thank you SisterofMary for sharing your experiences. Let me tell you that you are NOT alone! Nursing in today's Healthcare Marketplace is extremely stressful, and without many necessary changes, many nurses such as yourself will continue to become exhausted, burned out, and worse - develop Compassion Fatigue.

Self-care is really one of the best ways to prevent this from happening to you, but sometimes we just need to switch it up, or even take a break - so keep that in mind!

Good luck to you and thanks again for sharing and adding to this discussion!

Best,

Damion

[Damion Jenkins, MSN, RN]

Thank you Night_Owl for sharing your insights and adding to this discussion! I agree that inadequate staffing is one of the major contenders when we look at the prevalence of Compassion Fatigue. In fact, I've addressed the serious issue of Inadequate Staffing in a previous article in this four part series.

Here is the URL:

https://allnurses.com/inadequate-staffing-patient-safety-todays-t679018/

I must agree with you that when HCAHPS and Patient Satisfaction scores become the priority over quality patient care, it becomes very easy for nurses to demonstrate Compassion Fatigue. It's hard to come to work day after day constantly hearing from nursing leadership and hospital administration - "you're not good enough, you didn't do enough, you need to hurry up and discharge that patient, no you cannot take a break right now, we can't hire more help because of budgetary constraints, no one is getting a raise this year, do not clock in before 0653, do not clock out before 0723, happy nurse's week - here's your tote bag."

It's a complicated situation, and I agree that we must begin fixing the problem by focusing on establishing better staffing solutions.

Thanks again for sharing and adding to this discussion!

[Damion Jenkins, MSN, RN]

Thank you BeenThere2012 for your thoughtful contribution to this discussion!

I have to say that I too share your experiences. Although I have not been a nurse as long as you have (Thank you for your Service!), I too have experienced Burnout, and even felt myself starting to NOT CARE. Not caring - or the inability to care due to physical distress, emotional imbalance, or a combination of both is what Compassion Fatigue is.

Burnout is simply being at wits end with the day-to-day stress, disorganization, and toxic work environments. Burnout typically results in moving from one job to the next, or maybe steering directions - say from Med/Surg to Nursing Education, etc. Of course if Burnout is not addressed, such as by finding a breath of fresh air in a new setting or in a different role, then Compassion Fatigue can set in hard, and resulting in nurses leaving the profession altogether.

You're right! Nursing is just damned hard... but it doesn't have to be this hard. This is what we are working towards each and every day.

Thank you again for your contribution to this discussion!

Best,

Damion

[Damion Jenkins, MSN, RN]

Thank you Daisy4RN, ADN for adding to this discussion!

Please be advised that the terminology was not changed from Burnout to Compassion Fatigue.

"Compassion fatigue (CF) is a concept that refers to the emotional and physical exhaustion that affects helping professionals and caregivers over time. It is associated with a gradual desensitization to patient stories, a decrease in quality of care, an increase in clinical errors, higher rates of depression and anxiety disorders and rising rates of stress leave and a sense of humiliation in workplace climate.

Compassion fatigue in nurses can be explained as a cumulative and progressive absorption process of patient's pain and suffering formed from the caring interactions with patients and their families. The physical, emotional, spiritual, social and organizational consequences of CF are so extensive that they threaten the existential integrity of the nurse. Such consequences include, but not limited to, decreased level of job satisfaction, decreased productivity, increased rates of absenteeism, burnout, turnover, stress, insomnia, nightmares, headaches, gastrointestinal complaints, anxiety and depression."

Compassion Fatigue is far worse than burnout. Burnout typically results in nurses changing positions, or roles - not impacting their integrity, or causing them to leave the profession altogether.

Burnout is defined as: exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.

b : a person suffering from burnout

Unfortunately, it is always OUR responsibility to mange our responses to the stress of the current healthcare marketplace climate (because it's turning out to be pretty much the same issue across the country). I am happy that you find value in the strategies presented in this article.

Thanks again for adding to this discussion!

Best,

Damion

[Damion Jenkins, MSN, RN]

Thank you Katillac for your thoughtful contribution to this discussion.

Your recommendations and insight are invaluable.

Thanks again for adding to the discussion.

Best,

Damion