The Insidious Nature of Compassion Fatigue

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    This article defines and discussion compassion fatigue. It includes a personal account and helpful resources to use. I also invite readers to share their stories.

    The Insidious Nature of Compassion Fatigue

    com·pas·sion fa·tigue (noun): indifference to charitable appeals on behalf of those who are suffering, experienced as a result of the frequency or number of such appeals.

    Most of us who work in healthcare or deal with mental health or substance abuse patients on a regular basis are subject to compassion fatigue. Sometime during my ED career, I noticed that my attitude towards my patients had changed. I was becoming much more judgmental, edgy, somewhat hopeless, and quite cynical. It was only after I read an article on compassion fatigue that I realized that this is what I was experiencing. My compassion fatigue was a tricky phenomenon because it had such an insidious nature. I found it hard to believe that I started off quite this dark, bitter, and irreverent! My compassion fatigue accumulated from within, after each shift, over time, wearing away my shine and genuine love of helping others.

    Healthcare workers, especially those of us who work in an ED setting, continuously bear witness to the worst of human suffering ̶ physical, emotional, and spiritual. Naturally, very difficult emotions can be stirred up depending on how the situation resonates with us. Personally, I had a very difficult time dealing with alcoholics who were frequent flyers. I had an underlying belief that they were abusing the system and, often times, our staff. I had difficulty with the emotions that would come up over their constant demands for food, snacks, medication, and cab vouchers.

    In some ways, I felt as if we were enabling their sick cycle. When I realized that these feelings stemmed from my own inability to help a loved one with alcoholism, I became more self-aware and more accepting. I became aware that I was trying desperately to stuff, reject, ignore or transform my emotions (e.g., by eating, getting angry or using dark humor) to cope ̶ quite unsuccessfully I might add! I realized that I wanted to "fix" them. Even worse, I wanted to relieve my old pain fixing them.

    Recognizing compassion fatigue in ourselves can be difficult and there are many different sources of compassion fatigue. It is important to note that this is not an exhaustive list and compassion fatigue can take many forms. The following list of "symptoms" was taken from a wonderful web-based resource called, the Compassion Fatigue Awareness Project . This resource states that you may have compassion fatigue if you engage in the following set of behaviors:
    • Excessive blaming
    • Bottling up emotions
    • Isolation from others
    • Receiving more complaints from others
    • Voicing excessive complaints about administrative functions
    • Substance abuse used to mask feelings
    • Compulsive behaviors such as overspending, overeating, gambling, sexual addictions
    • Poor self-care (i.e., hygiene, appearance)
    • Legal problems, indebtedness
    • Reoccurrence of nightmares and flashbacks to traumatic event
    • Chronic physical ailments such as gastrointestinal problems and recurrent colds
    • Apathy, sad, no longer finds activities pleasurable
    • Difficulty concentrating
    • Mentally and physically tired
    • Preoccupied
    • In denial about problems

    If you sense that you experience compassion fatigue, chances are good that you are correct. I know that when we first started exchanging the term, compassion fatigue, everyone knew exactly what it was and how it felt. Your best defense against compassion fatigue begins with some self-examination, honesty, and awareness. Your openness to this process may lead to new insights into how old pain or trauma is triggered and relived over and over through your patients. There are some good resources that can help guide you on a journey of self-discovery and healing that will mediate the effects of compassion fatigue. Simple techniques are also helpful such as regular exercise, healthy eating habits, enjoyable social activities, journaling, and restful sleep. Accepting the reality of compassion fatigue in your life only serves to validate the fact that you are a deeply caring human being. It can be possible to successfully care for others while caring for yourself.

    I would really like to hear your stories about compassion fatigue.

    Below is a Ted Talk video titled, How to Manage Compassion Fatigue in Caregiving, by Patricia Smith. I found this to be quite helpful and validating.

    Last edit by Joe V on Jun 15, '18
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  2. Visit cwentworth profile page

    About cwentworth

    I am a doctoral candidate who has worked in many areas of mental health, including the emergency department. I could not have done my job without the expertise and support of my fellow RNs, LNAs, PAs and MDs. I have been eternally grateful for my experiences assessing mental health/substance abuse patients in the ED and will bring this experience into my next endeavor.

    Joined: Mar '17; Posts: 15; Likes: 32

    Read My Articles


  3. by   cwentworth
    Participant Introductory Letter & Informed Consent

    Dear Registered Nurses,

    You are invited to participate in a research study! Caring for the mental health population can present unique challenges in an emergency department setting. As part of my doctoral work at Rivier University, I am conducting a research study to pilot a new method of mental health training for registered nurses working in emergency departments across the country. You are invited to participate in this exciting study.

    Requirements for Participation
    Participation in the study requires completing a demographic questionnaire, viewing a 30-minute training webinar, completing a posttest and two short surveys (before and after the webinar). Completing these measures should take no longer than 10-15 minutes for each administration.

    Study Procedures
    This is an experimental, pretest, posttest design, with random sampling and strict confidentiality. Data will be collected through a private online survey tool called, Survey Monkey. All personal information (e.g., email address) will be kept strictly confidential. Receipt of your completed demographic form and surveys will serve as your agreement to participate. In order to participate, please complete the surveys without the assistance of friends or co-workers, and send materials back by April 30th, 2017.

    1. Once you agree to participate in this study, you will be sent an email that will include links to; a demographic questionnaire, two surveys, training video and posttest (75% = passing grade).
    2. After you have completed all initial tasks, you will be asked to fill out another set of surveys.
    3. After all necessary documentation is received and the study has been completed, you will be notified about the results via email.

    Risks & Benefits
    The risks of participating in this study are minimal. Although your participation would result in less than 1 hour of overall dedicated time (including webinar and 20-minutes of paperwork) the web-based model will allow you to participate in a private location at your leisure. The benefits of participating in the study are; gaining increased insight and knowledge and making a contribution to the field of science and nursing education.

    Costs & Compensation
    Your participation in this study will not cost you anything other than your time. All necessary materials, including supporting documents and resources, will be provided.

    The findings of this research may inform nurses and administrators about new methods of training for ED nursing staff. You can refuse to take part in this study, stop participation at any time, or not answer questions, without penalty. Your personal information will be de-identified. All documents will be numerically coded.

    If you have any questions or concerns, please feel free to call me at (603) 933-0934 or my advisors, Robert Walrath, PsyD or Angela Moussou PhD, (603) 888-1311. Your contribution is very important. I hope you will participate.


    Confidential Demographic Information Survey


    Colleen Wentworth

    Colleen Wentworth, MA, LCMHC
  4. by   oncnursemsn
    This is amazing- thank you. I don't work in an emergency department but have been an oncology nurse 34 years - and like you- am a doctoral student , but now in my 3rd year. I'm struggling with what I think is compassion fatigue, burn out? I'm exhausted and just tonight incredibly sad after in my ambulatory heme/onc unit admitted an "ambulatory" patient who was actively dying. For the third time this week. We just don't do palliative care and dealt with the family all day. My unit is an 18 chair infusion dept where we administer chemo/blood products and general infusions. I'm disgusted, infuriated and terribly depressed and I have no answers. Will look into your survey if I would be appropriate respondent?
  5. by   not.done.yet
    Excellent article. I would add intolerance/political angst to the list of compassion fatigue symptoms. I have many friends who are generous by nature, but who are casting votes against their nature simply due to what they have witnessed as ER nurses and home health nurses, wanting to deprive people who need care of getting care because of those they have seen or perceived as taking advantage of the system.
  6. by   Daisy4RN
    I think this is an important topic for all nurses. After these patients are admitted they become the problem of the floor nurse for 12 hours. There are many who come to the floor with high expectations "now that I am here". Taking care of these patients of course causes burnout/compassion fatigue. We are humans and have a limit to the amount we can give. With patients/families abusing the nurse, and the system (and yes, they do abuse the system), it does begin to wear nurses down. I cant tell you how many nurses I know that state "I used to be a nice person" before I became a nurse. I am not sure even with the "mental health training for nurses" that this problem will ever be solved, and I am not sure why you think compassion fatigue affects healthcare workers in the ED more than others, but I do wish you luck with your study.
  7. by   cwentworth
    Wow! Your job sounds incredible in so many ways - there is tremendous potential for burn out and such opportunity to find meaning and purpose in life. I am amazed at your commitment and willingness to approach such suffering on a daily basis. You are a special person who may need to realize the importance of self-care. You are definitely welcome to participate in my study. You do not need to be an ER nurse to participate in the Pilot Program! All you need to do is click on the link (demographic survey) and I will send you the information that you need. Thank you for what you do.
  8. by   cwentworth
    You are so right and thank you for stating that compassion fatigue can affect everyone. I wrote it completely from my perspective and afterwards, I thought about those of you who work in nursing homes, geropsych units, outpatient, med/surg, etc...

    I'm hoping that bringing this issue out into the open will help us feel less shameful about it. We might all start talking about it and then (hopefully) supporting one another.
  9. by   rockchickrn
    I am having compassion fatigue and total burn out.
  10. by   Cat365
    I get frustrated with repeat patients occasionally but I have a basic "live and let live" philosophy that stood me well in a previous patient oriented career and will hopefully stand me well for the rest of my nursing career.

    I always try to remember that no one can "fix" people. They have to do that themselves and they have to want to change. It's my job as an ER nurse to stabilize them. I don't have the time or the magic wand to "fix" them.

    I also try very hard not to judge. I say try because I'm not always successful but I keep trying. Im less successful when children are affected. Kids can't always make their own choices. I'm not sure I would want to change the fact that they affect me more. If that happens I think it would be past time to get a third career.