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Topics About 'Compassion Fatigue'.

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  1. As my friend and I settled into a quick bite of lunch, I casually asked her, "So how are your parents getting along?" I knew she had been taking care of her elderly folks for several years. While they lived fairly near her, they both had a number of health problems and between her work at the hospital and her own family, she had a hard time juggling all the responsibilities. Joan's eyes filled with tears. "I just don't think I can do it anymore. They don't want to leave home, but we have to make a change. I'm not sure where to turn." Caregiving is always busy, but it can become consuming and so draining that often caregivers run the risk of losing their own health and well-being. When people come to you as a professional nurse with that kind of SOS, do you know what to say? I asked Joan a few more questions, and she continued to vent, her pent-up feelings spilling out as she tried to eat to finish her sandwich. "I wish I understood more about the facilities around here. I just don't have time to go visit." I tried to help by outlining a few of the basics about different facilities in our area. Starting with the most independent living available, I then shared with her everything in between to the highest level of care at the nursing home. These general descriptions fit many places in the United States. Home with help This is usually the #1 choice for people who realize they need some extra assistance. They often want to stay home as long a possible and begin the process of hiring help, either privately or through home care services. While this can be a satisfactory arrangement for many, it quickly becomes very expensive for a long-term arrangement. It is also difficult to find just the right kind of help-someone who can assist with meals or medications or personal care. Currently, there are new trends in electronics that show promise in helping the elderly stay longer in their own homes, everything from monitors, to remote controls to voice-activated technology. Independent living These types of facilities have individual apartments, sometimes of varying sizes. They often include meals and housekeeping but rarely medication administration or nursing care inside the apartments, unless arranged privately. Residents must be able to do their own self-care, get to meals and function independently, for the most part. These types of facilities are private pay unless they are government subsidized. Assisted Living The range of care at assisted living facilities is growing. In general, the residents are required to be mobile in some way, whether ambulatory or with an assistive device. They receive personal care assistance, medication administration, all meals, laundry, and housekeeping. While residents need to be able to evacuate, many assisted living now allow current residents who have a hospice diagnosis to remain in their apartments, as long as they have help. The elderly who reside in assisted living can often take advantage of extra services such as transportation to medical appointments, and help with management of acute illness. Most of these facilities are private pay, although some long-term care insurance will cover it (Only 10% of the elderly have long-term care insurance according to Forbes Magazine). Memory Care Assisted Living These types of units are usually locked and cater specifically to patients experiencing memory loss, often secondary to Alzheimer's/Dementia or other similar disease processes. Patients here receive the same type of care as assisted living but with additional services geared toward helping relieve anxiety and decrease problem behaviors. Sometimes these facilities are free-standing and at other times they are a hall attached to a regular assisted living. Rehabilitation Facilities Patients often receive this type of care after a time of illness, an accident or a fracture. Intended to help restore function and improve the patients' ability to perform their ADL's, rehab units have specific goals, expectations, and deadlines that help to guide care. While in a rehab facility, the patient would get therapy directed to improving functional outcomes. Paid for by Medicare and insurances, time allowed in rehab is determined by carefully crafted and pre-determined guidelines. Nursing Homes Nursing homes care for several categories of patients, including those who require rehabilitation. They take care of residential patients (those with chronic care needs) and hospice patients who are not able to be at home. Nursing home patients who are there for rehab may have their stay covered by Medicare; those who are there for residential care are private pay (or insurance for the 10% of the population that carries long-term care insurance). Of those who are there for residential care who are also receiving hospice benefits, the room and board portion of their care remain the responsibility of the patient and family. The fact that long-term nursing care is not covered by Medicare comes as a shock to many who are needing to find a higher level of care for their loved ones. However, once the patient has spent expended all their resources, the government will begin to pay for nursing home care through Medicaid programs for the indigent. As Joan and I finished lunch, she talked some more about hiring help and beginning the process of investigating local assisted living facilities to see if she could find something that matched her parents' needs. I encouraged her to seek out a support group. As we went our separate ways, she smiled, "It helps just to talk it out!" Joy Eastridge
  2. 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 Re-occurrence 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.
  3. dzadzey

    Where Is Our "Safe Haven"?

    The profession of nursing carries with it a high risk for burnout and compassion fatigue. While these two terms may seem synonymous, there are some significant differences. These differences aside, however, the issue of how nurses can successfully cope with the potentially debilitating emotional and physical exhaustion that come with the close and intense contact with the emotions of patients and their families as we provide nursing care, needs to be addressed. There are a number of tools and techniques available, but are we making the most effective use of them? This signage, in the current context, begs the question of, "Where is the safe haven for nurses?" It's a question, the answer to which, nurses must be seeking from the administrators of acute and long term care facilities alike. Compassion Fatigue and Burnout Compassion fatigue and burnout may seem to be interchangeable concepts, and have some similarities, but they are separate and distinct. In both cases, we see "added coping and adaptational demands on nurses" (Boyle, 2011). The most significant distinction lies in their acuity, with burnout occurring over time and compassion fatigue presenting more acutely (Boyle, 2011). Additionally, burnout is generally a reaction to stresses experienced in the workplace, while compassion fatigue is a consequence of the experiences of the pain and suffering nurses are exposed to while caring for their patients (Boyle, 2011). In terms of those with a tendency to suffer from compassion fatigue, older nurses (≥ 50 years of age) seem to suffer less from compassion fatigue than do their younger co-workers. This may be attributed to their greater clinical and life experience (Sacco, Ciurzynski, Harvey, & Ingersol, 2015). Regardless of age and experience, compassion fatigue can have leave its mark on any nurse or other member of the patient care team. So, what can we do to make that "safe haven"? That place where we can take the time to recover our spent energies, our emotional and spiritual equilibrium? Building a "Safe Haven" There are three key components to creating the safe havens nurses and other members of the healthcare team need to foster recovery from the stresses leading to compassion fatigue. These are prevention, assessment and mitigation of the consequences that can arise while caring for acutely and critically ill patients. Work-life balance is a crucial aspect of this process, as it provides nurses the time and opportunity to take time to establish and follow a plan of self-care so that they can effectively care for their patients (Boyle, 2011). But this plan must be scrupulously and "relentlessly carried out in an attempt to enhance a calm state" (Boyle, 2011). This latter point, in my mind however, seems to be self-defeating. How can one achieve a measure of calmness, serenity and equanimity through such relentless pursuit? Mindfulness and diligence are more appropriate for this endeavor. As care givers, we have to recognize a very fundamental fact: we simply cannot face the suffering of patients and their families on a daily basis and remain unscathed by that experience (Boyle, 2011). Such an expectation is unrealistic at best and self-deceiving at worst. On an individual level, it requires mindfulness of our own internal states, and the knowledge to recognize the signs of our own compassion fatigue... Symptoms of Compassion Fatigue WORK RELATED: Avoidance or dread of working with certain patients Reduced ability to feel empathy towards patients or families Frequent use of sick days Lack of joyfulness EMOTIONAL: Mood swings Restlessness Irritability Oversensitivity Anxiety Excessive use of substances: nicotine, alcohol, illicit drugs Depression Anger and resentment Loss of objectivity Memory issues Poor concentration, focus, and judgment PHYSICAL: Headaches Digestive problems: diarrhea, constipation, upset stomach Muscle tension Sleep disturbances: inability to sleep, insomnia, too much sleep Fatigue Cardiac symptoms: chest pain/pressure, palpitations, tachycardia Source: (Lombardo & Eyre, 2011) At the organizational level, we see Employee Assistance Programs (EAP) and Pastoral Care providing support for nurses coming up against the wall that is compassion fatigue (Lombardo & Eyre, 2011). These, however, seem to be more reactive than proactive strategies. More proactive strategies would include having EAP counselors available on site for those nurses facing an emotionally challenging patients and/or families; debriefing sessions to aid in identifying stressors nurses face in caring for patients; making time for support groups during working hours to aid nurses in coping with the emotional fallout; and interventions to aid in bereavement for those patients who passed and making space on the unit or other space in the facility where nurses can find that safe haven (Boyle, 2011). Conclusion Dealing with compassion fatigue requires effort...proactive effort...on the part of individual nurses and the organizations they work for. On the individual level, we need to be mindful of our internal state and diligence in following a process by which we care for ourselves so that we can better care for our patients. We must, in this process, be gentle with ourselves. We will make missteps and mistakes in the process, the expectation of perfection is both unrealistic and counterproductive (Chordron, 1991). We must be proactive instead of reactive. At the organizational level a proactive stance is essential to prevent and ameliorate the effects of compassion fatigue for nurses and other caregivers. If organizational support is limited, or difficult to obtain, nurses need to step up and insist on having that "safe haven". Our health, and that of our patients, depends on it. References: Boyle, D. A. (2011). Countering Compassion Fatigue: A Requisite Nursing Agenda. The Online Journal of Issues in Nursing, Vol. 16, No. 1. Chodron, P. (1991). The Wisdom of No Escape and the Path of Loving-Kindness. Boston, MA: Shambala. Lombardo, B., & Eyre, C. (2011, January 31). Compassion Fatigue: A Nurse's Primer. The Online Journal of Issues in Nursing, Vol. 16, No. 1, Manuscript 3. Saakvitne, K. W., Tennen, H., & Affleck, G. (1998). Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory. Journal of Social Issues, Vol. 54, No. 2, 279-299. Retrieved from Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. The Online Journal of Issues in Nursing, Vol 16. Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersol, G. L. (2015). Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses. CriticalCareNurse, Vol. 35, No. 4, 32-43. Retrieved from Critical Care Nurse
  4. tiffanyselah

    Burnedout musings

    "Mommy, why do you have to go?" Every day now, I am asked that question from one of the most important people in my life - my six year old daughter. "I miss you when you are gone." "When you are home you sleep all day." "I miss hanging out with you." I pause only for a second, look deep in her eyes and consider whether this decision that I'm making in this moment will affect this soon to be adult forever. With the television blaring, fighting for attention I tell her, "I'm sorry baby, I have to work." I push her arms off of me and release myself from her grasp. I kiss my son on the forehead with his headphones on, barely acknowledging my existence. I wish for a moment that I could put more time into our relationship, but I don't have time. As I walk out, my daughter stands in the doorway in her true essence; hair flying every which way but down, shoes off, chipped nail polish screaming to be repainted, arms out, grin wide as the Nile saying "give me a hug." I hug her and close the door. My knees scream at me as I jog slightly down the stairs to my car. The brightness of the car lifts my sad spirits and dries the tears before they come out of my eyes. I start the engine of my V6 Convertible Ford Mustang and listen to the engine rev hoping that something in this material possession will make this separation easier. All the patients are now a blur. They're blurs of body parts, cries, moans, whimpers, whispers, dirty looks, yells for attention, yellow firefighter pants and as always blood on the ground. The whirlwind of emotions of the emergency room are now commonplace to me. But I still cringe whenever I see blood on the floor. I get right on my knees and wipe up the blood as best I can with the blurs of the ER whipping around me. I get up and keep moving because I know the drill here. Patience is a pastime, fear is nothing, condescension is expected, abuse is understood, sadness is normal, anxiety is a bartering tool, manipulation is rewarded.... and happiness is rare. When I leave this place, I leave a piece of me with each patient. Every shift, it's me that's restrained and pulled away to another facility against my will. It's me standing outside of the room stressing as 3 nurses hold my sick child down. It's me that lies in the bed with my eyes swollen shut so that I can't see. It's me that is getting attacked by another drunk patient next door to my bed. It's me losing my first child. It's me that is getting told I have cancer for the first time. It's me with a gunshot wound to the chest. It's me sitting in the hallway holding my newborn as the young doctor pronounces my husband. And it's me that's relieved of my anxieties and being sent home, only to be called later because I forgot my prescriptions. Breathe. This is compassion fatigue. This is burnout. This is my life, and every day I am told this is not happening, this is not bad, this is totally doable, this is not real. And every day I make the decision to come back. As I drive home sleepiness clouds my vision, my head rocks back and forth endangering my ride home. Careless Los Angelinos honk at me and whiz by me like I'm a drag on society. My whole world seems dark. My days seem long and meaningless, but no one notices my tears and my complaints are mute. What effects will this decision to continue this work have on my future and my life? We'll see once we get there.
  5. jk2185

    My Burnout Story

    I've been crying all morning coming from a pain so deeply repressed and locked inside me. I watched my last patient die three days ago and leave in his wake a broken family truly taken to the depths of misery and suffering. It was unexpected as most seem to be in an Intensive Care Unit. A hopeful wife of 20 years who claimed to have found her soulmate blindsided by her husband's death. I remember the daughter's face when she came to the bedside while I was performing futile CPR, a gasp of horror unknown to most people. Empty eyes and an instantly drained soul. They both, the wife and daughter, threw themselves on his body begging him to return from the dead. How many times have I seen this? Too many to count. Each time, I myself have felt the distinct pain of death and sorrow and stuffed in a vault deep in my psyche hoping to never release it. How many times have I been bestowed the "privilege" to give people the worst news of their lives. "Hi, I'm so and so, we've done everything we can, I'm sorry." "Hi, I'm so and so, your husband's stroke was catastrophic and unrecoverable. He may not make it through today." "Hi, I'm so and so, you are going to die and I'll be here to help you and make it as smooth as possible." Ever had a day where you got sent home because both of your patients died? Ever cleaned a dead body for the morgue, then gone to your 30-minute lunch break (and you only get 30 minutes, no more)? Several deaths I pin on myself. I lost two patients last year which I "know" I had a hand in. I should have known this, I should have done that. Of course, people tell me it wasn't my fault. Does that help? No....it's a deep knowing and a horde of permanent memories I will take to my grave. Then there's the clinical stress. Am I doing the right thing? Do I know what I'm doing? Ever looked at a med vial 5 or 6 times because you keep second-guessing what you're giving? I used to go home after a shift and read up on things I encountered during a shift that I was unsure of. I used to read textbooks for leisure. I've got ACLS forwards and backwards. Pretty sure I can interpret rhythms better than some of the residents. I'm not trying to toot my own horn; just pointing out that this drive (which according to popular belief is a good thing) has driven me off the cliff into a world of immense suffering. Maybe I just don't know how to cope. I thought having a couple beers or glasses of wine was the way to do it. Laughing with your coworkers about how messed up your day was or just venting to your innocent spouse. OR MAYBE, there's a better way to do this so that able people like myself aren't lost in this dark forest of despair. I've heard of certain facilities offering post-death huddles or post-major event huddles. Now I understand that's not plausible on a unit where 2-4 people die or have a major event a day, but something has to give. You're supposed to "buck up," or my favorite I've been told is "this is a sink or swim place." HA!!! What a joke. No wonder I'm where I'm at today. People aren't meant to be able to handle these kinds of stresses at their full-time job. I do remember a clinical instructor I had (a critical care guru) telling me that ICU nurses typically have a two-year shelf-life before changing disciplines. I remember thinking, "what weaklings, two years is nothing; I can do it." It's torn a hole in me. I quit my job yesterday. I don't sleep. The formerly strong, I can do anything, level one center, highest acuity, give me the sickest of the sick gunslinging cowboy has changed. I'm having trouble leaving my apartment. Time to get a good psychologist. I don't know if I'll be able to ever touch a patient again. This is hands-down the hardest thing I've ever done. I hope I can heal. I hope this reaches someone else out there experiencing something similar. Burnout and PTSD are real. Don't let them steal your life. my-burnout-story.pdf
  6. jeastridge

    Running on Empty

    "Come to me, all you who are weary and burdened, and I will give you rest." Matthew 11:28 Tears spilled over as I clicked off my cell phone and started the car, instructing my GPS to take me to my next hospice visit thirty miles away. The tears were not, as you might suppose, out of sadness for the dying patient that I was headed to see; they were instead tears of fatigue and self-pity, of overwork and of frustration. As I drove, I struggled to re-direct my emotions and to achieve control over all these unwanted feelings that seemed to bubble up from murky depths of discouragement. Deep breaths, calming thoughts, a focus on the particular patient that I was about to see, and a silent prayer, all helped me gather myself to continue to offer the best possible care when I arrived at the home. Being a professional nurse of many years, I know the signs of compassion fatigue or just fatigue in general. But life is not an idealized parade of lovely patients in an orderly pattern, nicely separated by re-energizing breaks where well-balanced meals suddenly appear, consumed while a favorite selection of music plays in the background. Real life as a nurse looks more like concentrated discipline to stay focused on the needs of the patient, while dismissing or delaying the cacophony of missed messages, equipment failures, scheduling snafus, and documentation demands. With time and experience, we all learn to prioritize and master the art of offering ourselves without becoming completely depleted--that is, unless you look at days like the one I refer to above. If we are to be honest, we all have days like that one: days where we overextend ourselves physically, emotionally and spiritually; days where we give until we are running on empty. Are you a person that fills up your car's gas tank when it gets half way to empty? Do you wait until the light comes on? Or are you the person who waits until the car sputters a bit before coasting in to the nearest station? As nurses who are also spiritual beings, sometimes we expect to keep running on fumes. We don't take the time we need to in order to fill our spiritual tanks. Instead, we survive on "fast food" of the spirit. I work as both a Hospice Nurse and as a Parish Nurse. I am usually asked to help with the orientation sessions for the new Parish Nurses. My topic is usually, "Time Management." One of the things I tell the new Parish Nurses is: "Minister out of the overflow." Use your imagination to picture a cup, a chalice. Now pour water into that cup until it runs over, like a fountain. As long as our nursing and care for others comes out of the overflow of our hearts, then we will not run dry. We will continue to be able to give and meet others' needs. But when we stop the in-coming nurture of our own souls and bodies, and begin, instead to dip into the cup itself, then we quickly find ourselves in tears as we ride down the road or the elevator, ready to step out to another shift. If we keep our lives in balance, then we can be those excellent nurses that we so long to be. It is our work to overcome cynicism, doubt, frustration and to journey on as advocates, compassionate healers who reach forward through the maze of computerized care to see the patient and meet them where they are. We move beyond the chores to the connections, to the real and therapeutic touch. And we don't give up because it is so hard. Let me tell you something: nursing has always been hard and it always will be. We find reasons to complain--we are human, after all--but truly, we have more technology, more ability to relieve pain and suffering, more treatments and more understanding than ever before. Let's do ourselves and our profession a service by focusing less on what is wrong, and instead maximizing what is good. Mother Teresa once said, "If you can't feed a hundred, just feed one." The idea that we may not be able to do everything for everybody assaults us daily. But we can make one person's day better. One patient. One co-worker. One environmental services person. Just one. Being competent and compassionate nurses stems from a balanced life, one that focuses on mind, soul, body--or said another way: if we focus on spiritual nourishment and self-care then our words and deeds will be those of a nurse who is both competent and compassionate. Self-care is not a self-centered, self-absorbed state of mind. It is not the mentality of "I work hard, so I deserve what I take for myself." Instead, it is maintaining a rhythm of giving from the spirit and receiving into the spirit. It is nurturing our whole selves so that we can continue to give. George Saunders, a contemporary fiction writer, writes, "What I regret most in my life are failures of kindness. Those moments when another human being was there, in front of me, suffering, and I responded...sensibly. Reservedly. Mildly. Err in the direction of kindness. Do those things that incline you toward the big questions, and avoid the things that would reduce you and make you trivial. That luminous part of you that exists beyond personality--your soul, if you will--is as bright and shining as any that has ever been." Let us remember that between the twin hills of competency and compassion lies the mountaintop of the true art of nursing. It is a place we all long to do more than just visit. We desire to live there, day in and day out, creating art through our work and making a difference one person at a time. Joy Eastridge, RN, BSN, CHPN May 13, 2015
  7. Lynda Lampert, RN

    Beyond Burnout: What is Compassion Fatigue?

    Jennifer Castaneda, RN, BSN, HCT, didn't know what was wrong, but she knew that she didn't want to work at the bedside anymore. When she was younger, her future profession was preordained. Many of her family members worked in the medical field. Now she stood at a precipice, and she couldn't figure out what was wrong with her life. Jennifer was the typical angry person, she admitted by phone interview. She was divorced twice, self medicating with alcohol, and constantly pushing people she cared for out of her life. "I got really great compliments from my patients. I got awards for my compassion," she states. No matter how bad her life got outside of the hospital, she never stopped being super nurse. She says, "I would end up giving more. The more my life was out of order, the next day I tried harder." She couldn't pick out a specific patient that made her realize the trouble she was in, but she does remember one patient that added fuel to a raging fire. He was post open heart, and had every appliance he could possibly have: chest tube, foley, external pacer, and telemetry wires. Unfortunately, he didn't have a great deal of family support, and he was always on the bell, asking nurses for small things. It got to the point that all of the nurses on the floor would take turns because their frustration levels were so high. Jennifer tried her hardest to be there for her patient, but what he was asking for drained her. Eventually, the patient got out of bed himself and fell, slipping on his feces, and increasing his stay by two weeks. She was devastated, and management didn't make it any better. "It turns out that it was not written in notes that he was never specifically told to not to get up," she states. "Nurses got into trouble for not documenting. I thought at that moment that 'I'm done'. The nurse who was singled out was our best nurse. We had worked as a team." This caring, compassionate, hard working nurse left the profession because she just couldn't give anymore of herself or sacrifice her life outside the hospital. Was she weak? Was she a complainer? Was she just someone who couldn't hack it? No. In fact, she was suffering from a condition known as compassion fatigue and, like many nurses, was unaware of it. The nursing profession has many challenges, but the twin specters of burnout and compassion fatigue are among the most crushing. Although there is a difference between these two conditions, they are related. They are devastating nurses across the country. According to the American Association of Colleges of Nursing, 13 percent of newly licensed RNs were working in a different career within one year of their licensing, and 37 percent indicated they were ready to change jobs. The turnover rate in nursing is one of the highest at 13.9 percent. Something is making nurses leave the bedside, and it isn't only lack of staffing or trouble with management. It is emotional stress that contributes to the mass exodus. Compassion fatigue affects thousands of nurses who don't know they are suffering from it. This does not mean they are tired of caring. It means they have taken too much onto their shoulders and don't know how to find their way out. Empathy and Compassion When most nurses hear the phrase compassion fatigue, they think that it means tired of caring, based on the words used to describe it. To most nurses, this is an insult. Never, under any circumstances, would nurses stop caring about their patients. Most nurses would go above and beyond for their patients, and that's part of the problem. Dr. Kate G Sheppard PhD, RN, FNP, PMHNP-BC, FAANP, Clinical Associate Professor, and PMHNP Specialty Coordinator for Community and Systems Health Science Division at the College of Nursing at University of Arizona suggests a different term for this common occurrence. She related in a phone interview that, "Every nurse said to me at some point that they may have compassion fatigue but they still have compassion. I have urged experts to a different term: emotional saturation. You're just full. Your shoulders are not big enough to take take all this on." Most of the confusion stems from the difference between empathy and compassion. Although nurses are encouraged to have both, the definition of each is important to understanding compassion fatigue. Empathy is feeling what someone else is feeling. It is putting yourself in their shoes. Compassion takes it a step further and urges the caregiver to do something to fix the problem. Dr. Sheppard explains it this way: "Empathy is understanding that a patient is cold. Compassion is getting the patient a blanket." Compassion is the impulse within nurses that urges them to fix the problems of their patients. Unfortunately, some things are not their responsibility to fix or cannot be fixed, When this happens, nurses have an emotional reaction that they have no outlet for. They are told they will simply get used to it. Burnout vs. Compassion Fatigue It is so easy to dismiss a nurse's distress as burnout. In fact, burnout and compassion fatigue are usually seen in combination, but they are not the same thing. Dr. Maryann Abendroth Ph.D., RN, Assistant Professor at Northern Illinois University School of Nursing & Health Studies states in an email interview that, "Burnout is generally associated with work overload. . . . Symptoms of burnout can start gradually and worsen over time. Like burnout, compassion fatigue symptoms are associated with emotional exhaustion; however, nurses experiencing compassion fatigue are traumatized due to bearing witness to those who are suffering. Burnout may be a precursor or a risk factor for compassion fatigue, which has a more sudden and acute onset than burnout." Dr. Sheppard agrees, "Compassion fatigue is overarching. Within it is both secondary traumatic stress and burnout. They go hand in hand. Burnout is from the environment. Burnout is not having the correct items when needed. I've rarely met someone with compassion fatigue that doesn't have burnout." Burnout describes stress that comes from conflicts with management, the incivility of doctors, and chronic short staffing. Compassion fatigue is crossing the boundaries between professional compassion and personal compassion for your patients. It means giving too much of your emotions and expecting too much of yourself. Compassion Fatigue: A Perfect Storm Many professions experience the phenomenon of compassion fatigue, but nurses are particularly susceptible due to the nature of the job. Dr. Abendroth states, "Part of the art of nursing is to be empathic and sensitive to the physical and emotional needs of our patients. Yet this calling can take its toll. Specifically, nurses who often define themselves as 'being their job' may be at particular risk because they may easily begin to blur the professional/personal boundaries between themselves and their patients." Compassion fatigue is often triggered by this blurring of emotional boundaries between the patient's needs and the nurse's. Nurses at risk for compassion fatigue tend to believe that they are the only ones who can care for their patients. How can I take lunch when something may happen to my patient? Patients will go south whether nurses take care of themselves or not. Lunch may actually help the nurse achieve the distance needed. Dr. Sheppard is familiar with this phenomenon: "Nurses at risk tend to think, 'I have to go check on MY patient.' They stop taking their breaks, because who's going to watch THEIR patient? This is total enmeshment with the patient, and the nurse can't walk away." Sometimes nurses are reminded of other people when taking care of a patient, such as a parent or a child. This can lead to further blurring of the emotional lines, making the need to fix that patient mean so much more than is healthy. Do you have compassion fatigue? It is possible that a large population of the nursing profession suffers from compassion fatigue. As with all conditions, it is important to recognize the symptoms before making a definitive diagnosis. The Online Journal of Issues in Nursing published an article by Dr. Brenda Sabo, RN, Ph.D., under the title "Reflecting on the Concept of Compassion Fatigue" which thoroughly describes the symptoms of both burnout and compassion fatigue. According to this source, burnout symptoms include: Anger & frustration Fatigue Negative reactions towards others Cynicism Negativity Withdrawal Physical complaints Psychological problems Cognitive issues Relational disturbances Similarly, compassion fatigue tends to present with these symptoms: Sadness & grief Nightmares Avoidance Addiction Somatic complaints Increased psychological arousal Changes in beliefs, expectations, assumptions Witness guilt Detachment Decreased intimacy Physical complaints Psychological distress Cognitive shifts Relational disturbances As demonstrated, both burnout and compassion fatigue have similar symptoms. However, compassion fatigue displays more of an emotional component than the frustration of burnout. Experts agree, though, that the two are often found together. One way to screen yourself for compassion fatigue is to take a test known as the ProQOL measure. It is used by therapists and experts to diagnose compassion fatigue, but it is also an excellent self-test to determine if you are suffering from this condition. Treating Compassion Fatigue For so many nurses, this situation seems hopeless. They feel like failures because they can't "hack it." They run from the bedside in droves, because they are so overwhelmed by the dual punch of burnout and compassion fatigue. All these professionals want to do is care for others, and it feels like they can't do what they were trained to do. When these thoughts and emotions run unchecked, it is likely to lead to clinical depression, personal complications, and career changes. Fortunately, the outlook is not so bleak, and you can do several things to restore your ability to function as a bedside nurse. One of the first steps you need to take is setting boundaries. What is a boundary? Dr. Sheppard explains, "Boundaries are saying I will take care of myself and I will take my breaks as scheduled. I am drawing a limit. Work will not push me and take that away from me. Boundaries are what you won't discuss with patients or family members, such as religion and sexual practice." For instance, many nurses won't take food offered by a patient. When the patient presses, nurses come up with excuses. Finally, the nurse takes the food and throws it out. This is a perfect example of breaking a boundary, a boundary set by the nurse who does not want to eat potentially contaminated food. In this situation, it is easy to dispose of the food, but when you cross boundaries and allow yourself to become more emotionally involved than you should, compassion fatigue results. Set boundaries that state you can't fix everyone, you will make mistakes, and that it's okay. You are not superhuman, and you don't have to be. Another way to combat compassion fatigue is adequate self-care. Although this sounds like psychological double talk, the core essence of it is vital to restoring your sanity. Dr. Sheppard recommends positive self-talk. "Mindfulness and self-compassion are key. Look how you talk to yourself. Would you talk like that to a colleague? Identify one example of when you berated yourself. Turn it around and imagine using the same words to the colleague. You never would say that. Get better at noticing the self-talk. Apologize to yourself when you slip up." Self-care can include many aspects of your life. Seeing a therapist isn't an admission of failure, but it is a way to learn boundaries and positive self-talk. Socializing with friends and colleagues can help to vent the emotions that you are keeping inside, helping you to avoid living in a self-imposed bubble. Journaling is another way to vent emotions, and you don't have to run the risk of judgement. You can also try meditation and mindfulness, both at work and at home. You can find ways to take care of yourself, release the need to save everyone, and find a way to make nursing work for you. Nurse Jennifer Castaneda did leave the bedside, but she learned valuable lessons from her time as a nurse. "My friend said to me, 'You're really angry.' I even took an anger management class, and it was a very positive experience for me. It taught me about self-care. It taught me that I was giving it all at work, but that didn't make it okay to hurt myself. I was not saving anyone by sacrificing all my energy to them. I needed to learn when to say I can't." She is much happier now, even though she no longer works in nursing. Jen is in a supportive relationship, doesn't abuse alcohol, and has made a life of helping others, particularly nurses. "I now help women develop strong boundaries, extreme self-care, and getting their needs met in relationships. I guess now I am not surprised that I have clients that are nurses, too." She runs the website www.jennifercastaneda.com. In this role, she teaches self-care through the use of hypnosis and positive interpersonal relationships. She has gone through the dark of burnout and compassion fatigue, coming out on the other side a happier person. "I am happy I became a nurse, and I am happy with what I am doing now," she states. "I just wish I would have known what compassion fatigue was and how to handle it in the first place. It may have made a difference in my life and career." Further Reading Overcoming Compassion Fatigue: A Practical Resilience Workbook; Martha Teater, MA, LMFT, LPC, LCAS, and John Ludgate, Ph.D. Back from Burnout: Seven Steps to healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care; Dr. Frank Gabrin To Weep for a Stranger: Compassion Fatigue in Caregiving; Patricia Smith Trauma Stewardship; Laura van Dernoot Lipsky and Connie Burk Compassion Fatigue and Burnout in Nursing; Vidette Todaro-Franceschi References Abendroth, M., (Jan 31, 2011) "Overview and Summary: Compassion Fatigue: Caregivers at Risk" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1 American Association of Colleges of Nursing; Nursing Shortage Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse's Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3. ProQOL Measure; The ProQol Measure In English and Non-English Translations Sabo, B., (Jan 31, 2011) "Reflecting on the Concept of Compassion Fatigue" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 1