When this happens, and compassion fatigue occurs, there are some things that nurses can do to help put themselves or their colleagues back on track to serve patients passionately and with renewed energy.
A prevalent issue
Compassion fatigue is prevalent in most every health care profession, noted Jude Bijou, MA, MFT, a psychotherapist, professional educator and workshop leader based in Santa Barbara, Calif. “I believe that it is due to having so many unexpressed emotions about all of the interactions, all of the heartbreak, fear and frustration that is part and parcel of witnessing and serving people at times when they are often at their most vulnerable,” she said.
Kathy Ault, director of pastoral care at Mercy Medical Center in Baltimore, Md., agreed. “I think the prevalence of compassion fatigue is very high among all caregivers,” she said, including nurses, physicians, chaplains and others whose role involves taking care of people who are going through a lot of suffering, pain and loss.
Those working in units with the sickest patients--the ICU, oncology units, emergency departments, for example--may be the most obviously impacted, but Ault noted that compassion fatigue can be found anywhere through the health care system because “you’re constantly caring for multiple people with multiple requests and the intensity and frequency of patient contact seems to be increasing.”
In fact, noted Caryl Eyre, RN, MSN, clinical nurse specialist in medical-surgical nursing at University Hospitals Case Medical Center in Cleveland, and co-author ofCompassion Fatigue: A Nurse’s Primer, along with Barbara Lombardo, RN, MSN, PMHCNS-BC: “I think it is very probable that every nurse will experience compassion fatigue at some point in their career.”
Eyre added that compassion fatigue is becoming more and more prevalent. “It’s really a very important topic in nursing because every year we have to do more and more with less and less. People go into nursing because they are caring, empathic, people, so that’s partly the set-up for compassion fatigue. If people don’t care, and can close themselves off, they don’t experience that. But, that’s not the usual personality of a nurse.”
Because compassion fatigue is so common--and can affect both the caregiver and the level of care they provide--it’s important for nurses and their managers to be able to recognize the signs.
Spotting the signs of compassion fatigue
Compassion fatigue, said Ault, “looks like what fatigue looks like in your own life.” For nurses, she said, one of the early signs may be starting to wonder if they need to make a job change, or they’re not finding fulfillment, satisfaction or energy in the work that they’re doing. In some cases, over time, compassion fatigue may be exhibited as a sort of “shell” that the nurse puts up “that makes it harder for them to have those intimate connections.”
Many of the signs of compassion fatigue are clear, said Bijou. “Maybe our thoughts go negative, maybe our communications are abrupt, maybe we’re continually fatigued, or maybe we get sick ourselves. These are all signs we need some self-care.”
Eyre agreed and added that she and her colleague, Lombardo, work with managers to help them be alert to the signs so that they can intervene. Managers have an important role to play here, she noted, because those who are affected by compassion fatigue are generally not able to spot the signs in themselves.
There are a number of things that health care organizations, their managers and staff members can do both to minimize the impact of compassion fatigue and to address it when it occurs.
Taking action
The health care organization can and should take a role in helping to address and relieve compassion fatigue, said Ault. In her work at Mercy Medical Center, she starts this process during orientation. “As we’re bringing new nurses into our system, we take an hour at the end of their orientation process to do a reflection in our Chapel of Light.” During that process she takes them through a guided imagery exercise as a means of providing some tools that they might use in their daily living. The medical center also does periodic symposia for nurses throughout the community focused on the concept of mindfulness and the importance of caring for themselves.
Case Medical Center is also focused on providing a variety of resources for staff to help them deal with compassion fatigue, said Eyre, and they encourage staff to think creatively about how to address their own needs and those of their colleagues.
As an example, one of the nurses at Case recommended having a room where nurses could go to decompress. While space was at a premium, a spot was found and converted into a quiet respite for all staff on the floor--from nursing to environmental services. It’s a “no phones allowed” place, designed not to catch up on phone calls or email, but literally to relax with soothing surroundings and music.
Finally, stressed Ault, individuals should draw strength from those around them to help fight off compassion fatigue. “It’s essential that there’s a community where people can talk and express and work through some of the intensity of the demands and losses they experience.”