When Compassionate Care Takes a Turn Toward Fatigue

When Compassionate Care Takes a Turn Toward Fatigue

Fatigue, emotional distress, or apathy resulting from the constant demands of caring for others — today’s nurses are facing new levels of “compassion fatigue.” Empathetic, passionate, and caring nurses can fall victim to the continual stress of meeting the needs of not only their patients but also their families. This can pose serious safety concerns on two sides of the spectrum. It can lead to errors and issues in patient care, and overall nurse burnout can drive more skilled nurses out of the profession.

According to the American Association of Colleges of Nursing, 13% of newly licensed RNs were working in a different career within 1 year of their licensing, and 37% indicated they were ready to change jobs. Lack of staffing, trouble with management, or salary issues aren’t the only things pushing nurses from the bedside. Significant, ongoing emotional stress is a key contributor that can often go ignored.

Defining the Issue

Multiple terms have been used to describe compassion fatigue, but in its simplest terms, compassion fatigue implies a state of psychic exhaustion where caregivers face a severe sense of malaise that results from caring for patients who are in distress over time. Charles Figley, PhD, a trauma therapist at the Figley Institute who is also affiliated with Tulane University School of Social Work in New Orleans, calls this phenomenon the “cost of caring” for others in emotional pain.

While all healthcare providers are subject to compassion fatigue, nurses are particularly vulnerable because they are inserted into the lives of others in an intimate way during a critical time in the individual’s life. They become partners instead of observers in a patient’s journey and are pulled into existential concerns of life, death, sadness, and loss.

In this regard, compassion fatigue could be considered an occupational hazard. Statistics Canada’s first ever National Survey of the Work and Health of Nurses (2005) found that “close to one-fifth of nurses reported that their mental health had made their workload difficult to handle during the previous month.” In the year before the survey, more than 50% of nurses said they had taken time off work because of a physical illness, and 10% had been away for mental health reasons.

Dennis Portnoy, a psychotherapist who specializes in professional burnout, compassion fatigue, and related topics, created a self-assessment tool that caregiving professionals can use to recognize attitudes and habits that perpetuate compassion fatigue. According to Portnoy, nurses who are experiencing compassion fatigue tend to identify very strongly with statements such as:

  • “People rely on me for support”
  • “When I make a mistake, I have difficulty forgiving myself”
  • “My achievements define my self-worth”
  • “I take work home frequently”
  • “I am willing to sacrifice my needs in order to please others”

Not to be confused with “burn out,” where a nurse may gradually withdraw and step away from his or her work, with compassion fatigue nurses may try even harder and give even more of themselves to patients in their care. Both scenarios can leave nurses feeling like they are running on empty, putting themselves, their co-workers, the public, and their patients at risk.

The Consequences of Compassion Fatigue

Nurses have a responsibility to themselves and their patients to ensure they are adequately supported to provide the highest quality and compassionate care possible. Facing multiple workplace stressors, coupled with the demands to respond to complicated patient needs as well as their home life, can negatively impact a nurse’s ability to cope with stress to the detriment of overall patient and nurse safety.

The consequences of such involved, caring work can lead to:

  • Inability to react sympathetically to a crisis or disaster because of overexposure to previous crises and disasters
  • Extreme states of tension and preoccupation with the suffering of those being helped to the degree that it can be traumatizing for the helper
  • Cynicism, emotional exhaustion, or self-centeredness in a healthcare professional who has been otherwise dedicated to his or her work and clients

This emotional exhaustion also can cause breakdowns in communication and build stress that leads to errors by the nurse, which pose safety risk and liability. According to the CNA and NSO Nurse 2015 Claim Report, allegations against nurses involving assessment and monitoring represent 15.7% and 13.8% of total claims, respectively. Compared with the previous data set, both allegation categories increased by 3.1% and 7.0%, respectively. Most of the assessment-related closed claims involved a failure to assess the need for medical intervention where the nurse failed to contact the treating practitioner for additional medical treatment. Over half the monitoring-related claims involved failure to monitor/report changes in the patient’s condition to the practitioner.

Compassion fatigue expert Francoise Mathieu writes that many factors outside of a nurse’s core care-giving work also contribute to the continuum of compassion fatigue. Current life circumstance, coping style and stressors at home from childcare or aging parent care all play a role. Some studies show that “helpers,” such as nurses, are more vulnerable to life changes such as divorce and difficulties such as addictions than people who do less stressful work. Workplace stressors such as managing paperwork, new technology, or organizational realignment can also play a role.

Although nurses are accountable for their individual practice, employers also have a responsibility to help identify and address sources of compassion fatigue in the workplace. Designing schedules and organizing work can be key strategies to help prevent the consequences of nurse fatigue, but early identification of compassion fatigue demands understanding and ongoing assessment. The Professional Quality of Life Scale (ProQOL) can help measure these symptoms and be used regularly to track changes over time, particularly when a nurse is trying prevention or intervention strategies.

Long-Term Solutions

Compassion fatigue and its negative impact on nurses, patient satisfaction, and safety is slowly becoming a better understood phenomenon in the nursing field. Acknowledging the severe emotional impact of a nurse’s obligation to routinely meet a patient’s immediate and comprehensive needs, nurses are in need of more specialized support resources to counter the impact. These can and should involve programming designed to educate nurses about the issue, resources to manage work/life balance, and efforts to design supportive and positive work settings.

Promoting self-care and other healthy rituals is important for preventing or recovering from compassion fatigue. Encourage nurses to participate in activities that can promote physical, emotional, and spiritual well-being. Nurses should also be encouraged to seek out support in the form of Employee Assistance Programs, caregiver or nursing support groups, or other forms of counseling and emotional support. Remember that self-care always includes adequate nutrition, hydration, sleep, and exercise.

The responsibility to solve for these risks relies with the healthcare industry as a whole, as well as management and nurses in the field to foster the environment and demand the resources necessary to overcome the issue.


This story was originally published by MedPage Today, a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals and provider of free CME.

Talking Turkey: What Nurses Do When Working on Thanksgiving

Talking Turkey: What Nurses Do When Working on Thanksgiving

Working on Thanksgiving can be great—extra pay and often a quiet day. But it can also make nurses wish they were home with their families.

We decided to ask nurses what they do to celebrate Thanksgiving when they do have to work. They told us what they do with their “work” families.

When Doria Musaga, RN, was working as a nurse, she said that the hospital would provide them with a free meal. But since it was, as she calls it, “the pressed turkey thing,” she adds that “it was dinner all the same and free.” She and her coworkers would often bring in more homemade foods to add to it.

“I have worked on the OB unit at two hospitals since I became a nurse. Usually, the hospital provides turkey for each nursing unit, and each staff member prepares a side dish to enjoy. Patients can choose to order a turkey dinner for their meal from food service. We give thanks for our healthy moms and babies. For the families being dismissed that day, we try to expedite the process so they can enjoy celebrating with extended family.”

—Lois Williams, RN, MN, RDMS

“I don’t work holidays any longer but my staff usually plan a feast with each one bringing some home-cooked part of the meal. The hospital usually provides a holiday meal, but rarely on the actual holiday–usually several days before.”

Lisa Fiorello RN, BSN, CCRN, RN-BC

“We would bring in pot luck snacks for Thanksgiving but we also scheduled shorter shifts to be home part of the day and rotated it year to year.”

—Janine McCowan, RN

“Everybody brings a dish in. We have a unit thanksgiving dinner during the shift.”

—Barbara Benzing Smith, RN

“You celebrate and give thanks with your work family as you would at home. Always be Thankful! Everyone brings a dish!”

—Cheryl Murad, RN

“At some places I worked, we would all bring a dish of food and have an open buffet so everyone to could get something on their break.”

—Theresa Zubrowski Woodson, RN

“I always had my own ‘Kristie’s (Christmas/Thanksgiving/Easter/etc.)’ with my family. At work, we always did a pot luck–usually it’s not quite as busy, and we could enjoy ourselves.”

—Kristie Davalli, CRNP

“We have pot lucks, and every one brings a dish to share.”

—Kristen Corkran, RN

“When I had to work Thanksgiving, my family would take sympathy on me, I never had to cook nor clean and had dinner waiting for me when I got home.”

—Estelle Schwarz, RN

5 Tips for Beating Holiday Burnout

5 Tips for Beating Holiday Burnout

Between work, fewer daylight hours, and the fast-approaching holiday season, it’s easy to experience burnout this time of year. If you’re feeling resentful, unfulfilled, exhausted, or bored of your job, these are your body’s warning signs that it’s time to make some changes—fast! Check out the following tips to reduce stress and beat holiday burnout.

1. Take inventory of your work-life balance.

Chances are good your work-life balance has gotten out of whack. When you’re home, are you able to disengage from work? Or, do you find yourself continually thinking about your job even when you’re not there? How’s your sleep, or your exercise regimen? If you’re overly focused on work and neglecting the activities that enhance your life, now is the time to reevaluate how you spend your time. Try shifting your attention to the things that increase your energy and sense of optimism, as opposed to drain or diminish them.

2. Immerse yourself in self-care.

As natural-born caregivers, it’s almost standard practice to put other people’s needs before your own. But if you want to beat burnout, it’s essential you incorporate a variety of strategies to help you unwind, relax, and rest each day. Maybe there’s a novel you’ve been excited to read? Or, perhaps you’ve been craving some time immersed in nature? Find whatever it is that de-stresses you and carve out some time for yourself. If need be, mark it on your calendar, and make these self-care activities non-negotiable. To combat burnout, you must continually recharge your mental, physical, and spiritual battery.

3. Set boundaries and stick to them.

This time of year, it’s almost a given that you’ll be tempted to overextend yourself in some way. But the more depleted you become, the closer you’re inching toward full-blown burnout. Set your boundaries for your work and home life and stick to them, even if you’re concerned you might be letting others down. Simply put, you can’t function well if you’re running on empty or ignoring the parameters you’ve set in place to revive you.

4. If you can take time off, consider doing it.    

Nursing is a 24/7 job, and patients’ health needs don’t stop just because the holidays are approaching. Knowing that others depend on you can create a sense of pressure that makes you feel like you can’t take time off. However, if you have the option to use some of your vacation time, consider doing it. Time away from work will help you feel less overwhelmed and more rejuvenated. Plus, you don’t need to travel if you don’t have the time or money; planning a short staycation might be just the thing you need to rest up.

5. Attend a continuing education class.

If you’re like me, your email inbox is flooded with a list of end-of-the-year sales for continuing education courses. There’s nothing quite like learning a new skill or deepening your understanding of an existing technique to re-invigorate your nursing practice and know that you’re helping your patients to the best of your abilities, and you’re combating burnout in the process!

3 Foam Roller Workouts to Reduce Back Pain

3 Foam Roller Workouts to Reduce Back Pain

Low back pain is a common complaint among many health care professionals. With long hours on your feet, repeated bending, and twisting, it’s no wonder your spine is aching at the end of the day. If you’re looking for a fast, safe way to get some relief, a foam roller might be just the tool you need to release the tight tissues of your body and ease your discomfort.

Plus, foam rollers are reasonably priced and can be found online or at most stores that sell sporting goods. Although they come in different shapes, densities, and sizes, a basic, high-density foam roller is a great place to start to learn some beginning techniques and learn what feels best to you.

Here, I’ve rounded up three videos that will show you how to use a foam roller to reduce or eliminate your back pain.


1. 15-Minute Foam Roller Tutorial for Low Back Pain Relief

In this 15-minute video by YogiApproved.com, the instructor guides you through a variety of exercises that release and mobilize the spine. Verbal cues are given to help deepen the sensation you may feel or to back off if a movement is too intense. What makes this video unique from others is that the instructor combines foundational yoga postures with the foam roller to target hard-to-reach muscles that become taut and contribute to low back pain.

2. 4 TOP Foam Roller Stretches for a Healthy Spine by Bozeman, MT Sports Medicine Specialist

If you’re pressed for time, this short video by Pro Chiropractic showcases four stretches, which will keep your spine healthy by improving mobility and flexibility. Foam rolling lengthens muscles, increases circulation, and delivers nutrients to restricted areas of your body, even when you only have a few minutes to spare. Since these stretches require a minimal time commitment, there’s no excuse not to give your back a little TLC!

3. How To Massage Away Lower Back Pain with Foam Rolling

In this video, foam roller DVD creator, Michaela Sirbu, leads you through a gentle session to remove trigger points and knots in the muscles that support the spine. These exercises are useful for both the novice foam roller user and the expert. A few words of caution when using a foam roller: You don’t need to induce pain to release the tight tissues in your body. Most likely, it took a while for the muscle tension to accumulate, so it’s going to take you a bit of time to dissolve it. Also, don’t hold your breath when performing the stretches. A steady breath will relax your body, reduce stress, and optimize the benefits of the foam roller.

Most U.S. Adults with Diabetes are Properly Diagnosed

Most U.S. Adults with Diabetes are Properly Diagnosed

This story was originally published by MedPage Today, a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals and provider of free CME.

The proportion of diabetes cases that go undiagnosed in the U.S. may be just 11%, much lower than previous, widely accepted estimates of one-quarter to one-third, a new study suggested.

The previous estimates were based on an analysis of national survey data that used only a single test to identify undiagnosed diabetes, but the new study used a second confirmatory test, as per guidelines from the American Diabetes Association (ADA), explained Elizabeth Selvin, PhD, of Johns Hopkins University in Baltimore, and colleagues.

The proportion of undiagnosed diabetes cases has also decreased over time, from 16% in 1988-1994 to the 11% figure in 2011-2014, they reported online in the Annals of Internal Medicine.

“Establishing the burden of undiagnosed diabetes is critical to monitoring public health efforts related to screening and diagnosis,” Selvin’s group wrote. “When a confirmatory definition is used, undiagnosed diabetes is a relatively small fraction of the total diabetes population; most U.S. adults with diabetes (about 90%) have received a diagnosis of the condition.”

“If we’re thinking about screening programs, these findings suggest that healthcare providers are doing a good job at diagnosing people when they’re coming in contact with the healthcare system,” Selvin said in a statement. “It’s those people who are not coming in contact with the healthcare system that need to be a focus of our efforts to ensure cases of diabetes are not missed.”

Selvin’s group analyzed the same data that was used for the previous estimates, which were published by the CDC: the National Health and Nutrition Examination Survey (NHANES) results for 1988-1994 and 1999-2014. The earlier data set included 7,385 U.S. adults, and the more recent set included 17,045.

The previous estimates relied on just one measurement of fasting plasma glucose, 2-hour glucose, or glycated hemoglobin (HbA1c) to identify undiagnosed diabetes. Selvin’s group defined undiagnosed diabetes as both elevated fasting glucose (≥7.0 mmol/L or ≥126 mg/dL) and an HbA1c of 6.5% or higher in people without a diagnosis of diabetes. Laboratory methods have changed since 1988, so the authors calibrated HbA1c values, and applied regression equations to the plasma glucose values, to take those changes into account.

The prevalence of total diabetes increased from 5.5% in 1988-1994 (9.7 million adults) to 10.8% in 2011-2014 (25.5 million adults), the study found. Confirmed undiagnosed diabetes also increased on an absolute scale, from 0.89% of the total study population in 1988-1994 to 1.17% in 2011-2014, but decreased as a proportion of total diabetes cases, the investigators said.

One of the strongest risk factors for undiagnosed diabetes was BMI. Individuals with a BMI of 30 or higher had more than seven times the risk compared to those with a BMI less than 25 (prevalence ratio 7.40; 95% CI 3.39-11.40).

Sex and race were also significant risk factors. Men were at higher risk than women (prevalence ratio 1.85, 95% CI 1.29-2.42). Compared with whites, Mexican Americans had more than three times the risk (PR 3.66, 95% CI 2.37-4.95), as did Asian Americans (PR 3.49, 95% CI 1.20-5.78). Blacks had more than twice the risk (PR 2.24, 95% CI 1.40-3.07), the investigators reported.

Individuals who lacked access to healthcare were also at greater risk. Not having had a recent healthcare visit (PR 2.43, 95% CI 1.61-3.26) and lack of health insurance (PR 1.63, 95% CI 1.02-2.25) were both significant risk factors for confirmed undiagnosed diabetes.

In an accompanying editorial, Anne Peters, MD, of the University of Southern California in Los Angeles, said, “Overall, these findings are encouraging. They show that there are not as many patients with undiagnosed diabetes as previously thought and that the proportion of cases is decreasing. However, diabetes is still going undiagnosed, particularly in persons who may not have regular access to healthcare or who have several risk factors. Thus, public health efforts to screen at-risk patients and help them receive care may be beneficial.”

The study underscores the importance of a second, confirmatory test to make a diagnosis in patients without symptoms, Peters added. “One test alone may be inaccurate, and making a diabetes diagnosis may have substantial implications for a patient. It may be psychologically distressing and affect a person’s eligibility for several types of insurance (including disability, long-term care, and life insurance policies).”

Peters pointed out some study limitations, including its cross-sectional design and the fact that fasting plasma glucose and HbA1c were measured from the same blood sample, not from separate samples drawn on different days, “which generally is the case during screening in a non-research setting,” she explained.

“Understanding the proportion of diabetes cases that are actually undiagnosed, and who those patient groups are, is really critical to allocation of public health resources,” the authors concluded. “Our results suggest that targeted screening in these populations and increasing health coverage could help make sure that persons who have diabetes receive a diagnosis and get the appropriate treatment that they need.”

The study was supported by the NIH.

Selvin disclosed no relevant relationships with industry. Co-authors disclosed relevant relationships with Abbott Diabetes Care, Becton Dickinson, Boehringer Ingelheim, Bristol-Myers Squibb/AstraZeneca,Calibra, Eli Lilly, Hygieia, Johnson & Johnson, Medtronic, Merck, Novo Nordisk, Roche, Sanofi, Takeda, Dexcom, the NIH, and the National Kidney Foundation.

Peters disclosed no relevant relationships with industry.

Educate Staff on How to Prevent Infection Transmission

Educate Staff on How to Prevent Infection Transmission

Healthcare personnel in the ambulatory care setting should be educated about how to best prevent the transmission of infectious agents, and infection prevention and control policies should be updated every 2 years, according to the American Academy of Pediatrics.

Writing in Pediatrics, an updated policy statement emphasized the importance of hand hygiene, as well as implementing specific isolation precautions when dealing with patients with specific highly infectious illnesses. The authors said that respiratory hygiene and cough etiquette strategies are necessary when handling patients with respiratory tract infections, such as cystic fibrosis. They further discussed the necessity of separating infected children from uninfected children, as well as proper disposal of all needles and medical devices and the appropriate use of personal protective equipment.

Finally, the authors addressed public health interventions, including that both patients and healthcare personnel should be up to date with their immunizations.


This story was originally published by MedPage Today, a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals and provider of free CME.