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.
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.