As a nurse, you have likely experienced compassion fatigue. When you see the term, you know exactly what this is. However, the concept of compassion fatigue is often difficult to understand or know exactly how to manage. After all, “compassion” is what nurses do every day. We care for people who are often dealing with a difficult health crisis, pain, suffering, and even death. However, it’s important to understand the impact compassion fatigue can have over time, be aware of red flags that might indicate a problem, and learn healthy ways to manage the effects of compassion fatigue.
Compassion Fatigue Defined
Compassion is often defined as having empathy and a sense of awareness of another’s feelings. This is a powerful emotion that may manifest in many different ways for each person. Fatigue is more complicated to define. It is a sense of being exhausted and utterly tired, with a focus on physical symptoms rather than emotions.
With these two concepts combined, compassion fatigue represents a profound sense of emotional and physical exhaustion as a result of exposure to another person’s trauma or suffering. The result of prolonged exposure to this type of emotional and physical stress can lead to burnout and even more serious consequences.
The Connection with Stress and Burnout
Prolonged compassion fatigue often leads to additional concerns such as withdrawal, depression, and stress-related job burnout. (This is described in more detail in a new nursing CEU course from Wild Iris Medical Education titled Work-Related Stress: Preventing Burnout, Compassion Fatigue, and Vicarious Trauma.)
There are many interesting points to consider related to compassion fatigue, particularly the elements that may place nurses at risk for this common job-related hazard. Nurses innately care for others, and that involves experiencing emotions. That’s what true caring is. However, it’s crucial to have a sense of balance between one’s caring, empathy, and emotions and the proper self-regulation needed to protect oneself from being overcome by the stress of a patient’s suffering and pain.
Risk Factors and Red Flags
One of the first steps to balancing the emotions of empathy and caring with healthy behaviors is to develop insight into what may place you at risk for compassion fatigue.
Risk factors may be different for each person. However, here are a few to be aware of:
- Caring for patients with life-threatening trauma or illness (i.e., ED, ICU, oncology/hematology settings)
- Having patient-care assignments with high acuity
- Working long periods without time off to rest and recover
- Lacking resources for emotional support (both within and outside the work environment)
- Forming close personal relationships with a patient and/or family
- Having a baseline empathic personality (being sensitive, compassionate, and intuitive in nature)
Red flags to be aware of include:
- Withdrawing from showing any emotions with patients (detaching and having a flat affect)
- Feeling as if you can’t manage your emotions (crying, anger, sadness, depression)
- Misusing drugs or alcohol to manage emotions
- Feeling as if you can’t relax outside of work (thoughts are on work or your patient instead)
- Missing work or calling in sick more often than usual
- Feeling a sense of lack of control
- Having physical symptoms (fatigue and pain)
- Experiencing sleep problems
Compassion is often defined as having empathy and a sense of awareness of another’s feelings.
Steps to Take
Many people enter the field of nursing because they want to care for others in a meaningful way. This speaks to having a baseline empathetic personality. Therefore, most nurses are likely to have at least one or two of the risk factors.
Self-awareness and self-care measures can help balance the emotions of caring with healthy behaviors. This self-awareness might start with a few simple steps. Discover what works for you and learn healthy ways to manage the stress of caring for others.
- Check in with yourself often. Stop and consider whether your emotional connection with a patient might be going too far. Ask yourself if you are getting too close to your patient or their family. Set healthy boundaries to protect yourself, while at the same time providing compassionate care.
- Reach out to others. It’s okay to need help at times. Ask for a break if you feel that your assignment is pushing you to the brink of emotional stress. Take the time to debrief and express your feelings with colleagues after an especially difficult loss or traumatic event. Your coworkers and manager will often give you the extra support you need to get through these pain points. And don’t forget to be there for your nurse colleagues when you see them struggling as well.
- Take a break. Be honest with yourself and your coworkers about when you need a break. Take 10- to 15-minute stress breaks as often as possible during a long shift. Use stress and relaxation strategies that work for you – such as deep breathing, imagery, or music. Ask for time away or a modified shift assignment to ease the heavy patient care load if possible.
- Keep a journal. It can be very helpful to write down your feelings in a journal. This is especially true if you feel as if you are not able to “let go” of emotions when you are at home. Take time after your shift to reflect on your feelings. Remember to reflect on not just the difficult emotions, but also any positive or joyful feelings that you had throughout your day. The act of writing them down may help you to see that the feelings are real and help you process them instead of holding onto them.
- Reconnect with why you became a nurse. It’s often helpful to remember why you decided to be a nurse. This connection with your motivation will give you a deeper perspective and experience the joy (instead of the sadness or pain) that being a nurse brings you. If you feel that your job is no longer bringing you joy, you may want to explore another way to use your nursing skills. This could be a different work assignment, teaching or mentoring others, or working on a unit that has a different patient-care focus.
Compassion fatigue has been described as a deep bruise to the soul. I think that is one of the most accurate descriptions of how this type of stress can impact a nurse. Today more than ever, it’s important to take steps to have a healthy balance of emotions that include compassionate caring along with moments of joy and happiness in your work every day.
RESOURCES:
Apps
- Breathe
- Calm
- Cozi
- Insight Timer
- Way of Life
- Happify
- PathSource
Websites
Stress Management, American Holistic Nurses Association
https://www.ahna.org/Home/Resources/Stress-Management
REFERENCES:
American Institute of Stress. (n.d.) Compassion Fatigue. Retrieved from https://www.stress.org/military/for-practitionersleaders/compassion-fatigue
Gustafsson T & Hemberg J. (2021). Compassion fatigue as bruises in the soul: a qualitative study on nurses. Nursing ethics, 9697330211003215. Advance online publication. https://doi.org/10.1177/09697330211003215
Peters E. (2018). Compassion fatigue in nursing: a concept analysis. Nursing Forum, 53(4), 466–80. https://doi.org/10.1111/nuf.12274
Salmond E, Salmond S, Ames M, Kamienski M, & Holly, C. (2019). Experiences of compassion fatigue in direct care nurses: a qualitative systematic review. JBI database of systematic reviews and implementation reports, 17(5), 682–753. https://doi.org/10.11124/JBISRIR-2017-003818
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