Managing Compassion Fatigue in Nursing

What is compassion fatigue in nursing?

Compassion fatigue is defined as “stress resulting from exposure to a traumatized individual.” It is a combination of stress and burnout that results in physical and mental exhaustion. This, in turn, inhibits one’s ability to provide the best possible care to others.

Compassion fatigue most commonly affects healthcare professionals that provide direct patient care — meaning that nurses are some of the most affected by compassion fatigue in the medical field.

Signs of Compassion Fatigue

Compassion fatigue, also sometimes referred to as vicarious or secondary traumatization, often comes on more quickly than burnout. Nurse burnout and compassion fatigue share some similar signs, including emotional and mental exhaustion, feeling isolated, and a sense of disconnect between one’s work and the goals or cause at hand.

However, compassion fatigue often includes more specific signs:

• Impairment of judgement and behavior
• A loss of hope, self-worth, and self-esteem
• A potential for PTSD and depression
• Negative impact on spiritual identity and worldview
• An overall decline in morale
• A decrease in cognitive function and ability
• Disturbances in sleep pattern

Why is compassion important in nursing?

Compassion in nursing is critical — research shows that when nurses show empathy and kindness, their patients actually heal faster. In other words, patient care that is delivered with compassion can accelerate the healing process and result in better outcomes for both patients and nurses.

Studies have shown that delivering patient care with kindness and empathy actually “calms patients, lowers blood pressure, and enables faster recuperation, reduced pain, and shorter hospital stays.”

But nurses suffering from compassion fatigue have limited kindness and empathy to infuse into their delivery of care. How can nurses prevent burnout? And, if they do lose empathy, how can they go about getting compassion fatigue treatment? And finally, what are ways to prevent compassion fatigue in the first place?

IMPLICATIONS FOR NURSING

The concept of CF is used in nursing practice as a negative response to repeated exposure of patients’ suffering.

• Compassion, empathetic ability, high use of self, and maintaining composure in stressful situations are reasons nurses are excellent caregivers. These variables make all nurses vulnerable to CF when stress is not managed, and professional boundaries are neglected.
• Nurses should not downplay their feelings for fear of appearing weak, as consistent stoicism can be a form of self-care neglect and improper stress management which can lead to CF development.
• Nurses enter the profession with a sense of pride, expecting to be valued by others as a provider of compassionate care, and to highly value the work they do because they made a difference.
• If those expectations and the tangible experience that follows are consistently misaligned, the sense of pride may dwindle to obscurity and cause nurses to question why they entered the profession.
• It can be difficult to recover from CF and nurses may leave the profession to escape their situation in a desperate attempt to cope with values conflict, as the compassion nurses once had for patients became null.
• The consequences of CF at the organization and system level are measurable, making these variables applicable to future larger scale quantitative studies on CF.
• The poor organization outcomes of increased turnover, worker’s compensation costs, lawsuits, and decreased reimbursements contribute to institution financial strain.
• Between nurses leaving the profession and financial implications for multiple organizations, the system would be impacted because this would worsen the nursing shortage and deplete monetary resources.
• Efforts to curtail CF should not rest solely on the shoulders of the nurse. Organizations should make efforts to spread awareness and destigmatize the concept of CF as every nurse has the potential to develop CF.
• Displaying value for nurses at the organizational level may be accomplished by cost-effective means, such as modification of words.
• Preceptors could be referred to as “mentors,” implying a deeper level of connection between coworkers. This could contribute to heightened personal and workplace morale.
• New employee packets should include a brochure of CF with a title in bold lettering stating “Compassion Fatigue: All Nurses Are Susceptible.” This would be attention grabbing and intrigue nurses to read forward.
• The brochure should include CF definitions, risk factors, manifestations, consequences, and resources available to employees.

Strategies for Prevention and Management:

1. Self-care: Prioritize physical and emotional well-being.
2. Peer support: Build strong relationships with colleagues.
3. Debriefing: Process traumatic events with team members.
4. Mindfulness: Practice stress-reducing techniques (e.g., meditation, yoga).
5. Time management: Prioritize tasks and manage workload.
6. Education: Stay updated on best practices and research.
7. Support systems: Lean on family, friends, and mentors.

REFERENCES

1. Peters E. Compassion fatigue in nursing: A concept analysis. Nurs Forum. 2018; 53: 466–480. https://doi.org/10.1111/nuf.12274
2. Zhang YY, Han WL, Qin W, Yin HX, Zhang CF, Kong C, Wang YL. Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis. J Nurs Manag. 2018 Oct;26(7):810-819. doi: 10.1111/jonm.12589. Epub 2018 Aug 20. PMID: 30129106.
3. Duarte J, Pinto-Gouveia J. The role of psychological factors in oncology nurses’ burnout and compassion fatigue symptoms. Eur J Oncol Nurs. 2017 Jun;28:114-121. doi: 10.1016/j.ejon.2017.04.002. Epub 2017 Apr 24. PMID: 28478848.
4. Coetzee SK, Klopper HC. Compassion fatigue within nursing practice: a concept analysis. Nurs Health Sci. 2010 Jun;12(2):235-43. doi: 10.1111/j.1442-2018.2010.00526.x. PMID: 20602697.
5. Sorenson C, Bolick B, Wright K, Hamilton R. Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. J Nurs Scholarsh. 2016 Sep;48(5):456-65. doi: 10.1111/jnu.12229. Epub 2016 Jun 28. PMID: 27351469.

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