Compassion Fatigue: Curbing the Cost of Caring

Empathetic care is vital to building trusting relationships with patients. But this crucial nursing skill can lead to compassion fatigue, which sometimes exacts a high cost—taking its toll in stress-related symptoms, job dissatisfaction, reduced productivity, and job turnover. Fortunately, steps can be taken to help.

Definitions of compassion fatigue vary, but commonly include physical, emotional, and spiritual depletion caused by the continuing stress of caring for patients in significant emotional pain and physical distress. It was first identified among oncology and emergency department personnel, but nurses in any specialty can experience this secondary traumatic stress.

Compassion fatigue is similar to burnout. Both involve frustration, powerlessness, and low morale. However, burnout usually develops gradually and leads to indifference and withdrawal from patients and from the job. Compassion fatigue typically has a more acute onset and leads to over-involvement with patients in need.

Recognizing the Signs

Nurses and health care organizations can curb the cost of compassion fatigue. A mentor, manager, or counselor needs to intervene by performing an individualized assessment with targeted interventions.

The first step is to recognize the signs:

  • Work-related effects: frequent tardiness or absenteeism, avoiding certain patients, reduced job performance, and a desire to quit
  • Emotional effects: anger, anxiety, irritability, mood swings, lack of enthusiasm, feeling overwhelmed, and substance use
  • Intellectual effects: memory problems and reduced objectivity; poor concentration, judgment, and attention to detail
  • Physical effects: headaches, gastrointestinal problems, muscle tension, impaired sleep, fatigue, cardiac symptoms, and decreased stamina

Gathering data about the affected nurse is also important and should include information about: 

  • work setting and working conditions
  • over-involvement with patients and families
  • typical coping strategies and crisis management skills
  • usual activities for physical, mental, emotional, and spiritual self-replenishment
  • openness to new self-care skills

Interventions

If assessment reveals compassion fatigue, work with the affected nurse to develop personalized interventions. Consider suggesting these options:

  • Check workplace resources, such as an Employee Assistance Program, for counseling on personal and work-related issues. Besides helping to develop an action plan for compassion fatigue, the program may present classes on related topics, such as elderly parent care, effective communication, and stress management.
  • Find a nurse-mentor who knows your unit’s expectations and can help identify coping strategies, such as changing the work assignment or shift, reducing overtime, scheduling time off, or attending a conference.
  • Connect with the Pastoral Care Department to support spiritual needs and possibly promote reminiscence after a loss, lead memorial services, offer prayers, and provide individual and group spiritual counseling.
  • Nurture yourself to help achieve work-life balance. Develop regular self-care strategies for nutrition, hydration, sleep, and exercise. Try stress-reduction techniques, such as yoga or meditation. Or simply take a break in a calm environment.
  • Participate in debriefing sessions that can identify helpful approaches to pivotal events in clinical practice. 
  • Attend regular staff conferences to discuss aspects of challenging patient situations. Express concerns and feelings and work with others to address these concerns.
  • If appropriate, participate in a new nurse support group. These groups help new nurses transition to staff nursing and find appropriate resources within the organization.

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