Christina is ready to quit. She feels tired, numb, and cynical during every nursing shift; her coworkers and the high patient ratios at her hospital annoy her. At home, she’s overwhelmed by even small tasks on her To Do list, such as taking her car for an oil change or scheduling her dog’s vet appointment. And despite being surrounded by patients and nurses all day, she frequently feels depressed and isolated from others.
There’s a term for what Christina is experiencing: compassion fatigue. It can show up in different ways amongst healthcare workers, but the Merriam-Webster Dictionary defines it as “the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.”
And it’s reaching epidemic levels; one survey found that even before the pandemic, 54% of physicians felt they no longer had any compassion left to give, even after a restful weekend. Since the pandemic? In reviewing a number of studies, MDPI found “that the quality of life of health professionals was significantly affected by the COVID-19 pandemic. Specifically, burnout levels increased from medium–high to high and compassion fatigue went from medium to high.”
The Emotional Burden of Providing Care
Is compassion fatigue the same as burnout? British author and scientist Tim Jarvis draws an important distinction: “Unlike burnout, which is caused by everyday work stresses (dealing with insurance companies, making treatment choices), compassion fatigue results from taking on the emotional burden of a patient’s agony.” For this reason, compassion fatigue is sometimes called “secondary traumatic stress.”
“It’s tiring that we are always expected be a certain way when we show up,” says Jaclyn Tjipto, RN. “During my ICU days, whether you were preparing a patient’s body for the morgue or telling family members a patient isn’t going to make it, you were expected to act ‘straight,’ matter of fact and let it roll off, move on. Then we do not talk about the effects this can have on the medical professional’s mental health and well being. We can feel massive grief that we’re often not given space to express. There isn’t enough emphasis in society on teaching us to care for ourselves – and that’s where compassion fatigue grows.”
The ramifications of compassion fatigue can stretch beyond an individual provider to affect their coworkers, patients, and workplace. Reduced productivity, an increase in sick days, and higher turnover are all common in a workplace where staff feel emotionally detached and cognitively drained.
The Root of Compassion Fatigue
Compassion fatigue is not a character flaw. It’s a natural outcome of our current healthcare environment. Providers are perpetually asked to see more patients, do more documentation, and stay professional when dealing with angry or unappreciative families. They may take on extra shifts, miss out on family time, and live off microwaved burritos in the break room instead of nourishing meals. Staffing shortages can put pressure on them to prioritize hospital needs over their own mental health.
“In nursing, there’s a culture where you’re taught to put others first and I believe that it’s not the healthiest belief to embody,” says Tjipto. “Nurses and doctors are expected to be healers but often these ‘healers’ don’t know how to heal themselves. And there can be a culture in the medical field where burnout is almost ‘glorified’, such as people taking pride in skipping their lunch breaks – it becomes this competition of who can sacrifice the most.”
Signs and Symptoms of Compassion Fatigue
While a tough week can leave any physician or nurse feeling dissatisfied, compassion fatigue persists over time. It can manifest in some subtle ways, such as:
- Feeling drained by even minor demands
- Abusing food, drugs, or alcohol
- Workaholism
- Insomnia and nightmares
- Numbness and lack of joy
- Social isolation
- Digestive troubles and headaches
- A sense of hopelessness and despair
- Taking longer to recover from stressful patient encounters
- Neglecting or delaying life management tasks
- Physical and mental exhaustion
Nicole Streich, RN, shared her experience with compassion fatigue.
“At my facility, the friendlier/newer nurses were expected to always volunteer more and to always say yes – whether it was in the scope of practice or not,” she said of her past job in a NICU. “Doctors and supervisors would resent you if you said no to something, older nurses were resentful of the newer nurses because they were ‘brown-nosers,’ and the newer nurses resented being asked to do extra work.”
The result: “My resentment led to sleeplessness at home, irritability with family, and feeling alone and unsupported during shifts. The focus became trying to make my leadership happy and wasn’t on my patients. I began looking for ways to numb out – to not have to be responsible for anyone or anything for at least 8 hours a day.”
Minimizing Compassion Fatigue
If despair and exhaustion continue long enough, quitting – or even leaving the healthcare field entirely – can feel like the easiest solution. Before your compassion fatigue gets to that point, try these practices.
#1. Set boundaries.
Think about how much you can give at work – and then practice holding firm to those limits. “Setting boundaries is so important. One incredibly important boundary is to say NO,” says Streich. “I think we are conditioned to believe that we have to just do what we are told – but why? Is it because something needs to be done, and there’s nobody else who can do it? Sometimes that might be it, but sometimes it’s because we are the ones who routinely do what nobody else will do. Doctors get to say no, supervisors get to say no – and nurses do too.”
#2. Ask for help before you are in desperate need of it.
Whether you talk to a counselor, colleague, or support group, sharing your experiences can help you unload burdensome feelings instead of suffering in silence. Tjipto recommends peer support so you can talk to other frontline workers who understand your frustrations and can offer real-world advice.
#3. Control self-medication.
After working too many shifts with too many draining patient encounters, it can be tempting to try to numb your feelings. That might involve drinking too much, substance abuse, compulsive overeating, running up credit cards, or risky behaviors. Ultimately the relief is short-lived and the original problem is still there, with the addition of new problems.
#4. Learn how to recharge and nourish yourself.
There’s plenty of generic advice on how to recharge: spending quiet time alone, getting more sleep, or going for a walk. But as Tjipto points out, what matters is finding something that works for you. “It’s about understanding what your needs are,” she said. “Find out how to take care of yourself and what kind of things will replenish you. It may be tricky at first – patience is of the essence. Practice self-awareness and compassion instead of self-medication.”
#5. Feel your feelings.
Many frontline staff wind up becoming jaded – or feel they work in a culture that demands they stifle their emotions. “It’s normal to feel sad if our patients don’t make it,” Tjipto says. “It’s okay to cry, to feel your feelings – even if you need to go out in your car and scream. The human in you makes you a better caregiver when it’s allowed to be integrated.”
#6. Don’t take on others’ suffering.
“You can witness what patients are going through without taking it on. That’s a lesson for many nurses,” says Tjipto. “In the OR, when we weren’t allowed to leave, we would take a moment to meditate with a mint or candy, breathe deeply to our pelvic bowls, and refocus on being at home in our own body and experience.”
#7. Support each other as a team.
Providers tend to worry most about supporting patients – but their team members also need a helping hand. Healthcare leaders can build a more supportive culture by offering mentorship and holding debriefing sessions after stressful patient incidents. The idea is to help frontline staff process their feelings in the moment and feel appreciated by their leadership.
The Road to Compassion Satisfaction
As a healthcare professional, you probably gravitated toward your career out of an innate generosity of spirit. Your empathetic nature is a gift when it comes to patient care, but it can also lead down the road of compassion fatigue. Let us know what practices you use to renew your state of compassion satisfaction – and how the industry can do better in supporting its providers on the front line.
