Compassion Fatigue: Key Insights to Protect Nurses

Key takeaways:

Regular exposure to illness and trauma can ultimately take an emotional toll on a nurse’s ability to perform in a clinical setting.
Symptoms may include disengagement, lack of empathy, and a decrease in the quality of care provided. Nurses suffering from compassion fatigue may also experience physical symptoms.
Workplace interventions can be used effectively to address the emotional strain nurses are exposed to on a regular basis.

Detachment, apathy, anger, depression, exhaustion and ineffectiveness. Everyone feels these emotions at some point, but when these are the words used to describe how a nurse feels about her job, you know that nurse is experiencing compassion fatigue.

What makes nurses vulnerable to compassion fatigue?

Compassion fatigue can happen to anyone—and it can be unpredictable. Due to the inherently stressful nature of nursing, nurses are at higher risk of experiencing compassion fatigue than most other professionals.

It is in the nature of nurses to nurture and care for others. Some have even gone as far as to label nurses as “compassion warriors”. When the phenomenon of compassion fatigue first rose to attention, it was coined as the ‘loss of the ability to nurture’. Seeing as nursing and nurturing go hand-in-hand, compassion fatigue can have significant implications for a nurse’s ability to effectively perform their professional duties. So, what happens when overexposure to distress and anguish impacts a nurse’s ability to provide an appropriate level of compassionate care? For these reasons, it is crucial for clinical leaders to be able to identify the warning signs of compassion fatigue amongst their employees and protect their passion for the profession to the best of their ability. One study on the implications of compassion fatigue described the phenomenon in the following way:

“Many nurses talked about constantly feeling afraid for their loved ones’ health and safety. They stated that after seeing victims of bizarre accidents, acts of violence, and random deaths in healthy people, they felt powerless to protect those around them. The secondary traumatic stress experiences had such an impact on these nurses that it overshadowed their enjoyment and belief in the profession”¹.

So, what happens when overexposure to distress and anguish impacts a nurse’s ability to provide an appropriate level of compassionate care? For these reasons, it is essential for hospital administrators to know the warning signs of compassion fatigue in order to intervene and protect their nurses.

Symptoms of compassion fatigue may manifest as:

Disengagement
- Nurses attitude may change
- Their ability to connect with patients may be impacted as they detach from emotionally draining situations
They may experience somatic symptoms
- Insomnia
- Headaches
- Gastrointestinal issues
Clinicians may appear disconnected as they struggle to provide the same level of nurture and compassion to patients
There may be a decline in patient satisfaction or quality of care

Addressing compassion fatigue can increase employee retention as well as the patient welfare. Seeing as nurses must act not only as first-responders but also ‘sustained-responders’ who provide ongoing support throughout the course of care, it is difficult to predict when or where compassion fatigue may be triggered. However, as nurse leaders it is crucial to provide nurses with appropriate resources to help minimize the negative consequences of compassion fatigue. Leadership strategies ranging from support groups to on-site counseling to art therapy can all offer effective approaches to support and protect nurses from compassion fatigue.

One trait that can make some nurses more vulnerable to compassion fatigue is their ability to communicate effectively. Nurses who lack basic communication skills may struggle to communicate confidently with patients and their families which can place additional stress on the nurse. As nurses strive to nurture those they care for, challenges arising from their ability to communicate well with their patients may lead to lower levels of confidence and job satisfaction. Nurse leaders can use continued education to improve the following basic communication skills can significantly improve a nurse’s ability to connect with patients:

Identify personal coping strategies
Develop caring communication styles
Establish boundaries in relationships with patients and families
Understand family systems theory and identify family norms
Re-frame ‘difficult’ interactions with individual patients and families
Resolve interpersonal relationship problems in the work setting
Cope with ethical conflict and dilemmas
Utilize self-care strategies such as meditation and mindfulness²

Beyond continued education, workplace interventions can be used effectively to address the emotional pressure nurses find themselves under. Not only are on-site interventions used to combat compassion fatigue, but they have also been proven to reduce workplace conflict and turnover which can promote staff collaboration and increase professional satisfaction. The following five-step program, known as the Accelerated Recovery Program (ARP) has been credited as an effective approach for addressing fatigue:

Identify, understand, and develop a hierarchy of what triggers symptoms of compassion fatigue
Review present methods for addressing difficulties in practice
Develop caregiver plans for self-treatment
Identify resources for addressing compassion fatigue
Teach effective self-soothing
Teach grounding and containment skills
Enhance proficiency in self-care and boundary setting
Teach video-dialog techniques for internal conflict resolution and self-supervision
Facilitate development of self-administered, self-care planning²

Still, it is the responsibility of nurse leaders to identify which approaches best fit their organization. Additional strategies that have been used to address compassion fatigue include:

On-site counseling. For nurses experiencing compassion fatigue, having a counselor who is easily accessible can provide a proximate resource for those in need of someone to share their experiences with.
Support groups for staff. Peer support can be a great tool for nurses to address the emotional stress they are under with each other. Not only do support groups create an opportunity for staff to connect with one another, they can also strengthen relationships and promote collaboration which may help reduce the pressures fatigue.
De-briefing sessions. When dealing with especially difficult cases, informal debriefing sessions can be used as an opportunity to address the potentially traumatizing events nurses are exposed to on a regular basis. They can also help leaders connect with their teams as they offer support in challenging situations.
Bereavement interventions. Nurses can experience grief when they lose patients, they have formed a special bond with just like anyone else. One way in which leaders can offer support in times of grief is by encouraging nurses to send sympathy cards to a patient’s loved ones or attend a memorial service when appropriate.

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Compassion Fatigue: Key Insights to Protect Nurses

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