COMMENTARY

Caring Too Much: Compassion Fatigue in Nursing

Marilyn W. Edmunds, PhD, CRNP

Disclosures

November 15, 2010

Compassion Fatigue in Nurses

Yoder EA
Appl Nurs Res. 2010;23:191-197

Study Summary

Traumatic events leave indelible marks on those who are touched by them. Those who care for or help individuals who are working through a traumatic event can also experience stress. Compassion fatigue is the term used to describe the emotional effect of being indirectly traumatized by helping someone who has experienced primary traumatic stress. To date, compassion fatigue has been studied primarily in nonnursing groups.

When watching a patient go through a devastating illness or trauma, the nurse may react by turning off his or her own feelings, or by experiencing helplessness and anger. Many nurses find themselves repeatedly on the margin of a traumatic event in the course of patient care.

Compassion fatigue may occur in situations when an individual cannot be rescued or saved from harm, and may result in the nurse feeling guilt or distress. Hospice nurses; nurses caring for children with chronic illnesses; and personal triggers, such as overinvolvement, unrealistic self-expectations, personal commitments, and personal crises, are linked to compassion fatigue.

Compassion fatigue is often linked to burnout, a related but different concept in which the nurse experiences slowly developing frustration, a loss of control, and generally low morale.

The purpose of this study was to describe the prevalence of compassion fatigue among a broad spectrum of nurses and to investigate the situations that lead to compassion fatigue and nurses' methods of coping.

A questionnaire with cover letter was placed in the hospital mailboxes of registered nurses in selected units of a Midwestern hospital. The convenience sample yielded a 60% return rate (n = 106) with 71 complete responses to both the quantitative and qualitative components of the survey. In addition to demographic information, the Professional Qualify of Life Scale, which includes a compassion fatigue test, and scales for compassion fatigue, burnout, and compassion satisfaction were included. Two questions requiring a narrative response provided data for the qualitative part of the study. The participants were asked to describe a situation during which they experienced either compassion fatigue or burnout and what strategies they used to deal with the situation, or how they got through the experience.

The burnout and compassion fatigue/secondary trauma scales correlated, suggesting that they measure overlapping phenomena. Compassion fatigue/secondary trauma was significantly higher in nurses who worked 8-hour shifts compared with nurses who worked 12-hour shifts. Compassion satisfaction was significantly higher in intensive care unit nurses than in emergency department nurses. Nurses with the least experience reported significantly higher rates of compassion satisfaction than the more experienced nurses. Compassion satisfaction was strongly negatively correlated with numerous items on the compassion fatigue/secondary trauma and burnout subscales. Nurses who had higher compassion satisfaction scores were more interpersonally "fulfilled," as defined by scores on "being happy," "being me," and "being connected to others." These nurses did not feel as trapped and did not experience difficulty separating personal life and work. They were less likely to feel exhausted, bogged down, or "on the edge."

Compassion fatigue was often triggered by patient care situations in which nurses:

  • Believed that their actions would "not make a difference" or "never seemed to be enough";

  • Experienced problems with the system (high patient census, heavy patient assignments, high acuity, overtime, and extra workdays);

  • Had personal issues, such as inexperience or inadequate energy;

  • Identified with the patients; or

  • Overlooked serious patient symptoms.

Coping strategies included making a change in personal engagement with the patient or the situation -- ignoring, disengaging; or changing the nature of their work involvement (leaving an organization, leaving nursing, transferring to other nursing units, changing from full-time to part-time hours, and changing shifts). Taking extra days off or taking a break from a patient were helpful short-term strategies. Nurses also requested help from other nurses or used informal debriefing to help them cope with stressful situations. Some nurses developed personal coping strategies to manage non-work-related stresses in their lives, such as praying, focusing on activities and relationships outside of work, and introspection.

This study found that some nurses were at high risk for compassion fatigue. Nurses were aware of the stress under which they worked, and some had articulated strategies for coping with it. Yoder suggested that nurses need to be given opportunities to recognize and talk about their stress and to make plans as individuals for how to cope with it.

Viewpoint

Caring is one of the foundational tenets of nursing. When nurses cannot care for patients at the therapeutic level, they will be ineffective. However, caring too much is a major risk for nurses.

Compassionate nurses are an essential and dwindling resource in today's healthcare system. The growing nursing shortage mandates that the nurses who remain must also be supported and cared for.

Although it is easy to say that nurses should be given the opportunity to recognize and talk about the stress that they experience, and to make plans for coping, these are challenging tasks. Trauma research indicates that people involved in traumatic events need to be able to "tell their story" 8 or 9 times to defuse the physiologic and psychological impact of what they have been through. Providing opportunities for nurses to get together to talk and support each other is common sense. As laypeople, we support and care for each other during stressful times. Somehow, we have to provide that same sort of commonsense therapy for healthcare professionals. Once people share what they are feeling, then strategies can be developed to cope with those feelings. However, in busy hospitals and clinics, it will be a challenge to find the time to provide these experiences.

Nurses don't have a monopoly on compassion fatigue. Other studies have demonstrated that psychiatrists, in particular, have high rates of suicide, severe depression, and general compassion fatigue. All healthcare providers need to find methods of mutual support for the anger, frustration, and helplessness that they experience at work.

Abstract

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