Magazine article American Nurse Today

Tired of Caring? You May Have Compassion Fatigue

Magazine article American Nurse Today

Tired of Caring? You May Have Compassion Fatigue

Article excerpt

Do you have trouble remembering what drew you to nursing? Do you take alternative paths through the unit to avoid running into a patient's family members? Do your colleagues get on your last nerve? Are you ashamed of how you've started to feel about your patients, coworkers, family--and the world?

Discontentment is a normal part of the human experience. But if you're overwhelmed by negativity and getting little to no enjoyment from your life or career, you may be suffering from compassion fatigue--and you need to pay attention to those symptoms now. (See Why nurses are at high risk.)

A persistent problem

In 1992, Carla Joinson coined the term compassion fatigue to describe an emotionally devastating form of burnout experienced by many in caregiving professions--from physicians and nurses to social workers, first responders, and 911 operators.

More than 20 years later, the condition has been heavily researched but continues to affect many nurses. A 2009 review of 57 studies of compassion fatigue conducted between 1992 and 2006 found that while often confused with burnout, the phenomenon takes a real toll on caregivers, patients, and other healthcare workers.

Is it compassion fatigue or job burnout?

Compassion fatigue usually occurs when nurses form such close interpersonal relationships with suffering patients that the nurse-patient boundary becomes blurred.

The nurse may unconsciously internalize the distress being experienced by one or more patients. The onset of compassion fatigue may be sudden (for instance, with the death of a single patient with whom the bond was very strong) or may arise gradually after cumulative losses.

Burnout, on the other hand, typically stems from ongoing workplace conflicts. Such conflicts can take the form of horizontal hostility between nurses, conflicts with nurse supervisors, unmanageable time demands and patient loads, dissatisfaction over making less money than other healthcare practitioners, and more. Ultimately, burnout is about career and job dissatisfaction, whereas compassion fatigue centers around the nurse's inability to establish personal boundaries against the heartbreaking realities of the nursing profession.

But for many nurses, compassion fatigue and burnout go hand in hand. A 2010 study of emergency department nurses found that roughly 82% had moderate to high levels of burnout and nearly 86% had moderate to high levels of compassion fatigue.

Symptoms of compassion fatigue

Nurses suffering from compassion fatigue often bottle up their emotions rather than talk about them. Over time, this can lead to mental and physical exhaustion, apathy, sadness, loss of enjoyment from activities once found pleasurable, and other symptoms similar to those of posttraumatic stress syndrome. Symptoms may begin to show up as physical and behavioral changes, including the tendency to:

* blame others for one's problems

* be overly negative

* self-medicate with drugs or alcohol to mask emotions

* isolate oneself from coworkers, friends, and family

* engage in compulsive behaviors (such as overspending, overeating, gambling, and sex addiction)

* experience nightmares and flashbacks

* neglect personal appearance and hygiene.

In some nurses, compassion fatigue may self-correct or occur intermittently. For others, it can lead to performance referrals for excessive absenteeism, tardiness, negative feedback as a result of poor performance or attitude, or mistakes due to inattention or distraction. If compassion fatigue isn't addressed early, it can permanently alter a caregiver's ability to provide compassionate care. Unfortunately, because of many nurses' reluctance to even acknowledge they need help, they may wait until a crisis occurs to confront the problem.

Addressing compassion fatigue

Nurses who try to address their compassion fatigue by "caring less" about what happens to their patients may end up with less favorable patient outcomes and reduced career satisfaction. …

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