Magazine article American Nurse Today

Compassion Fatigue: Are You at Risk?

Magazine article American Nurse Today

Compassion Fatigue: Are You at Risk?

Article excerpt

The author discusses the causes, symptoms, and interventions for compassion fatigue and burnout.

FOR MANY OF US, nursing isn't just what we do; it's who we are. Most of us became nurses because we care about people and want to make a difference in their lives.

Over time, nurses develop a nursing intuition and a working knowledge of disease and trauma. Our intuition, knowledge, and caring don't automatically shut off when we leave work. For example, have you ever seen a worrisome mole on a complete stranger? Have you felt concern about a friend's weight or a neighbor's smoking habits? Have you ever been in a public place when you heard someone coughing--and wondered at what point you might intervene? These experiences are common among nurses. Yet, inability to shut off our knowledge and caring may leave us feeling emotionally saturated and raise our risk for compassion fatigue.

Ideally, as nurses, we should feel satisfied with our work and derive satisfaction from providing excellent care. Compassion fatigue has been defined as loss of satisfaction that comes from doing one's job well, or job-related distress that outweighs job satisfaction. Sometimes, merely being exposed to another's traumatic experience leaves us feeling emotionally distraught. Called secondary traumatic stress, this is a part of compassion fatigue. As our sense of job satisfaction decreases, we may feel more burnout. A reaction to our work environment, burnout can stem from such conditions as short-staffing, long work hours, workplace incivility, and feeling dismissed or invalidated. (See Research on compassion fatigue.)

Who gets compassion fatigue?

Compassion fatigue can happen to any nurse--and it can be unpredictable. We know that nurses who work in oncology or see more patient deaths may be at greater risk. Also, when we form close, caring relationships with patients (especially if we lose our personal boundaries), we may be putting ourselves at higher risk.

Sometimes a particular patient or a patient's family member may remind us of someone important in our lives. If that patient or family member has died, we may be triggered emotionally. Many nurses I interviewed in my research described being triggered unexpectedly and profoundly by a smell (caring for a child with second- and third-degree burns over 50% of his body), a sound (a mother screaming with grief when told her 3-year-old child had coded and died), or a sight (a dog on the hospital bed with his head across his master's chest). Nurses who skip breaks, take extra shifts, or come in on their days off out of a sense of duty may be more at risk for compassion fatigue. One of the greatest risks for compassion fatigue comes when nurses forgo their own self-care.

What does compassion fatigue feel like?

In many cases, the first symptoms are emotional. Nurses talk about feeling bored with their work or feeling detached and distant from patients and colleagues. They may realize they're irritable and short-tempered. They may feel they've failed to relieve a patient's pain or to help a patient get well, losing their sense of pride in being a nurse.

Frequently, nurses with compassion fatigue talk about sleepless nights as they worry about what they forgot to do at work or replay disturbing events in their minds. They may be forgetful at work, in school, or at home. As compassion fatigue progresses, physical symptoms typically arise. Most nurses describe feeling physically and mentally exhausted, and many report headaches or backaches. Frequently, I hear nurses say they feel queasy just driving to work, and those feelings intensify as they walk in the door.

What happens to nurses who don't deal with compassion fatigue symptoms? First, their work performance changes; for example, they may be at risk for medication errors. Without realizing why, they may start to call in sick more frequently. They may be short-tempered, sarcastic, or rude to colleagues and even to patients or families. …

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