All nurses are at risk of experiencing negative personal experiences, during their careers from occupational factors. When we witness patient suffering, traumatic events, untimely deaths, or when errors occur that lead to patient harm; negative personal outcomes occur. Often the effects are short-term; however, with continued exposure or contact with traumatic circumstances, secondary traumatic stress/distress can develop. Once feelings emerge that include being overwhelmed with a fear of work and somatic complaints such as insomnia, aches/pain, anxiety, and depression, compassion fatigue (CF), is usually present.
CF is not simply feeling tired of work, nor is it burnout. CF is a combination of physical, emotional, and spiritual responses resulting from continued self-sacrifice. When nurses work towards optimizing the health and well-being of others, often their self-care is lacking. CF is noted when clinicians lose the ability to nurture others, as empathic fatigue is another way to think of CF. When nurses lose the desire and ability to care for others, there are personal consequences of inadequate performance which can lead to errors, decreased health physically, as well as psychosocially.
CF affects each person directly by impacting their well-being, familial relationships, and job satisfaction. On occasion, personal distress develops in which the nurse may choose to cope using unhealthy behaviors such as smoking, overeating, and self-medicating with alcohol or recreational drugs. Additionally, withdraw behaviors can occur, such as absenteeism, countertransference of negative reactions with incivility/bullying of peers, and lack of engagement at work, with family, and within their community. CF does not affect just the individual nurse; family, friends, patients, coworkers and institutions will experience negative outcomes and consequences as well.
CF is a significant issue for patient safety, and there are evidence-based practices that can decrease one’s risk. Personal self-care is necessary for coping and stress management to maintain the ability to care for one’s self, family, community, and patient/populations. Seeking work-life integration by meeting physical, emotional, and personal spiritual needs are not realistic at all times. Self-care in itself is limiting due to prioritizations with work and family. Integration of one's career with self-care along physical, emotional, and spiritual cultivation is necessary to promote one's well-being to facilitate empathic caring of others. As we are all reminded before flying, always put the mask on yourself first to best provide for those surrounding you.
Mindfulness-based practices have been found to be effective for both stress reduction and self-compassion. Prioritizing one’s time to work towards self-care is not being selfish, it is, in fact, foundational for personal growth and resilience. Mindfulness practices noted in nursing literature to improve and combat CF are Mindfulness-Based Stress Reduction, MBSR, and Mindful Self Compassion, MSC. Both have specific interventions that can be performed within five minutes of any part of one's day. A technique known as a body scan is when one takes a general survey of how one is physically feeling, usually sitting down. Begin at the toes and slowly move/scan up the body with thoughtful observation. Areas in the body are then discovered that are experiencing tension. When one is mindful of tension, relaxation exercises with breathing and gentle stretching can be beneficial. Loving-kindness meditations can be easily learned to extend from those we love and care for to include ourselves. Start with thoughts of those we love; I wish them peace, I wish them health, I wish them to live at ease, I wish them _____________. Then turn those exact thoughts to yourself, without any self-judgment; I wish myself peace, May I know health, May I live at ease, May I _____________. Talk to yourself as you would a dear friend.
Being Mindful can be stressful at first, noticing every time one is critical of one's self or one's negative self-talk can be enlightening. Self-care goes beyond diet and sleep; it includes gifting one's self with time to deep breathe, accepting one's limitations as not negative but with wisdom. Self-compassion, mindfulness, and meditations can be thought of as mental exercise, it takes time and is a skill set to learn. Acknowledging when work-related events/triggers create feelings of stress/distress responses should be encouraged to give nurses the opportunity to seek resources and supportive services.
The ability for personal timeouts such as quiet rooms/spaces, debriefing opportunities, and mentoring of novice nurses all have been showed to have a positive effect on preventing CF. Seeking support spiritually and emotionally is also recommended. There are many resources available to nurses; employee assistance programs are usually at no cost, meditation and light yoga practices online are too numerous to list, and wellness integration programs for stress reduction are also available including Cranio-Sacral therapy, Acupuncture, and massage. Mindfulness can be learned; please see the below noted references for more information. If we as nurses would only treat ourselves and each other the ways we treat our patients, more nurturing work environments would ensue. Let’s start to work together more proactively to promote this shift in our culture to incorporate self-care, interventions in times of stress/distress, and incorporating skills/resources all nursing staff can use to promote best possible patient care outcomes.
Bazarko, D., Cate, R. A., Azocar, F., & Kreitzer (2013). The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal of Workplace Behavioral Health, 28, 107-133. DOI: 10.1080/15555240.2013.779518
Boyle, D. A. (2015). Occupational stress in oncology nurse caregiving: Caring for ourselves. Clinical Journal of Oncology Nursing, 19(5), 499. doi: 10.1188/15.CJON.499
Figley, C. R. (1995). The transmission of trauma. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 248 -254). London: Brunner-Routledge.
Harris, C. & Griffin, M.T.Q. (2015). Nursing on empty: Compassion fatigue signs, symptoms, and system interventions. Journal of Christian Nursing, 32(2), 80-87. doi: 10.1097/CNJ.0000000000000155
Neff, K. & Germer, C. (2018). The mindful self-compassion workbook: A proven way to accept yourself, build inner strength, and thrive. New York: NY, The Guilford Press.
Potter, P., Deshields, T., Berger, J.A., Clarke, M., Olsen, S., & Chen, L. (2013). Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncology Nursing Forum, 40, 180-187. doi:10.1188/13.ONF.108-187
Regan, K.R. (2012). Basics of compassion fatigue.
Stamm, B.H. (2010). The concise ProQOL manual. (2nd ed.). Pocatello, ID: ProQOL.org
JoAnne Worthington, MSN, RN-BC, OCN is a registered nurse in the state of Ohio for over 20 years. Certified in both medical-surgical and oncology nursing. She is an adjunct faculty for Cincinnati State Technical and Community College for fundamental nursing students (ADN program). She is currently in her senior year of the DNP program at Mount St. Joseph University.