Why compassion fatigue plagues nurses and how to help: Q&A with Jefferson College of Nursing's Dr. Catie Harris

Catie Harris, PhD, RN, associate professor in the graduate programs at Philadelphia-based Jefferson College of Nursing, discusses compassion fatigue, an often-ignored phenomena among nurses and caregivers who are on the front lines of trauma.

Dr. Harris is also interim director of fellowship programs in advanced practice at Thomas Jefferson University in Philadelphia and founder of NursePreneurs, a mentoring platform that helps nurses become entrepreneurs.

According to Dr. Harris, if nurses do not acknowledge compassion fatigue and receive support, the effects can seep into patient care.

Question: What is compassion fatigue?

Dr. Catie Harris: Compassion fatigue, also known as secondary traumatic stress, is a real phenomenon that nurses or any caregivers can experience when they are exposed to the firsthand traumatic stories of others. Nurses are repeatedly exposed to stories of abuse, pain, injury and fear among other negative emotions. Without proper support and training, nurses who internalize these stories of trauma can be affected physically, emotionally, cognitively and behaviorally.

Healthcare providers have resisted the concept of compassion fatigue, as it historically represents a point of weakness or has been ridiculed as a character flaw. For example, if a nurse listens to the traumatic story of a patient and is affected by it, that nurse will frequently be dismissed by colleagues as being 'too involved' or not in control of her emotions. In response, healthcare providers learn to internalize and absorb the stories that are heard, which professionally is expressed as compassion fatigue.

Q: What are some of the telltale signs of compassion fatigue among nurses?

CH: Given the reluctance to accept compassion fatigue as a real phenomenon that all caregivers are at high risk to experience, it commonly manifests itself in various ways.

Nurse managers may find themselves dealing with staff nurses who are irritable, feel overwhelmed when small changes are needed on the unit, or senior nurses being sarcastic or highly critical of new nurses. Nurses themselves may feel a loss of hope, detached or even feel vulnerable to trauma. Poor coping with these feelings can lead to overeating, insomnia, denial of need for help or, even worse, turning to alcohol or drugs to numb the feelings.

Q: What are the effects of compassion fatigue on patient care?

CH: Clearly, a nurse who is irritable, overwhelmed or feeling detached can significantly impact patient care. A nurse suffering from compassion fatigue may come across as brusque, tired, or downright rude. The patient and the patient's family may lose confidence in the care being delivered if they perceive the nurse is overly tired or overwhelmed. The concerns may not be unfounded, as medications errors are more likely to occur when nurses are underperforming or dealing with high levels of stress.

The other major effect on patient care is the tendency for healthcare workers to blame the patient for the traumatic experience as a way of dealing with the stress of internalizing the narrative. This occurs frequently in patients who are victims of domestic abuse, prostitutes who come in with fractures, or heroin addicts who return to the hospital with complications. Nurses may avoid listening to the patient and blame the patient for their medical condition. This avoidance can deprive patients of the opportunity to access resources that could improve their lives and situations. For instance, if a nurse blames the patient for violence associated with prostitution, she may not recognize the distress signals a patient gives off that are common in sex trafficking cases.

Q: What can nurses do to mitigate compassion fatigue?

CH: The first step in mitigating compassion fatigue is recognizing it as a real condition that all caregivers are at high risk for. Listening to other people's trauma daily is a heavy experience and nurses need to recognize that this job takes a toll on them physically and mentally.

Suffering from compassion fatigue is not a personal flaw or evidence of character weakness.
Taking steps to reduce compassion fatigue is a professional responsibility. These steps can come in the form of a daily routine of self-care, relaxation, meditation, journaling or other creative expression. Many nurses report time out with friends or the ability to discuss their experience provides relief.

Creating personal boundaries is essential to helping nurses know when they are crossing the line and are at higher risk for experiencing symptoms of compassion fatigue. Don't share personal information that you prefer to keep private, don't allow people to hug or touch you if it makes you uncomfortable, or don't do favors for people because you feel like you must or you feel bad because someone is in a worse situation than you are.

Nurses need to care about themselves and take the necessary measures to make sure they are protecting their personal boundaries and engaging in self-care.

Q: What can organizations do to support nurses and prevent compassion fatigue?

CH: The culture of an organization comes from leadership. Prioritizing mental health and self-care for nurses is leading by example. Small changes could make a huge difference. For example, everyone needs a break. By encouraging nurses to take lunch off the unit, it reduces the probability of being interrupted by family, phone calls, pages, responding to alarms or other urgent situations that could easily be handled by a covering nurse.

Organizations can also create peaceful areas, like indoor or outdoor gardens or small quiet rooms for staff members to retreat to, provide access to mindfulness practices and offer support services for staff who need someone to talk to. Taking that a step further, counseling resources could be made a mandatory part of a nurses' job. Until there is no longer a stigma around caring too much, organizations need to be more aggressive in providing nurses access to help, because chances are it won't be utilized otherwise.

Compassion fatigue is a real phenomenon that affects nurses and all caregivers. Organizations and nurses have a professional responsibility to acknowledge and mitigate the effects of compassion fatigue, and it starts with awareness and acceptance of it. Compassion fatigue can be significantly reduced through self-care and small changes in the organization's expectations of the culture of each nursing unit.

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