Watching For and Overcoming Compassion Fatigue


By Debra Wood, RN, contributor

Most nurses enter the field due to strong desire to mitigate people’s suffering, but too much caring, especially when confronted with legions of victims of a disaster or patients with grave illnesses, can result in compassion fatigue.

“We want to do good and help people deal with illness, and it’s not hard to over do and not take care of yourself,” said Joan Monaghan, MSN, RN, APNC, coordinator of psychosocial support services at the Cancer Center at Hackensack University Medical Center. “When you are empty, your amount of compassion is limited.”

Compassion fatigue refers to a type of burnout, but differs from dissatisfaction with the job or frustration with the system in that it directly relates to caring.

“A lot of health-care providers have a big heart and are energy sponges,” said Judith Orloff, MD, an assistant clinical professor of psychiatry at the University of California, Los Angeles and author of the book Positive Energy: 10 Extraordinary Prescriptions for Transforming Fatigue, Stress & Fear into Vibrance, Strength & Love. “When they listen to somebody, they tend take on that energy in their own bodies and become exhausted by it.”

Orloff calls this intuitive empathy. Such people feel other’s pain and are overly sensitive.

Those suffering from compassion fatigue may feel chronically tired and irritable; dread going to work or walking into a patient’s room; not find joy in life; feel trapped; drink more alcohol or overeat; or experience an aggravation of existing physical ailments, such as headaches or fibromyalgia.

“A lot of caregivers have an inbuilt grandiosity that it cannot affect them,” said Robert W. Guynn, MD, chairman of the Department of Psychiatry and Behavioral Science at the University of Texas-Houston Medical School.

Nurses working in emergency departments, on oncology units, in hospice programs, and on disaster-relief efforts are at special risk, because of the trauma, death and seeming endless needs of patients.

“One way of protecting yourself is to be distant and cold, and that’s not ideal,” Guynn said. “A better way is to recognize one is vulnerable. A lot of caregivers—nurses and doctors—tend to hold in their emotions and not reach out to others.”

Yet, talking with someone you trust can bring relief. Monaghan frequently provides “hallway therapy,” stopping by a unit and listening to and supporting staff nurses. Just releasing their feelings to an experienced professional, without management responsibilities, can help put things into perspective.

Mercy Medical Center in Baltimore has added extra layers of assistance to help nurses cope with the emotional demands of the job. For instance, Monica Nelson, RN, BSN, coordinator for the Center for Nursing Excellence, listens and helps nurses adjust to work-life issues.

In difficult situations at work, Orloff recommends taking a three-minute meditation. The nurse goes off to a private space and focuses on something pleasant and breathing deeply, bringing energy to the center again.

Orloff also advises nurses to set boundaries. With a drama-queen patient, limit time in the room. The quality of the interaction is more important than the amount of time spent.

Caregivers at major disasters may benefit from debriefings with mental-health counselors. Recognize your own limitations—you cannot save everyone and cannot work nonstop.

To truly overcome compassion fatigue, nurses must learn to care for themselves. That may mean taking time to read, jog, listen to music or eliminate some commitments. Monaghan said nurses frequently look at themselves as super people, able to juggle multiple family and work obligations. But their self-expectations exceed reality.

“To break the cycle, nurses have to learn how to replenish their energy during their day and in their personal life and not continue that giving cycle,” Orloff said.

Orloff also recommends limiting time watching the news, which bombards people with negative energy. Turn on a funny movie instead or go for a walk. Do something to replenish your energy and spirit.

Very few nurses with compassion fatigue require professional mental-health care, although it often is available through employee assistance programs. Most of the techniques to avoid and deal with compassion fatigue are common sense and represent the same type of advice nurses always give others.

“Having fun is really important,” Orloff advised. “It’s not all about the seriousness of the human condition. Balance everything. Otherwise compassion burnout happens.”

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