When Nurses Catch Compassion Fatigue, Patients Suffer

An article from the Wall Street Journal that discusses compassion fatigue in nurses. I wrote about this syndrome and that of emotional burnout related to family members of those people with Borderline Personality Disorder (BPD).

When Nurses Catch Compassion Fatigue, Patients Suffer
By LAURA LANDRO

As a nurse in the cancer center at Barnes-Jewish Hospital in St. Louis, Wilhelmina Roney, 26, sometimes feels overwhelmed by demands from patients, even though she tries her best to care for them. During a rough week, patients may die in such quick succession that she barely has time to cope.

With the help of an innovative program offered by the hospital, Ms. Roney says she’s learned how to handle an occupational hazard she wasn’t prepared for: compassion fatigue.

The Barnes-Jewish program is one of a growing number of efforts by hospitals and nursing groups to help combat the constant assault on nurse’s psyches. In addition to meditation and stress-reduction workshops, such programs include discussions about difficult patient situations, support groups, and staff retreats focused on the emotional aspects of care giving.

Compassion fatigue is a combination of secondary traumatic stress from witnessing the suffering of others and burnout. It can lead nurses to feel sadness and despair that impair their health and well-being. Hospitals are tackling the problem amid a worsening shortage of nurses and concerns that patients may suffer. Compassion fatigue can reduce nurses’ empathy and lead them to dread or even avoid certain patients, raising the risk of substandard care.

Nurses who avoid patients “don’t form the relationship necessary to truly understand the patient, identify their problems early, and adapt therapies to their needs,” says Patricia Potter, a nurse researcher and director of research for patient-care services at Barnes-Jewish. Nurses can also become rude and cynical, which can discourage patients from asking them for help, she says, adding less observant nurses may be more error-prone.

Compassion fatigue has been linked to decreased productivity, more sick days and higher turnover among cancer-care providers. A 2008 study led by the University of Nevada, Reno’s nursing school found that about 12% of registered nurses in the U.S. weren’t working. Of those, more than 27% cited burnout or stressful work environments. High turnover and the subsequent increased workload on remaining nurses can result in higher death rates and reduced patient safety, studies show.

“Recognizing, managing and relieving these issues are critical for nurses and their employers,” as well as for patients, says Holly Carpenter, a senior staff specialist at the Center for Occupational and Environmental Health of the American Nurses Association in Silver Spring, Md.

Compassion fatigue was identified as a special problem for nurses in the early 1990s. The ANA’s Healthy Nurse program sponsored its first workshop on the issue at its annual conference last year, with another planned for this year, and it offers special resources on its website. The New York State Nurses Association conducted its first compassion-fatigue workshop at a hospital last year and is urging hospitals and nursing schools in the state to offer such programs.

Concerned about turnover in the oncology unit and evidence of stress among nurses, three Barnes-Jewish nurse managers approached Dr. Potter and the head of the hospital’s patient and family counseling program, Theresa Deshields, for help in 2009. The problem was especially acute for those caring daily for very ill patients whose survival was in doubt. The nurses seemed susceptible to emotional and physical stress and as a result, sometimes disengaged from their patients.

A survey of 150 staffers found that compassion-fatigue symptoms were high enough to warrant intervention.

The hospital turned to Eric Gentry, a Sarasota, Fla., psychotherapist who specializes in teaching stress-management techniques to disaster responders and emergency physicians. A pilot program he created for 14 nurses was promising enough for the hospital to fund development of the compassion fatigue course, now open to all staffers at the hospital, from physicians to housekeepers.

The course includes a checklist of symptoms to watch out for, and offers “antidotes” to compassion fatigue, such as creating a support network. Participants are taught the importance of focusing on “intentionality”—the caring intention that brought them to the health care field in the first place—while accepting their own limits in doing only the best they can on any given day.

The course also teaches physical, stress-relieving exercises. Dr. Gentry says that in anxious or stressful environments, people often react by keeping their bodies tightly clenched all day in anticipation of danger. Relaxing the pelvic floor—the area under and around the pelvis—has been shown to release tension and help control anxiety, he says.

“Being a caregiver is difficult and full of challenges, and that isn’t going to change,” says Dr. Potter. But nurses, she says, can be taught to “self-regulate their stress and restore the energy they need to provide the best patient care.”

Ms. Roney, the cancer-unit nurse, says she first learned about the course after asking a supervisor if there was any way to help with low morale on her unit, including her own. She found herself discouraged when patients or families weren’t satisfied with her care or had a negative outlook.

A particularly draining experience came when a patient in his 40s demanded to know how she felt about caring for cancer patients and if she liked her job. She said she loved it and tried to keep the conversation positive, but he declared, “Well, I’m dying,” despite a likelihood that treatment could extend his life.

“Trying to be compassionate with someone like that is much more difficult” than with some other patients who remain upbeat, even while undergoing chemotherapy, she says.

Jamie Bugg, a 32-year-old nurse at the oncology center, says some of the training felt awkward, such as a session in which participants team up and look into each other’s eyes silently for a minute, and then say positive things about what they observed about each other during the exercise.

Still, Ms. Bugg says she hopes all of her colleagues take the compassion-fatigue course.

“There is a daily toll when you see so many sad aspects of things and people at the end of life, knowing how sick they are and knowing this could be their last holiday,” she says. “We need better ways of coping than internalizing everything.”

Nursing’s Emotional Toll
Compassion fatigue, a combination of secondary traumatic stress and burnout from increasing demands of nursing, can include these symptoms:

Work Related

• Avoidance or dread of working with certain patients
• Reduced ability to feel empathy towards patients or families
• Frequent use of sick days
• Lack of joyfulness
• Physical
• Headaches
• Upset stomach, digestive problems
• Muscle tension
• Insomnia, too much sleep
• Fatigue
• Chest pain/pressure, palpitations, tachycardia (elevated heart rate)
• Emotional
• Mood swings
• Restlessness
• Irritability
• Oversensitivity
• Anxiety
• Excessive use of nicotine, alcohol, illicit drugs
• Depression
• Anger and resentment
• Loss of objectivity
• Memory issues
• Poor concentration, focus and judgment

Source: American Nurses Association