Compassion Fatigue In Critical Care
BY ANNE MARIE STANLEY
“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet” (Remen, 1996)
According to the Bureau of Labor and Statistics’ Employment Projections 2014-2024, Registered Nursing is listed among the top occupations in terms of job growth through 2024, while also projecting the total number of job openings to rise to 1.09 million by 2024.1 With all this projected job growth in the field, how is it that so many nurses are experiencing workplace compassion fatigue and burnout and hospitals continue to have high turnover rates?
Both the physical and emotional impact that critical care nursing can have on nurses often goes overlooked until the mounting pressures result in negative consequences. In a critical care setting where death and dying are a daily occurrence, nurses are at risk for experiencing compassion fatigue.
High patient acuity, high-stakes decision-making, and minimal room for error all contribute to the problem, which is exacerbated by an ever-expanding workload.2 The increased responsibility and workload with minimal or decreasing resources create the perfect storm for nurses in these complex settings.
Compassion Fatigue: What is it?
Compassion fatigue is conceptualized as the combination of burnout, psychological and physiological responses to prolonged chronic emotional and interpersonal stressors, and secondary traumatic stress, which is the health care workers’ response to vicarious exposure to trauma arising from treating patients who have directly experienced traumatic or extremely stressful events.3 Known as the “cost of caring,” compassion fatigue can often lead to changes in the caregiver and their ability to feel empathy for their patients, loved ones, and co-workers.
Compassion fatigue can be felt by any healthcare professional; nurses, physicians, social workers, case managers, and patient care technicians to name a few. Most often individuals report:
increased cynicism at work
loss of enjoyment in their career
low job satisfaction, which can culminate in depression
Notable Signs and Symptoms of Compassion Fatigue
While the signs and symptoms vary for each individual, here are a few of the most common notable signs and symptoms of compassion fatigue that health care professionals can exhibit4:
Reduced ability to feel sympathy and empathy
Anger and irritability
Increased use of alcohol and drugs
Dread of working with certain clients/patients
Diminished sense of enjoyment of career
Disruption to world view, Heightened anxiety or irrational fears
Intrusive imagery or dissociation
Hypersensitivity or Insensitivity to emotional material
Difficulty separating work life from personal life
Absenteeism – missing work, taking many sick days
Impaired ability to make decisions and care for clients/patients
Problems with intimacy and in personal relationships
An individual’s personal life circumstances, personality traits, and known coping methods all play a role in how compassion fatigue may affect them. Knowing these things about yourself can help to recognize the complexity at which compassion fatigue is affecting both your personal and professional life, as well as, help to identify prevention techniques.
Preventing Compassion Fatigue
Early intervention in identifying specific signs and symptoms can help to prevent the snowballing effect that can take place with compassion fatigue. Creating a supportive work environment to allow discussion and recognition among colleagues can ultimately help to “normalize” feelings you may be experiencing.
Many hospitals have constructed debriefing committees which are used after difficult cases, to talk through the emotions that may have been felt while caring for a specific patient. Additionally, regular scheduled breaks, changing difficult assignments after multiple shifts (continuity of care is not always best practice), leaving the unit for meal times, and peer support are all excellent tools that aid in the prevention of compassion fatigue.
Rosseter, Robert. “Fact Sheet: Nursing Shortage.” American Association of Colleges of Nursing, vol. 22, no. 1, 2017.
2 Larson, Jennifer. “Warning Signs of Nurse Burnout in Critical Care.” American Mobile – Travel Nursing Blog, 2015, www.americanmobile.com/warning-signs-of-nurse-burnout-in-critical-care/
3 Kelly, L. A. (2017). Effect of Meaningful Recognition on Critical Care Nurses’ Compassion Fatigue. Retrieved from http://ajcc.aacnjournals.org/content/26/6/438.full?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Am_J_Crit_Care_TrendMD_0
4 Mathieu, F., M.Ed. (2007). Running on Empty: Compassion Fatigue in Health Professionals. Rehab & Community Care Medicine. Retrieved from http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf