Compassion Fatigue

Working in an emergency department can be extremely stressful for nurses. Seeing a high volume of patients with potentially high acuity shift after shift exposes nurses to stress and puts them at risk for compassion fatigue. Having worked as a registered nurse in a Level II trauma center, I have witnessed first-hand the amount of stress that takes a toll on nurses. “Nurses who provide care to traumatized individuals can have intense and painful emotional responses” (Schmidt & Haglund, 2017). As time goes on, this stress has the potential of turning into compassion fatigue.

I believe it would be beneficial to train staff and implement a coping skill in order to address this problem of compassion fatigue.

Compassion fatigue is defined as a very tense feeling that is experienced to those who are in a constant stressful environment. The three major components of compassion fatigue are burnout, secondary traumatic stress, and compassion satisfaction. Burnout is defined as the experience of perceived demands that outweigh the perceived resources. Secondary traumatic stress includes feelings of despair, anxiety, sleeplessness, complaining, lack of satisfaction with job, nausea, or depression. Compassion satisfaction is the joy that nurses receive from taking care of patients in their time of need. When compassion fatigue occurs, there is a lack of this compassion satisfaction. When providing care to a traumatized patient, nurses can have intense and painful emotions as a response. Compassion fatigue can result from this if nurses do not recognize these feelings and take action (Schmidt & Haglund, 2017).

According to McDermid, Mannix, and Peters, up to 80% of nurses in emergency departments experience moderate to high levels of compassion fatigue (2019). Observance of coworkers within my department, I have noticed an increase amount of burnt out nurses. I see the lack of caring and compassion that they show for patients. These nurses who present with compassion fatigue have numbed themselves with the stress of the emergency department. They do not enjoy their job anymore. They are the ones who complain and are not satisfied with their career anymore.

A cross sectional study by McDermid, Mannix, and Peters, determined that moderate to severe levels of compassion fatigue negatively impact nursing job satisfaction and ultimately, patient outcomes (2019). While there are multiple ways to cope with compassion fatigue. I would like to focus on debriefing. “Debrief is one method that has been shown to decrease professional stress and improve concentration, morale, and work engagement” (Schmidt, & Haglund, 2017). Debrief was originally used in the military, with a goal to improve learning performance. In healthcare, debriefing is a nonthreatening, low-cost way to discuss unanticipated outcomes. It can help identify opportunities for improvement, and to heal as a group (Schmidt, & Haglund, 2017). It is important to reduce the stress experienced by the emergency staff by implementing strategies for the management of traumatic events. Introducing debriefing strategies can help in this implementation

With potentially 80% of emergency room nurses experiencing moderate to severe compassion fatigue, being aware of the risks can help nurses make a conscious effort in prioritizing and engaging in activities that can help alleviate the stress and renew their energy (McDermid, Mannix, & Peters, 2019). A descriptive survey took the opinions of 150 emergency nurses and doctors in a study for debriefing after stressful events. After describing what they perceived to be the purpose of debriefing, 94% of the participants said it can provide staff with emotional or psychological support. 43% said it can help staff improve or review clinical practice and 18% said it can foster team spirit (Healy & Tyrrell, 2013).

Many areas can contribute to compassion fatigue. Assessment of the organization identifies risk factors can vary due to different patient care interactions, different patient ratios, and different role-related stresses are present for emergency staff. Some external stressors that may relate to compassion fatigue include overcrowding, pressure to improve flow and increase throughput, patient satisfaction, fiscal goals of the organization, and experiencing critical incidents. These stressors put emergency nurses at a high risk for developing compassion fatigue.

The proposed solution that I would implement is debriefing. The goal to debriefing for nurses is to reach resilience. Resilience is defined as the ability to positively adjust to difficult times and to cope successfully despite adversity (Schmidt, & Haglund, 2017). As a team, I would like to form a support group that can participate in debriefing to gain resilience. This group would come together monthly to meet with the all emergency staff for education and reflection. The group would consist of the department manager, a social worker skilled in trauma, and the nursing staff members. All staff members are welcome to join, such as doctors, physician assistants, patient care assistants, and potentially students. Debriefing would be carried out in the department through meetings could be held for an hour each month, for group education and reflection as well as shorter sessions following traumatic events.

My most valuable resource was an article called, “Debrief in Emergency Departments to Improve Compassion Fatigue and Promote Resiliency.” The article included narrative from a nurse who suffered from compassion fatigue. It was during a debrief session she began to realize what was happening to her. She states, “…I became better at talking about my feelings and being a better caregiver because I understood myself better and had the support of colleagues.” (Schmidt, & Haglund, 2017). In the context, the nurse’s reflection and social support may provide her with protection in the future against compassion fatigue due to adverse events. This intervention of debriefing can give nurses the tools to protect themselves from stressful workplace events. This will result in less burnout, less turnover, and an increase in job satisfaction. (Schmidt, & Haglund, 2017).

Resources to include are many roles already used in the organization; but brought together for a specific purpose. I would begin by proposing the idea to the administration and project management team. The project management team can help turn the idea into a new practice. Social workers and pastoral care representatives would be available for education and grief processing, but at little additional cost to the organization. Meetings would be held on-site with convenient access for emergency staff. No costs associated with the procurement of meeting space. Communication with staff could be email or text, as well as posted training and information boards. The debriefing meeting would take place once a month with staff well notified ahead of time via email. 

The meeting would be an hour length of time, with fifteen-minute incremental focused times so staff with assignments can rotate through, preferably at a time when census is low. Moderate costs for training materials such as fliers estimated at less than $50.00 per month. Additional training for meeting coordinators, nurse leaders and charge nurses could be scheduled within established education software with no increase cost. Fees associated with the proposed solution are minimal. Having debriefing sessions and opportunities will help the emergency staff improve their coping skills and protect their mental health. When a nurse becomes burnt out due to compassion fatigue, it is more expensive to fill their space when they are out of work. Preventing compassion fatigue also helps nurses decrease their chances of error and improves patient outcomes.

I would estimate a debriefing project could take about 3 to 4 months to get started. Once approved, the first month would include the proposal to staff at the monthly staff meeting. Social workers and pastoral services would be introduced and the debrief protocol would be outlined for staff. I would also include the project management team and leave the option for staff to volunteer to help with the project. The second month the project management team with the aid of volunteer staff members would set the schedule for the debriefing meetings and determine setting meeting plans. Together, we would also create a plan for how to handle urgent debriefings to be held after traumas and code events. If the charge nurses are going to take lead of the debriefing under certain circumstances, they will need some specialized training. I could arrange for them to get formally trained in the third month. This will give them a base to trauma debriefing. As time moves forward, their experience will grow. By month four, we can start with the first monthly debrief meeting. Any post event debriefs can be discussed as well as providing staff education on coping and processing. Each meeting will be reviewed to improved future meetings. It may take some time getting used to, but I think this implementation could be very beneficial.

The administrative team are important stakeholders for my implementation because they are the ones who would give me the approval to go ahead with my plan. They have buy-in on maintaining quality staff. They also have a control in my department budget. The social work team and pastoral care workers are important stakeholders to my implementation because they are a part of the foundation to my plan. They provide a vital role being the emotional support and psychological experts. Emergency staff are also important stakeholders to my implementation, especially the charge nurses. The staff provide feedback on what would work on the floor with this plan and what will not. The charge nurses are the ones who will call a debrief outside of the scheduled debrief meetings, if necessary. They are the other part of the foundation to the plan when the social workers are not available because they will obtain the proper training required for the debriefs.

To engage with my administrators, schedule a meeting to propose my idea with them. Propose the plan, including stakeholders, budget money, and goals. Ideally, I anticipate positive feedback for this plan. I expect the administrators would see the proposal as beneficial, inexpensive, and a healthy way for nurses to obtain coping skills. To engage with the social workers, schedule a meeting with their department, including their director. Present my plan and ideally would receive positive feedback with volunteers who would like to participate. With emergency staff, the proposal would be presented at a routine staff meeting and through email. I’d expect enthusiastic cooperation with the idea and some to volunteer to help with the implementation. With the volunteers of the social workers and emergency staff present, the plan can be presented to administrators. This will show the administration team that the idea is serious and organized.

In order to work with these key stakeholders, it is important to identify how the proposed change positively impacts each stakeholder. Administration will be interested in money spent, money saved, organizational benefits, social worker and pastoral care will be interested in well-being of staff and patients; and staff will be interested in improving their job satisfaction, mental health, and the ability to work. After the first meeting, follow up meetings would be scheduled with stakeholders and discuss what went right, what could have been improved, and what can we do to move forward. This would help us learn and grow to create success for the plan.

In order to gain authorization to implement this proposal, approval comes from administration. They are the ones who will approve of the plan and budget. The ones who will be participating in the implementation are the social workers and the charge nurses. The charge nurses do need to be trained either by the social workers or by attending a class for the proper communication techniques. Communication with those involed will take place through work email. The criteria to judge the success of the proposal is based off the staff’s feedback. Feedback can be collected during routine staff meetings and also email survey.

During the process of my investigation, I fulfilled the role of scientist by observing the behavior of my co-workers throughout the day. I also researched my subject of compassion fatigue. I needed to know what compassion fatigue was and what were the symptoms of the problem. I also needed to understand why this was happening to nurses and what was being done about it. Various articles helped me achieve my research and multiple of them had the same resolution, debriefing. I also had to theorize a solution.

During the process of my investigation, I fulfilled the role of a detective by researching the solution to my problem. With the primary article that I researched, I reached the conclusion that debriefing may be an answer to defeat compassion fatigue in nurses. Another article that involved a study concluded that nurse’s opinions on debriefing were nothing but positive. Working in an emergency department, I have noticed that the nurses are showing signs of compassion fatigue. These signs included tiredness, lack of satisfaction in job status, non-caring attitudes, stress, and more frequent complaining. Increases in these symptoms could be potentially dangerous for not only the patients and the department, but for these nurse’s health and well-being. Decreasing these signs and symptoms by promoting a debriefing plan is important for staff and patient safety.

During the process of my investigation, I fulfilled the role of manager of the healing environment developing a debrief plan. Actions that I took to create the success of the plan were multiple meetings not only with staff, but administration and the social work department as well. I communicated with my staff and valued their thoughts and ideas to incorporate in this plan. I arranged charge nurses to go to proper debrief trainings so that they can be effective leaders if an urgent debriefing needs to take place. I was available when the plan launched for the first time to gain feedback and provide support.  

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