Compassion Fatigue Impact Nursing Job Satisfaction

Compassion Fatigue Among Nurses

Multiple studies have been conducted on compassion fatigue among nurses and the ultimate effect it has on the patients under the nurse’s care. Nurses experiencing the issue of compassion fatigue exhibit physical and/or psychosocial problems that can be detrimental to the nurse and the patients under the care of the nurse. Compassion fatigue is, “the term used to describe the combination of burnout and secondary traumatic stress” (Kelly, Runge, & Spencer, 2015). Journal of Nursing Scholarship describes compassion fatigue as, “the caregiver’s cost of caring and results when caregivers are exposed to repeated interactions requiring high levels of empathic engagement with distressed clients; it can be a significant contributing factor in caregiver burnout (Figley, 2002)” (Sorenson et al.

, 2016). 

Compassion fatigue can be caused by stress, unrealistic work expectations, increased work load, and many other factors. Many nurses, especially new graduate nurses, are suffering from compassion fatigue due to these factors. Leadership in nursing is affected because nurses turn to leaders for help in fixing their problem of compassion fatigue. Leaders in nursing are needed to provide support for nurses. Yoder-Wise describes, “The role of the nurse leader is to create a practice environment that fosters open communication and collaborative practices for achieving mutual goals that enable nurses to employ constructive approaches to conflict management” (Yoder-Wise, 2015, P.444).

Significance Review

Compassion has been known to be a requirement for all nurses. Kathy Douglas states, “It seems reasonable to assume most people in care delivery begin with a well-developed sense of compassion and caring. It is, however, not clear this is always the case. It would be interesting to hear from the nursing community at large; how often we screen, upon entry into education programs, the profession, or on hiring, for the characteristic of emotional availability and compassion” (Douglas, 2010). When nurses experience compassion fatigue, the requirement of compassion is lost. In studies conducted, compassion fatigue has shown to be prevalent in multiple specialties and areas of healthcare. The Journal of Compassionate Health Care published an article that investigates compassion fatigue in nurses, the journal states, “Quantitative data was collected between 29.09.15 to 17.11.15 using a questionnaire pack which included demographic and work-related questions, the Secondary Traumatic Stress Scale (STSS), to measure the incidence and levels of Compassion Fatigue (CF), and the Self-Compassion Scale (SCS) [52], to measure the incidence and levels of Self-Compassion (SC)… The results revealed that nearly 46% of the respondents had a mean total STSS score that fell within the range of 41 to 57, indicating that they had moderate to very severe levels of STS…” (Upton, 2018). 

Moreover, the study concluded that nearly half of the respondents fell within the range of having severe secondary traumatic stress and as stated, burnout and secondary traumatic stress are what make up compassion fatigue. Within the article by The Journal of Nursing Scholarship another study conducted, “The vast majority of nurses working in EDs reported symptoms of traumatic stress within the past week, with 33% of them meeting all criteria for STS (Dominguez-Gomez & Rutledge, 2009). Another report revealed that 86% of ED nurses had high CF scores, and 82% reported high burnout scores (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010)” (Sorenson et al., 2016). Through these studies, it can be concluded that there is a problem with compassion fatigue in the healthcare field among nurses that needs to be remedied.

Influencing Forces

Many factors influence and contribute to nurses obtaining compassion fatigue such as stress, increased workload, unbalanced home and work life, unrealistic expectations and patient attitudes. The Journal of Compassionate Health Care conducted a study of factors influencing healthcare and among the factor of increased workload within the study an anonymous nurse stated, “When it is just me and another health care assistant and we have got twelve patients to look for and seven of them need both of us to give them just basic care, such as hygiene needs like their bowels. You just can’t do it. I wish I had six patients, then there would be a lot more connection and a lot more of me knowing what’s going on” (Upton, 2019). Also, in the same article, an anonymous nurse reported on the effects of patients and their families attitudes, “The media is toxic because it is feeding into people’s minds the completely wrong impressions of what we try to do. [Patients] who have not been in hospital before and their loved ones look for mistakes and are not happy with things. Whereas the patients who are frequent visitors to the ward, they recognize that we are doing everything we can” (Upton, 2019). Nurses are scrutinized on their work daily by management, collogues, and patients. 

Moreover, when nurses feel like daily that they are not enough or adequate to take care of their patient with a satisfying outcome and management does not take nursing concerns into consideration it leads to burnout which in return leads to compassion fatigue. “Weak management of staff was identified as contributing to stress during their nursing work and affecting their experience of Compassion Fatigue. Interviewees were particularly vocal about the reluctance of nurse managers and senior medical colleagues to deal effectively with difficult, disruptive patient behavior. They believed that reports by RGNs were being ignored, even when voiced through the policies and procedures set out by the Hospital Trust” (Upton, 2018). It is very frustrating for nurses to work in environment where the nurses can’t depend on their management. Also, “Nursing is a very stressful occupation (Dickerson, 2013). 

Work-related stressors, such as an ever-increasing workload, rotating shifts, high patient acuity, inadequate staffing, ethical conflicts, dealing with acute illness and death, role ambiguity, the multiple, complex, and continually growing number of responsibilities, constant multitasking, work relationships, and job insecurity have all been associated with increased stress, possibly culminating in complete exhaustion and burnout (Rudan, 2002; Krichbaum et al., 2007)” (Yoder-Wise, 2015, P.520). Thus, a very stressful work environment creates a large frame for nurses to make mistakes such as medication errors, especially for new graduate nurses that are not prepared for the stressful environment which in return makes it an unsafe environment for patients.

Resolution

Although compassion fatigue is plaguing nurses across the United States, there are many proposed resolutions. Moreover, before being able to fix the compassion fatigue one must know the signs and symptoms which are, “apathy, frustration, hopelessness, irritability, poor concentration, boredom, anxiety, depression, isolation, cynical towards work, tardiness, absenteeism, short term memory issues, fatigue, weight changes, error rate an issue, personal uses of chemicals increasing, and more critical of team members” (Douglas, 2010). Kathy Douglas wrote, “Our tendency is to give to the point of exhaustion. From there we either continue to give at the cost of our own well-being or health or we shutdown, knowing one cannot give from an empty well. There is a strong case to be made that the limiting factor on one’s capacity for caring and compassion is an individual’s ability to replenish this part of themselves. While one can look to and even advocate for structures within the health care environment that support one’s selfcare, ultimately the responsibility for self-care belongs with one’s self” (Douglas, 2010). Thus, nurses tend to put their whole being into caring for others without first caring for themselves which leads to burnout and compassion fatigue. So, as a resolution Douglas proposes to care for oneself to care for others. 

A strength to Douglas’s proposal is that some nurses may find it useful to take care of oneself first that are not already experiencing compassion fatigue, however it is a weakness for the nurses who are already experiencing compassion fatigue because it would not fix the root cause. Another article suggests educating the nurses on compassion fatigue, “Throughout the discussion of the study results, evidence has emerged that it is essential for health care organizations, such as the NHS, to provide a healthy, supportive and compassionate working environment for their acute medical care hospital nurses, in which the nurses’ emotional well-being is fully supported. 

Nursing staff need to be made aware of the causes, symptoms and reinforcing cognitions and behaviors of CF, so that they can consciously address them. This should start from the early days of nursing education, rather than only teaching the prescriptive requirements of the 6 Cs [6] as a goal for compassionate care… Encouragement of a more self-compassionate workforce through protected and uninterrupted breaks should be established in order for staff to recharge and refuel, along with the provision of flexible shift patterns to better balance work and home life.” (Upton, 2018). An article published in the Journal of Nursing Scholarship also supported taking preventative actions and states, “Self-care was reported to be the most significant preventative measure HCPs could take to protect themselves from developing CF and RCs. Education and teamwork also contributed to the prevention of CF and RCs in HCPs. Coping with emotionally trying situations and self-efficacy, or an individual’s perceived ability to have some control over one’s own behavior, task, and environment, decreased the risk for CF and RCs (Benoit et al., 2007; Pietrantoni & Prati, 2008). 

Educational programs that taught recognition and prevention of CF and RCs were effective in teaching resilience and coping mechanisms to HCPs when implemented in interventional studies or through professional training (Berger & Gelkopf, 2011; Meadors & Lamson, 2008; Michalec et al., 2013; Potter et al., 2013; Weidlich & Ugarriza, 2015)” (Sorenson et al., 2016). It is a strength that early education would provide the nurses education on the symptoms to look for and risk factors to avoid compassion fatigue. Combating stress and balancing work life and home life have also been stated to combat issues that contribute to compassion fatigue. “Self-management is a means to achieve a balance between work and personal life, as well as a way of life to achieve personal goals within self-imposed priorities and deadlines. Time management is clock-oriented; stress management is the control of external and internal stressors. To achieve a balance in life and minimize stressors, nurses must learn to sit back and see their own personal big picture and examine their personal and professional goals. 

Personal priorities also must be established. Stressors and coping strategies need to be identified and used. By developing these techniques, nurses can gain a sense of control and become far better nurses in the process” (Yoder-Wise, 2015, P. 540). A strength of achieving a balance in life and minimizing stressors would be that the nurse, especially new nurses, would not become burned out as quickly which in return would decrease the risk for compassion fatigue. A weakness is coping strategies may be different from nurse to nurse therefore making it hard to standardize to educate all nurses.

Proposition

I propose, that nurses be taught early education to avoid compassion fatigue and provide early intervention. It is essential nurses be taught how to identify the signs of burn out and stressors early to avoid compassion fatigue as early as while in nursing school. I highly agree with the statement, “Nursing staff need to be made aware of the causes, symptoms and reinforcing cognitions and behaviors of CF, so that they can consciously address them. This should start from the early days of nursing education, rather than only teaching the prescriptive requirements of the 6 Cs as a goal for compassionate care” (Upton, 2018). As a recommendation, I recommend beginning in nursing school teaching students how to effectively identify the signs of burnout and stressors to avoid eventually having compassion fatigue. “While hospitals may be aware of their older generations of nurses experiencing burnout and loss of empathy from their prolonged time in the profession, they must also be aware of the younger generations who demonstrate increased risk for CF. Additionally, recruitment efforts should be matched with efforts to retain nurses, specifically as they gain more experience and increase their risk for burnout and STS” (Kelly et al., 2015). 

Furthermore, I also recommend having an education seminar on compassion fatigue during the orientation process upon being hired at any facility as well as completing compassion fatigue continuing education courses. I also recommend the use of awards and a process to acknowledge nurses for all the hard work they do. As a nurse, sometimes being recognized for a good job on a task gives a boost in confidence and encourages you to keep moving forward. “Addressing CF results in energized moments and feelings of contribution, which is beneficial for both the nurse as well as the hospital system. Addressing CF provides the opportunity for nurses to reconnect to their original passion to enter into the profession, as well as align with an organization’s values and mission (Potter et al., 2013). The DAISY Award serves as one mechanism for providing recognition. However, meaningful recognition can come in many beneficial forms, such as feedback about how one’s work impacted another and made a difference (Lefton, 2012, 2014)” (Kelly et al., 2015).

Conclusion

In conclusion, compassion fatigue causes nurses to have both psychosocial and physical symptoms that creates and unsafe environment for them and the patient’s they are taking care of. Moreover, the issues of stress, unrealistic work environments, management, patients and their family’s attitudes, and increased work load all contribute to inducing compassion fatigue. As burnout and stressful events increase, the chances of having compassion fatigue increases. Through the use of early intervention such as education on compassion fatigue as early as nursing school and continuing education on it, the incidence of compassion fatigue can be drastically decreased.

References

1. Douglas, K. (2010). When caring stops, staffing doesn’t really matter. Nursing Economics, 28(6),
2. 4159. Retrieved from https://login.iris.etsu.edu:3443/login?url=https://search.proquest.com/docview/820874434?accountid=10771
3. Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal of Nursing Scholarship : An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 47(6), 522-528. doi:http://dx.doi.org/10.1111/jnu.12162
4. Sorenson, Claire, BSN,C.C.R.N., R.N.C.N.I.C., Bolick, Beth,D.N.P., N.P., Wright, Karen,PhD.,
5. N.N.P.B.C., & Hamilton, Rebekah, PhD, RN,C.N.L., F.A.A.N. (2016). Understanding compassion fatigue in healthcare providers: A review of current literature. Journal of Nursing Scholarship, 48(5), 456-465. doi:http://dx.doi.org/10.1111/jnu.12229
6. Upton, Katherine Valentine. (2018). An investigation into compassion fatigue and self
7. compassion in acute medical care hospital nurses: A mixed methods study. Journal of Compassionate Health Care, 5(1), Journal of Compassionate Health Care, June 29, 2018, Vol.5(1).
8. Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby

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