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Suffering from Compassion Fatigue, Burnout or Both? What a Nurse Can Do

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By Megan Murdock Krischke, contributor 

May 16, 2013 - When it comes to feeling worn down in your job, it is important to distinguish between nurse burnout and compassion fatigue because they have different sources and different solutions, explained Dana Nelson-Peterson, DNP, MN, RN, administrative director for ambulatory nursing services at Virginia Mason Medical Center in Seattle.

Avoiding nurse burnout 

Nurse burnout is typically the result of the work environment, such as workspace design, assignment levels and scheduling. 

Dana Nelson-Peterson: nurse burnout and compassion fatigue are different.
Dana Nelson-Peterson, DNP, MN, RN, emphasizes the importance of distinguishing between nurse burnout and compassion fatigue.

“Nurses reach a point where they are no longer able to compensate and cope with the negative aspects of their work environment and it is hard to keep coming back to work,” said Nelson-Peterson. 

A recent CareerBuilder survey found that 60 percent of health care workers reported feeling burned out in their jobs--and 34 percent say they plan to look for a new job in 2013 and 45 percent say they will look for a new job over the next two years. 

Participants in the survey noted that a work–life imbalance due to heavy workloads and inflexible scheduling was a major source of job dissatisfaction. Organizations also stated that extended job vacancies have created a negative impact. More than a third of the surveyed health care organizations have job openings for which they cannot find qualified applicants.

While burnout is nearly always an organizational-level problem, Nelson-Peterson encourages individual nurses who are dissatisfied with their work environment to bring the issue to the attention of nursing leadership. 

“Of course the process of making organizational changes varies between organizations, but I would say that nurses need to be empowered to find their voice and to know the chain of command,” said Nelson-Peterson.  “I want to believe that if they engage their leadership team that they will be heard and that the leaders would work with the nurse to make a needed change.”

She also suggests that nurses should be collaborating with other health care leaders and providers when decisions are being made around policy. 

“Frontline nurses have very important information that needs to be teed up to where decisions are being made,” she said.

Combatting compassion fatigue 

In addition to burnout, nurses often face compassion fatigue, which results from the inability to help a patient no matter how much effort is expended; it can involve physical fatigue, emotional distress, or apathy resulting from the constant demands of caring for others without good self-care. The condition is especially common among nurses who work with patients who have chronic diseases or life-limiting illnesses. 

“When nurses get to the point where they are suffering from compassion fatigue, they can become calloused and withdraw from the delivery of health,” explained Nelson-Peterson. “They go through the motions, but are unable to actually care about a patient. This can have a negative impact on outcomes and staff and patients’ satisfaction.” 

Kelly Johnson: self-care helps nurses stay passionate about patient care.
Kelly Johnson, MSN, RN, NEA-BC, says working with a team you enjoy is key to staying passionate about nursing.

When it comes to combatting compassion fatigue, Kelly M. Johnson, MSN, RN, CRRN, NEA-BC, vice president and chief nursing officer for Children’s Hospital Colorado, says that self-care is critical. 

“Nurses are great at taking care of everyone but themselves. In order to provide the highest quality and most compassionate care for patients and families, nurses need to first care for themselves. Stay connected with family and friends, attend to spiritual needs, participate in hobbies and activities that provide a sense of renewal,” she advised. “And of course, eat right, exercise and get plenty of rest, and reach out to professional assistance through counseling. Most organizations provide employee assistance programs that can be extremely valuable [and free] resources.”

Among the support services offered by Children’s Colorado is a two-day training program called HeartMath. The course teaches techniques to lower stress and increase resilience, as well as how to engage positive emotions to facilitate healing. These techniques not only benefit nurses, but can then be taught to patients. 

Being proactive, finding renewal 

Nelson-Peterson also suggests that continuing one’s education can help renew passion for nursing and even help remedy both burnout and compassion fatigue.

“The Institute of Medicine’s report on the future of nursing laid out four high-level actions that nurses can take to look to the future. One of those four is returning to school to complete a BSN or to earn an advanced degree.  Even if it isn’t in a formal academic program, earning continuing education credits can infuse you with new energy and new ideas.  Pursuing continuing education puts you in a place where you can be part of the collective power of problem solving and harnessing ideas that other organizations are implementing.” 

Another Institute of Medicine (IOM) recommendation is that nurses work at the top of their scope of practice.

“Nurses should be aware of what the scope of their practice is. Often a nurse’s work is not appropriately skill–task aligned. Nurses can get buried in clerical work, faxing and copying, rather than doing what they were trained to do--hands-on nursing in the clinic or at the bedside,” said Nelson-Peterson. 

“When I reflect on what nursing is,” she continued, “the whole act is really epitomized by being able to provide care to patients and their families during some of the most vulnerable times of their lives. We do a disservice to our nurses and our patients when we pull nurses from the bedside.”

“When nurses understand the role they have been schooled in and that they are blessed to be able to practice, when they can find their voice and articulate the value of what they bring to the patient and the patient’s family, that will help them address any type of burnout or compassion fatigue they might be experiencing,” Nelson-Peterson concluded.

Related articles:
From the Heart of a Nurse: A Tale of Caring, Burnout and the Path to Self-care 

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