Compassion Fatigue's Surprising Costs

Exhaustion is nothing new in the world of nursing, but the emotional and physical toll of doling out high levels of empathy must be addressed by leaders who have the power to make positive changes.

The need to be constantly compassionate saps nurses of energy and can lead to poor judgment, and worse.

Researchers, who presented their study this month at the British Psychological Society's annual conference, found that emotional exhaustion was especially prevalent among nurses who needed to show high levels of empathy and compassion every day, such as nurses who care for children and hospice patients.

The researchers, who surveyed 351 nurses about their work and home lives, also found that this fatigue could spill into their home life and personal relationships.

Compassion fatigue is nothing new in the world of nursing, but this new study struck me because it came on the heels of the annual Gallup survey showing that the public, once again, has voted nursing the most ethical profession.

Seeing those two pieces of news together stopped me in my tracks. Wow, that's a lot of pressure, I thought. It's a practically impossible standard of goodness. Nurses are not only expected to be expert clinicians, but also near-angels. It's no wonder they are utterly exhausted on every level, both emotionally and physically (12-hour shifts, I'm looking at you).

Nursing is 'Demanding and Difficult'
"Healthcare is a highly emotional[ly] charged environment, especially for nurses. With life and death decisions being made every day, it is no wonder nurses feel tremendous pressure," Patricia Smith, founder of the Compassion Fatigue Awareness Project and a Certified Compassion Fatigue Specialist, tells me via email. "They enter the profession with hopes of making a difference, but then after working a short time, they start to realize how demanding and difficult the job is."

Having recently been on the patient end of nursing care while my daughter, Chloe, was hospitalized earlier this month, I saw firsthand how calm, cool, and collected the nurses were who cared for her.

Emotions Run High
Who monitored Chloe 24/7, expertly navigating and anticipating every twist and turn of her condition? Who was endlessly patient and kind and unflappable when Chloe was scared and uncooperative? Who followed me into the bathroom and talked me off the ledge and let me cry into her arms?

And what do nurses do with all of that emotion? Where does it go if it doesn't come out during patient care?

Studies about compassion fatigue have shown that it can result in everything from headaches, to substance abuse, to poor judgment. And according to Smith, it can also result in nurse-to-nurse hostility.

"What I have noticed… is that nurses tend to take out their frustrations on each other. There is a saying that 'nurses eat their young.' And I have found that to be true," she says. "Their culture has been built around the idea that new nurses need to jump through hoops and learn the hard way."

Smith says that nurse leaders need to break this toxic tradition and instead help them navigate the profession and its challenges in a more productive way.

Leadership Needed
"Instead of throwing them to the wolves, leaders need to become mentors. Hospital leadership must understand compassion fatigue and how it affects the nurses, and ultimately the patients. They must work to create a culture of caring as opposed to a culture of curing," she says.

"And this caring must extend out to their staff. When the majority of caregivers become compassion fatigued, the organization itself takes on the symptoms of compassion fatigue. And this affects everything, including the bottom line."

If nothing else, the threat to a hospital's bottom line should be enough to shake nurse leaders into action. "Somehow staffing must be scheduled to allow regular breaks and lunch breaks. The nurses must take accountability for themselves and practice authentic, sustainable self care daily. This means eating well, exercising, building a strong support system, and learning appropriate ways to communicate needs," Smith says.

"Additionally, they must strengthen their resiliency in order to keep returning to their work daily to provide healthy, ethical, and healing care."