Nurse Self Care: Understanding and Managing Compassion Fatigue

Nurses are nurses because they care about people. Their compassion and empathy toward others get them through working long shifts, the weekends and holidays, the never-ending data entry requirements, and the ever-present weight of stress on their shoulders. A nurse's capacity to endure pain and suffering is legendary, but it isn't limitless. 

Nurses are people, too, and there's only so much they can take before compassion fatigue comes calling.

What Is Compassion Fatigue?

Working in the medical field exposes you to the gamut of human suffering: disease, injury, chronic and debilitating illness, and man's inhumanity. The rewards for this work are enormous, but the profession can take its toll, often through the process of compassion fatigue.

Compassion fatigue is the umbrella phrase for the physical, cognitive, emotional, and behavioral drain that healthcare professionals can experience, making it difficult to empathize with their patients. It isn't the same condition as caregiver burnout; there is a difference.

Caregiver Burnout vs. Compassion Fatigue

Caregiver burnout and compassion fatigue frequently find themselves lumped in together, to where it becomes hard to tell the difference between the two. But there is a difference. The symptoms are similar, and you may experience both, but the root causes distinguish the two.

You experience irritability, tiredness, and apathy with burnout and compassion fatigue. Burnout usually results from widespread, systematic stress. It leaves the nurse feeling powerless in its wake. Burnout develops gradually, and the nurse can rarely point to a single event or reason that caused it.

Compassion fatigue results from a traumatic event, or multiple events, that the nurse witnesses or encounters second-hand. Compassion fatigue can hit suddenly, in an "out-of-the-blue" sort of way. Some specific compassion fatigue symptoms that differentiate it from burnout include:

• Feelings of guilt, self-doubt, failure, sadness, and powerlessness
• Sleep disturbances
• Increase in emotional intensity
• Depression, with signs of post-traumatic stress disorder (PTSD)
• Difficulty concentrating
• Impairment of behavior and judgment
• Feelings of isolation accompanied by loss of morale
• Decrease in feelings of self-worth
• Anger toward perceived perpetrators or events causing the reactions you're experiencing
• Apathy and emotional numbness

In a nutshell, a nurse laboring under the weight of compassion fatigue may inwardly feel "sick of sick people," and that's not a state of mind where a nurse wants to be.

Who Is Most at Risk?

If you suspect a coworker is experiencing empathy fatigue, it's vitally important to bring it to their attention. The nurse most affected by compassion fatigue may be the last to recognize what's happening. Those most at risk for developing this condition include:

• Caregivers new to the field are more likely to feel overwhelmed by their new and often unfamiliar responsibilities.
• Having a history of personal trauma can make one prone to empathy fatigue.
• Caregivers who lack a personal support system to help them prevent emotional trauma.
• Those who carry a large patient load, interacting with a greater number of clients, have an increased chance of exposure to trauma.
• Nurses working long hours are prone to sleep deprivation, especially if they provide care to someone in their personal lives.
• Individuals who have difficulty communicating their emotions are more prone to internalize stress, allowing it to build up and increasing their exposure to potential trauma.

Identifying compassion fatigue is the first step toward managing it.

Managing Compassion Fatigue Through Self-Care

Once you recognize the signs and symptoms of compassion fatigue within yourself, it's important to manage it. Professional support is essential, but you should not underestimate the benefits of self-care to put you on the road to recovery. 

Any self-care plan should address six core areas of concern: physical, emotional, psychological, spiritual, professional, and relational. Steps you can incorporate into your self-care plan to address each concern include:

Physical

• Evaluate your diet and commit to healthy changes
• Create a space within your home as a designated "calming space"
• Develop bedtime routines geared toward "winding down" and stick to them
• Get involved in a physical activity you enjoy
• Take time off from work to visit family and friends, even take a vacation!

Emotional

• Set aside time to spend with those you love
• Create a list of self-affirmations. Tell yourself what's good about you!
• Express your emotions rather than hold them in. 
• Volunteer with a group that's focused on something you enjoy doing
• Keep a record of moments when you felt strong

Read More: Daily Mindfulness Exercises To Support Your Work

Psychological

• Work with a therapist or counselor
• Journal about your day, leaving the unpleasant experiences on the page
• Focus on the positive aspects of your workday
• Confide in a trusted friend or colleague
• Clear the stress from your personal life

Spiritual

• Listen to music that inspires you or watch inspirational programming
• Enjoy time in nature (stop and smell the roses!)
• Make a list of things that give you hope or inspire faith
• Post inspirational notes to yourself 
• Take part in religious services

Professional

• Talk with your supervisor about altering your shift patterns
• You're entitled to breaks—take them!
• Join a peer support group, or start one if there are none available

Relational

• Evaluate your relationships and free yourself from any toxic entanglements
• Cultivate peer support mentors at work who can check in on each other
• Make time for friends and family
• Seek support from your spouse/partner/significant other
• Set boundaries with patients and coworkers, then stick to them

It's important to remember that putting yourself first isn't selfish.

Read More:  How to Leave Work Stress at Work

Occupational Hazard

The American Nurses Association estimates there are four million registered nurses in the United States, making nursing the most significant healthcare profession in the U.S. Providing empathic, personalized care to patients and their families predisposes nurses to compassion fatigue, making it an occupational hazard. But it's one that healthcare workers can beat through awareness, education, proactive self-care, and good, old-fashioned nurses watching out for each other.