How To Recognize It and What To Do When It Hits
By Bryan Christopher Warne, RN
It can happen suddenly-- slamming into you like an elephant plopping down for a nap on top of your chest. It can happen gradually, too.
Your heart feels like it is beating just fine, but it doesn’t have the ability to expand any more. It is doing nothing more than pumping blood through your veins; it's simply keeping you going.
You walk in and out of patient rooms and you don’t seem apathetic. You are going through the normal motions, the normal nursing routine you’ve built up over an extended period of time.
But you realize, that at some point, you stopped using your heart. You stopped feeling as deeply for your patients as you once have.
You interact with them, but it seems bland or you feel disconnected from the interactions. You feel blank going into the exchange and blank coming out of it. Maybe you feel robotic. Or hardened. Or simply unengaged.
You are probably still giving excellent physical care and meeting all of your patients’ physical health needs, but you've lost the connection.
You stop to assess yourself and you ask, "What do I feel?"
As has happened to so many nurses, you find that you feel...nothing.
What you are experiencing may be a form of compassion fatigue.
It can happen overnight, but more often that not, it happens slowly, over a long period of time. And it is extremely common in the field of nursing.
Just as we can pull a muscle or cause undue strain and injury to ourselves if we don't use our bodies in the proper ergonomical ways, repeated strain to the emotional body can also cause dysfunction.
These things can and do happen mentally and emotionally as well, when we don't pay attention to how we are using our faculties.
Conversely, just as we use over-head lifts and turning sheets to prevent back strain, we can use tools to prevent the mental and emotional strain that can come from repeated over-use of the heart, mind and spirit.
The key to preventing compassion fatigue among nurses is to understand it, to recognize how it manifests, and to implement practices that can mimimize it from escalating.
If you’ve ever felt the way I mentioned above, then you’ve already experienced some level of compassion fatigue. The most important thing, at this stage, is to recognize what you are experiencing and to allow yourself to reset. If you keep pushing yourself at this point, it is likely to get worse. Conveniently, the methods for recovering from compassion fatigue are quite similar to the means of preventing it in the first place.
Below are some tried and true suggestions for recovering from compassion fatigue that can also be used as preventative measures once you have regained your caring and compassionate nature.
1. Take time off. Now. Trade a shift, get a nurse to cover you, or call in if you have to.
To some nurses, this may seem impossible in the face of car payments, mortgages, children’s daily needs, college funds, etc., etc., etc...
The truth is, if you don't take a day off once you start to disconnect from everything but the physical tasks of nursing, you put the physical and mental health of your self and your patients at risk. Working long nursing shifts without a break is not sustainable, especially if you have significant responsibilities at home as well. You become crabby, short-tempered, and may find it hard to stay centered in difficult situations; all because you have pushed all your faculties to the brink of exhaustion.
2. Actually plan to take scheduled time off.
Once you've had a day to rest, put in your request for an actual scheduled break. If you don’t, your body and mind just might decide to go on vacation without planning. This doesn't need to be an actual vacation, which can be stressful in and of itself, but should be a break from caregiving. If you don't make time for self-care, you'll continue to tire easily when caring for others.
3. Make yourself a priority.
Take a spa day, go get a massage, or just allow yourself to enjoy a good book and a nap for goodness' sake! Remember those NANDA approved Nursing Diagnoses? It's your turn to provide interventions based on your own Readiness for Enhanced Self Care. Put your own self first. As a nurse, you deserve it, and you know it. Now do it.
4. Take breaks and make time for rest, at work.
By law, we are to be given a thirty minute lunch (un-interrupted) and two fifteen minute breaks on a shift. As a nurse, you know as well as I do that taking a break sometimes seems nearly impossible. But just like planning for scheduled time off of work, you should do your best to set aside at least thirty minutes to completely check out from the duties of your position each day.
Have a charge nurse watch your patients (or follow the specific protocol in your facility) and take time sit in the break room to eat and relax. This is a time when you are NOT answering call lights, NOT answering the work provided cell phone, NOT charting, but simply taking the full length of your break. While this seems hard to do, once you start giving yourself 30 minutes out of the 720+ minutes on your shift, you'll understand just how vital this break is.
A simple break to take care of your own bodily needs can refresh you, and this break time is a right you have earned as a healthcare provider. Make it work for you and there will be less propensity for you to be burned out from the job.
The Number One Way to Prevent Compassion Fatigue in Nursing
All of the above techniques are effective and should be a part of your regular nursing interventions for yourself. But let me offer the following recommendation as well, which I consider to be the number one way to take care of both yourself and your patients--without falling into compassion fatigue, and while maintaining the highest level of care--the care that naturally resides within your heart and mind.
If you imagine your level of compassion as the gas gauge on your car dashboard, you will realize that there is a certain level of compassion that you have at any given time.
Now, realize that there are people that you are going to naturally 'vibe' or connect with in such a way that it is going to be like filling up with the highest grade gasoline you could. As a result, you will burn brighter and you will be able to give more and more compassion to others.
These are the interactions where you give your compassion openly to your patient and your patient is able to also give in a reciprocal fashion. Often this means that they will just fully appreciate and be grateful for your kind and compassionate care. This can fill your tank.
Now, there are other individuals who will tax you at every turn. The care you give is never ever enough for these individuals.
The amount of compassion it would take to persuade this person to glimpse the depths that you have already gone to, and would go to, for them, can leave you with an empty gauge. You can, and perhaps do, give all that you can to these individuals, and I say, sure…go right ahead and give as you see fit.
Do the very best that you can for these folks, but know that at some point on the road you're traveling as a nurse, you will come to understand that everyone has a certain baseline for empathy and compassion. Attempting to change that baseline within your twelve hour shift is like trying to change the direction of a lava flow mid-eruption.
The point is, you can do everything you can for each and every patient…in fact, you should. But somewhere along the road, you will need to begin to exercise discernment regarding how much empathy you are able to give to each person you come across.
If you will accept that discernment now, it is yours, and it is your safety equipment for protecting your heart and mind as a nurse.
Compassion and empathy go hand in hand. You can feel for someone, and as a nurse, it’s one of the built in expectations, one of the responsibilities and one of the greatest opportunities we are given.
To feel for your patients, in whatever way you can, can be a transcendent and deeply healing experience.
However, it is important to be cognizant of the difference between empathy and sympathy with your patients; the difference is the key that prevents you from making the compassion killing mistake of taking their pain and suffering as your own. Doing so will not lessen their pain, and it can only lead to more compassion fatigue for you.
Instead, you may need to stop trying to give so much, and simply understand that when the gas gauge is emptied by a patient in extreme suffering, your compassion may simply be the listening, and the being there, which might actually help them heal.
I would never advocate for withholding compassion and empathy from any person, yet there is a deep inner knowing that can come about, when you listen, realize, and finally say to yourself…
"Maybe, at this moment I can’t do anything more for this person. Maybe, if I am simply silent and listen, there will be a way that I can provide empathy without draining my own compassion tank to empty."
As nurses, we often take it upon ourselves to be the beacons of compassion for others, even when it is detrimental to our own health.
That's why I remind you that it is not your job to heal every physical, mental, emotional or spiritual wound that your pateints have, and definitely not within twelve hours.
Be present, and do what you can while you are there, but don’t fret over not being able to solve every ill.
When you set this type of boundary in your nursing care, and you realize that you can only give as much empathy and compassion as you have in your tank, you begin to understand that this applies to yourself as well. When you overly sympathize with your patients you are not being compassionate with yourself. When you take on the pain and suffering of all your patients, you are not refilling your tank, merely draining it. How can you assist in the healing of others, if you yourself are lacking?
The surest way I've found to prevent compassion fatigue is to make sure that you are equally as compassionate with yourself as you are with your patients.
Setting boundaries, acknowledging when you can't solve every problem for every patient, and letting go of that burden will naturallly allow you to infuse compassion and empathy into other interactions--most importantly into interactions with yourself.
Bryan Christopher Warne graduated from an accelerated nursing program in 2012. He began his nursing career in the Float Pool, gaining experience on units like Telemetry, Neuro, Renal, Pulmonary, Med-Surg, Ortho and Rehab. He is currently a travel nurse.