pandemic leads to compassion fatigue, burnout for health care workers

as the nation enters its sixth month of the covid-19 pandemic, healthcare providers on the frontlines are facing compassion fatigue.

kim chaudoin | 07/27/2020

nurses are known as nurturers. compassion and empathy are at the very heart of the nursing profession. nurses are relied upon to provide medical treatment, support and encouragement during times of physical, emotional and spiritual anguish.

but who nurtures the nurses?

on march 11 when the world health organization declared the novel coronavirus disease, covid-19, a pandemic. a national emergency was declared in the united states on march 13. since that time, the nation’s healthcare professionals, of which nurses comprise the largest group with more than 3.8 million registered nurses nationwide, have been hard at work around the clock caring for the more than 4.3 million individuals in the united states who have tested positive for the virus to date. as the pandemic nears its sixth month, these providers face physical and mental burnout. 

however, continual exposure to and internalization of another's suffering can lead to something else — compassion fatigue. compassion fatigue can be deadly, robbing individuals of the ability to care or empathize, says dr. chelsia harris, executive director of lipscomb’s school of nursing and author of created and called: a journey to and through nursing.

“a nurse’s innate capacity to nurture and take on another’s suffering as if it is his or her own … to have empathy or the deep awareness of another’s suffering and the desire to do something to make it better is compassion,” explains harris, one of the nation’s leading researchers on compassion fatigue. “fatigue is extreme tiredness resulting from mental or physical exertion or the state of being weakened under repeated stress. compassion fatigue leads to an inability to nurture and can have a detrimental impact on the health and wellbeing of that nurse.”

more than burnout

according to the american institute for stress, burnout and compassion fatigue exhibit themselves in several common ways such as emotional exhaustion, reduced sense of personal accomplishment or meaning in work, mental exhaustion, decreased interactions with others (isolation), depersonalization (symptoms disconnected from real causes) and physical exhaustion.

burnout is often mistaken for compassion fatigue. harris co-authored an article with dr. mary t. quinn griffin, associate professor in case western reserve university’s francis payne bolton school of nursing, that was published in the journal of christian nursing about their research on the phenomenon. in nursing on empty: compassion fatigue signs, symptoms and interventions, harris and griffin assert that burnout triggers and characteristics differ in significant ways. 

“combining the old and new schools of thought, burnout is believed to be triggered by increased workplace demands, increasing healthcare expectations in general, lack of resources, interpersonal stressors and organizational policy leading to diminished caring, cynicism and ineffectiveness.”

harris defines compassion fatigue as the physical, emotional and spiritual result of chronic self-sacrifice and/or prolonged exposure to difficult situations that renders a person unable to love, nurture, care for or empathize with another’s suffering. 

“i love talking about compassion fatigue,” admits harris. “i’m passionate about it and i want to help people.”

a perfect storm

the covid-19 pandemic has created a perfect storm for compassion fatigue to affect nurses which is unlike other challenging times such as during the 2008 h1n1 pandemic and healthcare professionals caring for victims of the 9/11 terrorist attacks. 

“we have to think about this as completely different because there is the component of not only healthcare providers being exposed to an excessive amount of trauma and suffering, which is typically what leads to compassion fatigue, the longevity of the exposure of trauma and the actual severity of that trauma, but this also has an additional component which is a fear of the unknown,” says harris. “it’s the unknown — what is the capacity of this virus? what does it do? if there is going to be a vaccine, when will that come? that is just an added component to the entire equation this time. and then some of the things these healthcare providers are seeing is traumatic.”  

among the unique aspects of the covid-19 virus is that it has not only affected typically vulnerable populations, but young, healthy individuals who, at times, have rapidly declined. 

“we go into this profession with the mindset and the calling that we are going to help serve people, we are going to assist god in his saving of lives. this is what many of us feel like we are called to the profession for,” harris explains. “so, when you have failure after failure after failure because you don’t know about this virus and there aren’t treatment modalities in place that have been extraordinarily successful and you are watching people suffer and ultimately lose the battle it creates an exponential among of trauma and loss that is weighing on our healthcare providers. and there is so much pressure and they’re exhausted. you feel like a failure”

“the healthcare provider — the nurses — have a feeling of helplessness because they’ve exhausted all of the measures that they typically know to do but this particular virus is acting differently,” she continues. “then you add the compassion component. in nursing what we do is to provide compassion, to be the advocate for the patient and to bring all of the health care professionals together while also inviting the family into that scene. but because of the contagious nature of covid-19, families have basically been eliminated not because of choice on the part of the nurses but because of necessity. this virus has compounded any internal struggle that we as healthcare providers have ever experienced.”

warning signs and consequences

left unchecked, harris warns, compassion fatigue leads to two primary consequences: inadequate performance and decreased holistic health. it may also lead to nurses leaving the profession. healthcare providers suffering from compassion fatigue may demonstrate poor judgement, make errors, less than desirable interactions with patiences, decreased discernment and declining quality of care. personally, they may suffer physical ailments such as headaches and gi issues and exhibit psychosocial traits such as apathy, detachment, depression and irritability. they may also be impacted by a lack of sleep, loss of self-worth, loss of hope and changes in their worldview and spirituality.
 

nurses as well as managers and administrators need to be aware of the warning signs, symptoms and the consequences to be able to identify this condition in themselves or among colleagues. harris says managers, particularly in a time such as the covid-19 pandemic, need to watch for signs of compassion fatigue that may manifest itself as spiritual emptiness, a decreased sense of fulfillment, disconnectedness to people, lack of motivation, sensation of fatigue, personal and career dissatisfaction and feelings of helplessness related to “the unrelenting sacrifice of self and/or prolonged exposure to trauma.”

“ultimately when you’re not being filled up, then you’re empty. you can’t give any more. couple that with the physical needs and the external forces and it’s a trainwreck for the wellbeing of the nurse,” she says.  

with the preexisting nursing shortage combined with an overwhelmed workforce that is on the frontlines fighting the covid-19 pandemic, conditions are right for compassion fatigue to have a growing impact on nurses in the days and weeks to come. harris says it takes a combined effort of the individual nurse and healthcare administration to combat this sometimes crippling condition. 

strategies for managing compassion fatigue

acknowledging that compassion fatigue exists is the first critical step, harris emphasizes. “nurses are known for trying to be tough and putting up a front that says, ‘i’m okay,’ even when they are far from that,” she says. “talking about it and making it okay to feel that is critical to moving forward and creating a nourishing environment.”

when nurses experience symptoms of compassion fatigue, there are several personal interventions harris recommends to help them cope. these include 

• work/life balance,
• developing personal and professional support systems,
• determine personal coping strategies,
• getting adequate sleep,
• healthy nutrition, 
• regular exercise, 
• taking time away for vacations or long weekends, 
• attending to spiritual needs and 
• getting involved in enjoyable pursuits and hobbies. 

equally important, however, in fighting compassion fatigue is a supportive work environment that is nurturing and compassionate for nurses as well as patients, harris says. 

harris suggests several tactics that unit leaders and healthcare administrators can use to combat compassion fatigue on the organizational level. 

• talk about it. managers should include a discussion of compassion fatigue in regular meetings to educate nurses about warning signs and to teach interventions. 
• acknowledge staff contributions. it is essential for organizational leaders to recognize and thank nurses for their compassionate care. this can be done in meetings or with a note, email or other gesture.
• education. formal education training about setting boundaries, conflict resolution, ethical dilemmas and self-care address critical issues that can lead to compassion fatigue. 
• timeouts. give nurses who are caring for patients during intense periods with the critically ill, intensive care units or those nearing death a timeout. this is a period of time when a nurse can take a break (even just a few minutes) to step away to reflect. related to this is rotating the care of high-stress patients when feasible to give a nurse a break from caring in the same situation day-after-day.
• provide quiet rooms for staff. 
• debriefing. this is a useful practice following any intense period of caring or prolonged difficult situations. 
• develop a buddy system to pair new and experienced nurses.
• encourage personal journaling.
• offer collective ways to share difficult experiences to assist in processing grief and expressing compassion fatigue. 
• provide on-site counseling. 
• nourishment. nurses often skip meals or eat unhealthy foods due to work schedules which contribute to fatigue. administrators should encourage healthy lifestyles and provide healthy food, including snacks, to personnel. also encourage walkling and other exercise.
• form nurse support groups to meet outside of work. this helps nurses process work experiences together, receive feedback and encourage each other. 
• treat employees wholeheartedly and the way they themselves would want to be treated. 

harris says there are also ways that individuals outside of healthcare can encourage and support providers. when talking to family members and friends who are in the nursing profession, harris suggests providing a place for the frontline people to get their minds off of the heaviness of grappling with the pandemic.

“they need an escape,” she explains. “it’s ok to ask questions, but if someone doesn’t want to talk about their day that’s ok, too. these providers don’t need to relive their day over and over. they need a place where it’s safe to laugh, to cry, to be themselves. they need an outlet. i would challenge those with friends and family who are healthcare providers to create moments that fill them back up, that bring them joy. give them an outlet that’s not job-related.”

for more information about harris’ book created and called: a journey to and through nursing, visit www.chelsiaharris.com/shop/createdandcalled.

lipscomb’s school of nursing, housed in the college of pharmacy & health sciences, offers a bachelor of nursing in science degree. learn more at www.fellaworld.com/nursing.