Compassion Fatigue and Burnout in Nursing

Compassion fatigue and burnout—it’s a popular topic in nursing. It’s tough to know how to maintain a good work/life balance and show compassion for patients while still preserving your own mental and physical health.

Vidette Todaro-Franceschi, PhD, RN, FT, Professor, The College of Staten Island & Graduate Center, both of the City University of New York, is also the author of Compassion Fatigue and Burnout in Nursing. As the second edition of the book recently published, we asked her questions about how things have changed.

What are some of the biggest changes that you’ve observed regarding compassion fatigue and burnout in nursing since the first edition of the book?

Since the first edition in 2012, a greater emphasis is being placed on the relation between nurse well-being and patient care, as evidenced by the growing body of research and practice literature. There are more studies being performed in the area of professional quality of life, and the significance of having a “happy” as well as “healthy” workforce is finally getting proper attention.

A number of nursing organizations have advanced various programs to foster a healthy work environment and promote work-life balance. For example, in 2013 the American Nurses Association (ANA) launched an initiative with the development of a professional issues panel to address nurse fatigue. Since then other professional issues panels have been formed to focus on moral resilience and workplace violence, among others. In 2017, the ANA began a critical initiative called the Healthy Nurse, Healthy Nation Grand Challenge (HNHN GC), which is geared toward enhancing both nurse well-being and the health of the nation—a win-win for all.

Lastly, years ago I would have been tarred and feathered for saying that no one coming to work should be asked to leave their baggage at the door, or that it was ok for a nurse to say, “I need a mental health day” or “I just cannot do it.”  Today, I think, there is recognition that we—nurses—are human beings; we feel, we hurt, we cry, and it’s ok.

What are the biggest challenges for nurses experiencing poor professional quality of life?

The biggest hurdles for nurses who are experiencing professional quality of life issues (related to: compassion fatigue, moral distress, incivility, lack of preparedness to care for patients who are dying, death overload, PTSD, burnout, unhealthy work environment) are: acknowledging that there is a problem, recognizing that there are choices and actions that they can take, and lastly, turning toward self and other(s) in ways that foster health and contentment. These three things form the basis of ART^©, a mindful awareness model, which I developed to assist nurses and other carers to enhance their professional quality of life. 

Mindful awareness is the key to acknowledging how one feels (the A of ART). However, this can be challenging, since the majority of nurses work in fast-paced, chaotic places and are not paying much attention to how they feel as they go about their work. In fact, coworkers, friends, or family members may identify that there is a problem before the suffering nurse becomes aware. Hence, nurses should engage in mindfulness at work (and at home) in order to acknowledge both the good and the bad feelings associated with their work (with the goal to maximize the good and minimize the bad).

Once a problem has been acknowledged, it is essential to figure out what choices one has and what actions can be taken to fix whatever needs fixing. This can be another difficult hurdle for some nurses. A nurse might think that she/he has no choice(s), or may be fearful of change. Nurses need to recognize that there are always choices (doing nothing is a choice), and then intentionally choose and take action to change their work circumstances (the R of ART).

The last part of ART is turning toward self and other(s) (the T of ART), which entails connecting and/or reconnecting with the things that contribute to health and happiness, whatever those things might be. Nurses need to put the oxygen mask on their own faces first, figure out what makes them happy, and what will contribute to their well-being. Of course, this is easier said than done because nurses are typically self-sacrificing and altruistic. But nothing good can come from self-sacrifice that results in an unhealthy, unhappy person, especially one who is responsible for the health and well-being of others.

Making changes in eating, drinking, sleeping, and exercise habits can be difficult. Motivating oneself to go out with friends or family, or even to go out for a walk around the block may seem incredibly daunting when one is physically or emotionally exhausted and unhappy. Turning towards self and other(s) has to be taken one small step at a time, mindfully. Eventually, new good habits can replace old bad ones.

What improvements have occurred for nurses who experience professional quality of life issues such as compassion fatigue and burnout?

With greater awareness of the importance of nurse well-being for patient care quality, in many settings, health care administration is focusing efforts on creating a healthier, happier workforce. For example, many workplaces now have wellness, meaningful recognition, and resiliency programs.

What do you think is most surprising to people and/or nurses regarding compassion fatigue and burnout?

The fact that many individuals are compassion fatigued or burned out (or other things), without realizing it. Whenever I teach and/or talk about it, there seems to be this reverberating AHA! 

Anything else?

People who work with all living beings (humans and animals) should be educated about professional quality of life issues. They should know how to identify compassion fatigue, moral distress, death overload, PTSD, and burnout as well as the effects these things can have on their health/well-being, work productivity, and patient safety. 

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