MSN, RN, NPD-BC
Whether you just graduated or have many years of nursing experience, at some point, you’ve heard the phrase, “compassion fatigue.” The possibility of experiencing compassion fatigue, in any nursing setting, is always present. And while the concept isn’t new, there has been more acknowledgment of the issue, particularly among emergency department (ED) nurses.
Some studies show that ED nurses have about 25% higher levels of compassion fatigue than nurses in other areas. As we all know, the ED can be a fast-paced, stressful environment with its fair share of traumatic and emotionally distressing experiences. Because of this, the first thing we may think about is the physical and mental effects of being an ED nurse.
However, significant neurological effects can occur because of compassion fatigue.
I am in no way attempting to deter anybody from becoming an ED nurse. It’s is an honorable calling. If anything, I want to share knowledge so that, if there are signs of compassion fatigue, you are better equipped to take care of yourself.
Let’s dive in further, beginning with the foundation of what compassion fatigue is, the neurological effects, and strategies on how to manage it.
Carla Joinson coined the term “compassion fatigue” in 1992, referring to it as the “cost of caring” and the “loss of the ability to nurture.”
Since then, varying definitions for compassion fatigue have come into play. Simply stated, compassion fatigue “describes the physical, emotional, and psychological impact of helping others — often through experiences of stress or trauma.” Some may refer to it as secondary stress reaction, secondhand shock, secondary traumatic stress, or vicarious trauma. This is mostly because it’s associated with occupations that may have stressful environments.
This is not to be confused with the term “burnout,” which is more a byproduct of what you might experience due to compassion fatigue. This will be discussed later when I get into the impact compassion fatigue has on nurse well-being and patient care.
Aside from the urgent care cases (common colds, etc.), patient acuity in the ED is generally high. Caring for the critically ill and critical injuries can be emotionally and mentally taxing. Unlike other areas where you may care for the same patients for the full 12-hour shift, the ED has high patient turnover. There’s a constant flow of patients, which does not allow for adequate breaks during most shifts.
ED nurses work with patients who have alcohol or substance-use disorders, psychiatric patients, life-threatening injuries, and more. Many ED nurses have a mindset that they know what they signed up for. Dealing with stressful encounters is a part of the job. It is common to think you’ve built up a tolerance. But there are only so many times you can witness traumatic events before they start to affect you.
Exposed to traumatic events on a regular basis can result in secondary traumatic stress. Where a nurse may think a tolerance has been built up, the reality is the constant stress can affect resilience over time.
A supportive work environment allows nurses to provide adequate patient care. Challenges such as understaffing, limited resources, and feelings of insufficient support from leadership, can intensify compassion fatigue. As stated before with patient volume, the inability to take breaks during a longer shift can also contribute to physical and emotional exhaustion.
The neurological effects associated with compassion fatigue are multi-dimensional. Below I will discuss the areas where compassion fatigue can lead to adverse neurological effects:
Compassion fatigue can activate the hypothalamic-pituitary adrenal (HPA) axis. The HPA is the communication system between the hypothalamus, pituitary gland, and adrenal glands. Its function is to regulate the body’s stress reaction by releasing stress hormones, such as cortisol.
Chronic activation of this stress response can result in persistent high cortisol levels, which can cause immune system dysfunction, cardiovascular issues, and metabolic issues. Chronic stress response also causes neurological issues, disrupting neurotransmitters, such as serotonin and dopamine, which are instrumental in mood regulation and cognitive function.
High levels of stress hormones can cause structural changes in the brain, leading to memory issues. This is due to the impairment of the hippocampus. In addition to memory impairment, chronic stress can affect the prefrontal cortex. This subsequently affects judgment, decision-making and problem-solving abilities. It affects how the brain decides whether to persist or quit.
Compassion fatigue can also lead to increased amygdala activity. Known as the brain’s “fear center,” the increased activity can result in symptoms of anxiety and depression, or even emotional numbness. You might develop an emotional detachment — a precursor to apathy in patient care.
Muscle tension from chronic stress affects the neck, shoulders, and back, not to mention more frequent headaches or migraines. The neurological issues associated with compassion fatigue can disrupt sleep patterns, further exacerbating cognitive and emotional issues, along with increasing physical tiredness.
It is often said that you cannot pour from an empty vessel. The care of a patient is only as good as the well-being of the nurse.
Considering all the effects already discussed, the well-being of the nurses has a direct effect on the level of care we can provide. The numbness mentioned earlier affects the level of empathy we have for our patients. Empathy is the very foundation of what we do. When that is altered, the quality of nurse-patient interactions is affected.
In the same frame, cognitive impairment can have a serious impact on quality of care. Imagine being cognitively impaired as a nurse and having difficulty with memory and decision-making. This can lead to medical errors. For the sake of patient safety, it is important to know how to manage compassion fatigue.
It sounds cliché, but “self-care” shouldn’t just be a trendy phrase. It is so very important.
The care you provide as a nurse is only as good as your well-being. Treat yourself right physically through an exercise regimen, regular check-ups, and food that nourishes the body. Try your best to get adequate sleep. If you have not reached that goal, no judgment. I think many of us are a work in progress in that regard.
Reflect on why you became a nurse. Focus on the parts of your job (and of your life) that bring you joy and peace. Be intentional about what you allow to consume your thoughts. Initial thoughts are inevitable and uncontrollable. However, we do not have to dwell on them.
Catch those negative thoughts, take a moment to breathe deep, and fight them with positive words of affirmation and express gratitude. Infuse a little humor into your everyday life. USE YOUR PAID TIME OFF (PTO). I cannot stress this enough. Make a choice to recharge and refill your cup. Again, no judgment. I know this is easier said than done.
Remember that self-care does not necessarily mean you must do this alone. Find your crew at work and outside of work. The last thing anyone should do is pretend as if the overwhelming aspects of life and work are not happening. Your crew is the set of people you feel comfortable laying pride to the side and being transparent with.
This can help promote work-life balance. The reality is that there are some people who can exacerbate an already overwhelming situation. You have the choice of how long to be around negative people. We all know at least one “Negative Nancy” that always sees the glass half empty and can cause low morale to spread around your department like wildfire. Choose to gravitate toward high performers and those who acknowledge the reality of a grave situation without adding more negativity.
Debriefing sessions after a traumatic event are imperative. This gives caregivers a structured environment to discuss experiences, feelings, barriers, and a plan moving forward. It also creates a sense of emotional support. As stated before, no nurse should go through compassion fatigue alone. Alone time to process everything is healthy. Isolation is not.
Debriefing can be one-to-one or in small groups, informal and peer-facilitated or leader-facilitated. It is beneficial in reducing stress levels and promoting social support among colleagues.
However, it’s not exclusive to traumatic incidents. Cumulative stress debriefing sessions can address gradual accumulation of stressors from multiple sources over time. Studies have shown that cumulative stress debriefings can significantly reduce compassion fatigue symptoms and improve job satisfaction in nurses.
Peer support is valuable; however, leadership support also makes a world of difference. Nurse leaders should be able to recognize signs of compassion fatigue and address issues in real-time. Not only is this a matter of caring for your staff, but it can improve retention. In all honesty, everyone from staff to leadership should receive some form of education related to compassion fatigue, coping strategies, and resilience.
There is no shame in seeking professional therapy. Break the stigma that therapy means you are crazy or weak. If anything, seeking professional assistance means you are exercising wisdom. The first step would be to seek options through your organization’s employee assistance program.
The term compassion fatigue has been thrown around as a buzz word for years. However, if you have not done so already, it is time to take compassion fatigue seriously. Whether you are an emergency department nurse or a nurse in another area, recognizing the signs and implementing prevention and management strategies creates an environment where nurses can thrive. As a result, we can see better nurse AND patient outcomes. I wish you all the best! Be well!
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