In July 2021, over half of the coronavirus patients admitted to intensive care units in Springfield, Missouri, hospitals died. Such a high loss of life must have taken a heavy toll on the nurses working in those COVID units. Situations like these and others during the pandemic have placed unprecedented pressure on the health care community.
While treating critically ill and dying patients in crowded spaces, nurses have had to deal with their own fears of contracting the virus. Moreover, safety restrictions that prevented family members from visiting dying relatives left nurses with the task of comforting patients during their final moments.
These challenges have overwhelmed nurses and led to other issues that can impact patient care, most notably nurse burnout and compassion fatigue. Working in high-risk situations, such as pandemics and disasters, can result in nurses experiencing psychological problems.
For these reasons, nurse leaders play an instrumental role in effectively addressing nurse burnout and compassion fatigue. Understanding these conditions and how they differ from one another empowers nurse leaders to implement strategies that can prevent them.
What Is Nurse Burnout?
Like most professionals working in high-pressure situations, nurses can feel emotionally and physically exhausted after a long shift. They may also experience days when they feel detached or even uncertain of their ability to do their job. However, nurse burnout goes beyond a single bad day or even week at work. What is nurse burnout then?
The World Health Organization (WHO) defines nurse burnout as an "occupational phenomenon" that can occur when ongoing stress on the job isn’t adequately managed.
Burnout happens when nurses continuously feel emotionally exhausted, full of self-doubt, and cynical toward their patients and fellow health care workers. Diminished feelings of personal accomplishment are also characteristic of nurse burnout.
Factors Associated With Nurse Burnout
Typically, burnout occurs when nurses experience problems or an imbalance for a prolonged time period in one of the following areas:
Excessive work hours can easily lead to physical and mental fatigue. Long shifts can result in sleep deprivation and insufficient time to recover from the psychological stress inherent in nursing. Additionally, nurses assigned more responsibilities than they can handle or given insufficient resources to properly complete their duties may also experience high stress levels. If stress accumulates over time with little or no relief, nurses may develop burnout.
To feel gratification in their work, nurses need to maintain a certain level of control over how they do their job. Micromanagement can deprive nurses of their autonomy — a key element of job satisfaction. It also signals a lack of trust, potentially compounding nurses’ anxiety about their work and shaking their confidence.
Hard work deserves fair compensation. Health care facilities that underpay nurses or fail to provide them with opportunities for promotions they’ve earned diminishes job satisfaction. A lack of recognition can also leave nurses feeling undervalued and underappreciated.
A sense of belonging at work can help offset the stress that nurses experience on the job. Camaraderie and cooperation help relieve the burden of a hard day as well. However, work environments that lack a sense of community can leave nurses feeling isolated and unsupported, compounding any difficulties they may experience.
Fair work environments foster employee engagement and satisfaction. Conversely, when nurses experience unequal treatment from supervisors or unfair practices that favor some individuals over others, they may feel less safe and may not feel respected. This can contribute to the mental exhaustion associated with burnout.
Consequences of Nurse Burnout
The emotional and physical fatigue associated with nurse burnout can interfere with a nurse’s ability to function well. This not only affects a nurse’s well-being but also harms patient care and satisfaction.
Symptoms of fatigue associated with nurse burnout include the following:
- Inability to concentrate
- Poor recall
- Impaired judgment
- Diminished ability to communicate
It’s no wonder then that nurse burnout can affect a nurse’s job performance. With less energy and compromised critical thinking capacity, nurses experiencing burnout may struggle to make sound clinical decisions, possibly causing unintentional harm to patients. This may increase the risk of accidents and reduce the quality of care delivered.
For example, overly fatigued nurses may make more errors in diagnosis and incorrectly administer medication. They may misread patient charts or miscommunicate information to other health care providers.
Burnout also affects how nurses interact and communicate with their patients. Since the condition often makes nurses feel distant and detached, patients may find them insensitive or uncaring — negatively impacting the patient-nurse relationship.
This, in turn, can harm patient health outcomes. A recent study published in the International Journal of Environmental Research and Public Health found that the relationship between nurses and patients affects the quality of care that patients receive as well as health outcomes. It also impacts the extent to which patients participate in their own health care decisions.
Research published in JAMA Network Open has shown a correlation between patient participation in health care decisions and patient satisfaction.
What Are the Signs of Nurse Burnout?
Nurse burnout manifests in different ways. Typically, nurses will exhibit behaviors that indicate both physical and emotional distress related to their job. For example, nurses may become listless and depressed or grow indifferent toward their patients. Other signs may include the following:
- Chronic fatigue
- Anxiety and panic
- A sense of dread about going to work
- Lack of joy on the job
It’s not uncommon for nurses to work 12-hour shifts. While this can cause them to feel tired, under normal circumstances, they should have opportunities to recover and get needed rest. Temporarily feeling tired, however, differs from constant exhaustion. Nurses who struggle to carry out their regular daily routines due to fatigue may be experiencing burnout.
Additionally, nurses may occasionally feel irritable or worried throughout a demanding workday. Positive feelings, like gratification from a job well done, generally offset a nurse’s anxiety, but nurses experiencing burnout may find their sense of purpose replaced by frustration. Also, occasional days of dreading work or lacking enthusiasm no longer come and go, but stubbornly persist.
Other signs of burnout that nurse leaders can look for include the following:
- Regularly arriving to work late
- Taking excessive sick days
- Resisting workplace changes
- Withdrawing from social activities at work
The Physical Effects of Burnout
Signs of nurse burnout can manifest in physical symptoms. Nurses experiencing burnout may complain of:
- Digestive problems
- Disrupted sleep and insomnia
- Body aches
The chronic fatigue typical of nurse burnout can contribute to heart disease and high blood pressure. It may also make nurses more vulnerable to illnesses such as the flu.
Early identification of burnout can stem its progression. When nurse leaders recognize the signs of burnout, they can implement strategies that lower stress levels for nurses in distress. This can provide nurses with needed support that prevents the issue from getting out of control.
The cooperative nature of the nursing profession makes managing nurse burnout critical to maintaining a high level of care. Burnout reduces a nurse’s performance and concentration; this, in turn, can negatively affect patient outcomes and compromise the work of other nurses working as a team.
Recognizing and managing burnout also protects the well-being of the nurses themselves. Health care organizations have an obligation to take the steps needed to shield nurses from the damaging effects of burnout.
Nurse Burnout Prevention Tactics
Though nurses can’t control many of the factors that lead to burnout, they can practice behaviors that help reduce stress and stave off the condition.
Self-Care for Nurses
The American Nurses Association (ANA) Code of Ethics for Nurses exhorts nurses to take care of their own health and safety. Indeed, maintaining one’s own health makes it possible to care for someone else’s. However, the demands of the profession can cause nurses to neglect self-care. It’s critical that nurses keep in mind the importance of getting sufficient exercise and sleep, as well as taking care of their mental health.
Consider the following strategies that can help protect a nurse’s well-being:
Relaxation techniques, such as mindfulness meditation, can help alleviate stress and create balance in a nurse’s life. They can also build awareness, improve emotional regulation, and foster positive thinking, all very useful accomplishments for nurses experiencing burnout.
A recent study in the Journal of Holistic Nursing found that by practicing mindfulness meditation, nurses increase self-compassion and decrease self-judgment. Ultimately, the researchers concluded that mindfulness meditation helps mitigate nurse burnout.
Nurses often carry out demanding physical tasks. Eating a healthy diet and getting proper exercise can play an important role in ensuring that nurses have the energy to keep up. However, job-related stress and variable hours can affect what and how much nurses eat, leading to over- or undereating. For these reasons, nurses can reap important benefits from prioritizing their nutrition and physical activity.
By prepping healthy meals in advance and scheduling time to work out, nurses can boost their immune system. Good nutrition also delivers essential nutrients to the brain, producing stress-reducing effects.
Nurse Support Groups
Social and peer support can serve as an invaluable outlet to nurses feeling overwhelmed by their job. Support groups offer nurses safe, nonjudgmental spaces to share their thoughts and process their experiences with others who understand. This helps relieve some of the built-up pressure. It can also give nurses a chance to share strategies for managing job-related challenges.
Support from Nurse Leaders
Nurse leaders can help manage burnout by providing their nursing staff with the appropriate support. This involves creating a culture that promotes nurse safety and wellness. Positive work environments that encourage healthy practices reduce job stress and can decrease burnout.
In addition to developing a system that monitors nurse stress levels, nurse leaders can implement programs that encourage nurses to practice self-care and teach them strategies for managing their stress loads.
By offering incentives such as bonuses or paid time off to participate in wellness programs, nurse leaders can increase staff involvement. Effective techniques that nurse leaders use to promote wellness in the workplace include the following:
Wellness coaching programs can connect nurses to social workers, nutritionists, and fitness instructors to provide guidance on managing their mental and physical health. By providing nurses with on-site or virtual coaching programs, nurse leaders empower their staff to adopt healthier eating habits, practice mindfulness techniques, and learn new relaxation methods.
Access to Fitness Centers
Nurse leaders can encourage nurses to stay active by setting up on-site exercise rooms where they can conveniently work out before or after their shifts. Nurse leaders may also arrange for on-site fitness classes or create partnerships with nearby fitness centers that give nurses discounted or free access.
A supportive workplace community helps raise nurse morale and reduce conflict. This means that even during stressful times, nurses will feel that they can turn to one another for understanding and cooperation. By promoting positive relationships between nurses, nurse leaders help reduce stress levels and build trust.
Ways to build a sense of community among nurses include the following:
- Designating time in staff meetings for personal sharing
- Celebrating nurse milestones, accomplishments, and birthdays
- Organizing community events, such as diabetes walks
- Initiating discussions with nurses to explore their ideas, concerns, and values
What Is Compassion Fatigue?
Nurses are exposed to the trauma and suffering of their patients. They regularly care for patients in pain or treat patients dealing with devastating diagnoses or conditions. This places intense emotional demands on nurses who may then personally absorb their patients’ experiences as secondary trauma.
While helping patients through their suffering can provide nurses with profound satisfaction, over time it can also lead to compassion fatigue. Physical, emotional, and spiritual exhaustion characterizes compassion fatigue, as does a compromised ability to complete job responsibilities. Nurses in this destructive emotional state also feel confused, isolated, and powerless to care for others.
Symptoms of compassion fatigue include the following:
- Decreased pleasure in life
Nurses experiencing compassion fatigue typically struggle to empathize with their patients. Instead, they feel removed from them and focus on the technical side of their work, neglecting the compassionate aspects of their role.
Burnout vs. Compassion Fatigue: Key Differences
To understand what compassion fatigue is, it’s useful to explore how it differs from burnout. While physical and emotional exhaustion characterize both conditions, each has notable differences.
The repeated exposure to trauma that leads to compassion fatigue often alters a nurse’s ability to feel compassion. Burnout doesn’t. While burnout does lead nurses to depersonalize their patients, it doesn’t necessarily interfere with their ability to connect with people in other relationships. A stressful, negative work environment causes burnout, whereas the impact of caring for others causes compassion fatigue.
Onset also separates the two conditions. Compassion fatigue can occur right after a nurse experiences secondary trauma. Burnout typically develops over time as work stress accumulates.
What Triggers Compassion Fatigue?
Several factors that can contribute to compassion fatigue include heavy caseloads, limited resources, and stressful work environments. Situations that lead to compassion fatigue include the following:
- Providing care for those in mourning
- Delivering care in dangerous environments
- Confronting suicide
Nurses with a tendency to prioritize patients’ needs over their own also face a significant risk of developing compassion fatigue.
A systematic review of numerous studies on compassion fatigue published in JBI Evidence Synthesis generated some valuable insights about what triggers compassion fatigue. The research found an association between nurses’ feelings of powerlessness and their experience of compassion fatigue.
Situations that can provoke feelings of powerlessness may include the following:
- Wanting to provide needed care to a patient while lacking the support or skills needed to do so
- Delivering quality care with compassion, but failing to change the patient’s health outcome
Experiences such as these can deplete nurses’ emotional resources and leave them vulnerable to compassion fatigue.
Additionally, becoming overly involved with patients poses significant risks. One of the greatest rewards of nursing is the connection that caregivers forge with their patients. However, strong connections coupled with loss can drain nurses and result in compassion fatigue.
Compassion Fatigue: Nursing and Care Delivery Impact
Like nurse burnout, compassion fatigue doesn’t just harm the nurses experiencing it. It also impacts patient care delivery by reducing a nurse’s work performance. The poor health and hopelessness associated with compassion fatigue often affect a nurse’s judgment, which can lead to medical errors.
Numerous studies have established that empathy in health care plays an important role in achieving optimal health outcomes. Empathetic nurses better understand patients’ feelings and opinions, enabling them to conduct accurate assessments and design treatment plans that improve patient health.
The gradual erosion of empathy characteristic of compassion fatigue disrupts the patient-nurse dynamic. When nurses lack empathy, their ability to communicate with patients suffers. This can impact their ability to build trust with patients. Poor communication can also affect patient safety and the patient experience.
The consequences of lack of empathy may include patients receiving:
- Delayed tests
- Incorrect medications
- Wrong treatments
Effects of Compassion Fatigue on Professional and Personal Relationships
The emotional distress that compassion fatigue causes can affect how nurses relate to their colleagues and family members. Nurses’ inability to feel empathy for patients can extend to other relationships, compromising their interactions with peers and loved ones.
For example, hospice nurses who lose several patients in a short time span may become reluctant to get close to new patients. They may struggle to sleep; grow anxious; and begin to make mistakes, such as administering incorrect doses of medication. These errors may shake their confidence, causing them to withdraw from their colleagues. Already overwhelmed, nurses experiencing compassion fatigue may resent other nurses who need their help. They may snap at them or be uncooperative.
Additionally, small stresses at home may feel more weighty. This may increase tension with their spouse. If they also care for children or older family members, nurses may respond to them with indifference or feel helpless to adequately meet their needs.
What Are the Signs of Compassion Fatigue?
Combating compassion fatigue starts with identifying it. The condition affects nurses’ thoughts, behaviors, and moods in ways that interfere with their professional and personal lives. Common signs of compassion fatigue include both physical and emotional and behavioral symptoms.
Physical Symptoms of Compassion Fatigue
Helping others through traumatic events can disrupt a nurse’s physical well-being. The stress and emotional overload of compassion fatigue can manifest physically. Common physical symptoms include the following:
- Digestive problems
- Sleep problems
- Muscle aches
- Heart problems
Additionally, nurses experiencing compassion fatigue may notice changes in appetite, difficulty concentrating, and diminished memory.
Emotional and Behavioral Symptoms of Compassion Fatigue
Compassion fatigue also affects nurses’ emotions and behaviors. The condition not only diminishes self-worth but also creates feelings of numbness. As a result, it can cause nurses to isolate themselves, neglect friendships, and disconnect from peers at work.
Compassion fatigue frequently causes nurses to experience severe mood swings and develop pessimistic attitudes that can alienate friends and family. It can also lead to hypersensitivity. The depression associated with compassion fatigue may result in difficulty concentrating and restlessness. Another common manifestation of compassion fatigue is addiction or self-medication. Nurses may turn to alcohol, drugs, or gambling in an attempt to soothe their pain.
Nurse leaders have the power to equip their team with coping strategies to manage and recover from compassion fatigue. For this reason, it’s crucial for nurse leaders to promptly recognize the warning signs. By taking timely steps to implement compassion fatigue interventions, nurse leaders can safeguard the well-being of both nurses and their patients.
Preventing Compassion Fatigue: Tips and Tactics
Nurses can adopt self-care strategies to protect themselves from experiencing compassion fatigue. Building emotional resilience and developing coping strategies also plays an important role in strengthening their ability to manage the challenges of the job.
Nurses are driven to take care of others. However, it’s imperative that they also take care of themselves. To keep compassion fatigue at bay, nurses should get sufficient rest, maintain a healthy diet, and stay physically active. This gives them a chance to recover and refuel.
Practicing meditation and other relaxation techniques, such as breathing exercises and yoga, can also help bring peace of mind and help nurses manage the stresses they encounter.
Making a conscious effort to maintain a healthy work-life balance helps ensure that nurses have the time necessary to replenish their emotional well and take care of their own physical health. Without any renewal time, nurses will likely lack the energy to consistently exhibit compassion and connect with their patients.
Building emotional resilience helps nurses avoid damaging states of mind. The term "emotional resilience" refers to the skills, knowledge, and insights nurses develop that enable them to overcome adverse events. Emotionally resilient nurses work to:
- Regulate their emotions and self-calm
- Project hope and optimism
- Avoid harsh judgments about themselves
- Acknowledge and process their emotions
Nurses can also build emotional resilience by developing support systems to help them cope with challenges. They may, for example, seek out counseling or classes on stress reduction through their organization’s employee assistance program. They may also adopt coping rituals that help them deal with the grief they may experience on the job.
Nurse leaders can play a valuable role in promoting personal wellness and emotional resilience among their nursing team. By creating environments that encourage staff to adopt self-help tactics or, if necessary, seek therapeutic help, nurse leaders can prevent compassion fatigue.
For example, nurse leaders can create on-site respite centers to give nurses a place to unwind. They may provide regular sessions of healing touch treatments for their staff or devote discussion time to personal wellness during staff meetings.
Compassion Fatigue Resources and Tools
To combat compassion fatigue, health care providers should highlight the various resources that nurses can access to avoid or overcome it, such as support groups or reading materials that address the issue.
In turn, nurses should access the various resources to overcome compassion fatigue. Support groups provide nurses with a network of understanding peers who listen and who can offer advice. Additionally, nurses can find a host of reading materials that address the issue and discuss coping strategies and insights for overcoming compassion fatigue.
Organizations such as the Compassion Fatigue Awareness Project provide suggested reading lists that direct nurses to useful articles or books on the topic.
The American Nurses Foundation recently launched the Well-being Initiative, which provides resources to help nurses manage the trauma and stress from COVID-19. The project gives nurses access to various digital tools and information on mental health and wellness.
To help nurses recognize and process their stress and trauma, the initiative has organized virtual groups for nurses where they can express their thoughts. The Well-being Initiative focuses on providing both responsive and prevention measures, such as:
- Writing workshops
- Peer-to-peer conversations
- "Warmlines" (similar to hotlines but not meant for crisis situations)
- Cognitive processing techniques
- Mindfulness exercises
- Educational materials
Some of the initiative’s specific offerings include the following:
Nurses Together: Connecting through Conversations
With Nurses Together: Connection through Conversations, nurses looking for peer support can connect with other nurses through video calls. These one-hour video calls, which volunteers lead, offer a safe space for nurses to explore issues related to wellness, recovery, grief, and care dilemmas.
Narrative Expressive Writing
Writing helps process distress, increase mindfulness, and build resilience. Narrative Expressive Writing is a five-week program that gives nurses writing prompts related to COVID-19 and allows them to respond anonymously. A qualified leader reads what nurses have written and offers confidential feedback.
The Happy app aims to deliver emotional support 24/7 to nurses struggling with anxiety, fear, daily life, or life and death issues. It connects nurses to a team of support givers who provide one-on-one help.
Assessment tools are another important resource for tackling compassion fatigue. Nurse leaders can use these tools to assess their staff’s risk of compassion fatigue.
Assessment tools present a list of invisible and visible signs of compassion fatigue and ask nurses to identify any items that apply to them. For example, the assessment may ask nurses if they secretly avoid interactions with patients or have outbursts over minor issues. Then, based on how many signs are identified, the assessment can determine the presence or absence of compassion fatigue.
When administering these assessments, nurse leaders can engage their teams in discussions about compassion fatigue, its dangers, and strategies for managing it.
Creating a Happier, Healthier Care Delivery Team
Shielding nurses from burnout and compassion fatigue is crucial for nurses’ well-being and patient safety. By implementing programs that identify and address these two issues, nurse leaders can promote healthier work environments and ensure better patient outcomes.
Explore how Hawai’i Pacific University’s Master of Science in Nursing online program trains nurse leaders to build happier and healthier care delivery teams.