How Trauma Nurses Can Combat Compassion Fatigue

Compassion fatigue is more than burnout. For trauma nurses, this may include referring to patients by their diagnoses, not their names. It’s feeling a lack of personal accomplishment. It’s no longer wanting to help colleagues. The only goal becomes clocking in and out each day.

“Compassion fatigue is the combination of burnout and what we call secondary traumatic stress,” says Lesly Kelly, PhD, RN, FAAN, a researcher at CommonSpirit Health and Arizona State University who examines nurse and patient outcomes associated with clinician well-being.

Her funded research includes studies on nurse burnout, the healthcare work environment, and leadership behaviors. “We all know burnout- It’s the emotional and physical exhaustion, not just ‘I’m tired,’ but ‘I can’t do this anymore’ beyond tired. Secondary traumatic stress is the exposure to patients’ suffering and exposure to traumatic events and picking up that trauma and experiencing the same symptoms.”

There are more than 3.8 million registered nurses in the U.S., making it the nation’s largest healthcare profession. Prior to the COVID-19 pandemic, 30% to 40% of nurses reported some level of burnout or moderate burnout and that’s not even taking into account the unknown prevalence of secondary traumatic stress, said Dr. Kelly. It’s also safe to assume that burnout among trauma nurses has dramatically increased during the pandemic that’s killed millions of Americans.

Women experience higher rates of burnout than men, and younger and less experienced nurses show higher levels of burnout regardless of specialty. Burnout is associated with higher risk for cardiovascular disease, higher body mass index, higher cholesterol, as well as insomnia, depression and mental disorders.

Unseen effects may include substance abuse, post-traumatic stress disorder and suicide. Female nurses are twice as likely to die by suicide than the general population and 70% more likely to commit suicide than female physicians, according to a University of Michigan study published in 2021.

There are multiple ways for trauma nurses to combat burnout and compassion fatigue.

• • Be aware of the warning signs of burnout and compassion fatigue and talk to your family so they’re also aware. Recognize the difference between a bad day and something more serious. Read more about the symptoms here.
  • Find ways to reduce stress, including deep breathing exercises, meditation, mindfulness and journaling. Develop interests outside of work that make you happy and replenish your energy levels. Focus on kindness and letting go.
  • Get enough sleep.
  • Exercise, hydrate and eat a healthy, balanced diet.
  • Be grateful, even for the smallest of things. Each day, write down three good things in a journal. “Science shows that when put gratitude into our day, we have more joy and more positive interactions,” Dr. Kelly says.
  • Seek compassion satisfaction through positive patient interactions, professional growth and development and focusing on aspects of nursing that bring you joy.
  • Build personal resilience. Harvard Business School offers five ways to build your personal resilience at work.
  • Find a supportive work environment that seeks to mitigate the inevitable trauma of being a nurse. Examples include hospital chaplain services, employee assistance programs (EAP) or post-code pause and moment of silence following a trauma/code event to allow for a moment to regroup before rushing to the next patient.

In May 2019, the World Health Organization revised the 11th edition of the International Classification of Diseases to note burnout as an occupational phenomenon, not a medical condition. Burnout and compassion fatigue can have a detrimental effect on organizations as well, leading to worsening patient care, higher mortality rates, job dissatisfaction among clinicians, decreased productivity and turnover.

“This is not your issue, 100% this is a workplace issue,” Dr. Kelly says. “Now we absolutely know that burnout comes from your work environment. It’s important to do all the individual resilience work— the journaling, deep breathing and meditation— but if you keep going back to a bad work environment, it will never get better.”

Dr. Kelly says healthcare organizations must begin by acknowledging and talking about burnout and compassion fatigue. Some already do a good job at this, but it must become commonplace. The next step is measurement- just as employers measure employee satisfaction and engagement, they need to measure their own employees’ wellbeing. The next step is for each organization to act on their specific wellness data, she said.

“We must work on reducing the stigma (of burnout and compassion fatigue),” Dr. Kelly said. “People still have a fear of calling their EAP program or saying they need time off for mental health or a counseling appointment. We need to put resources in place to talk about this and to make people feel safe to interact with those resources.”

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