Compassion Fatigue: Recognize It and Address It in Healthy Ways

Maybe it hits you one day in the ICU, where you’ve been caring for COVID-19 patients since Day One, or walking into the room of a new patient after report: Why does this all feel robotic? Why is it so hard to muster up the empathy I normally feel for my patients and their family members? What’s going on with me?

These feelings could be signs of compassion fatigue. 

What is Compassion Fatigue?

Compassion fatigue is a state of emotional withdrawal where apathy or indifference toward others is experienced. Unlike the “burnout” of everyday stress, compassion fatigue is associated with physical and mental exhaustion caused by over exposure to human suffering. This can range from repeated exposure to people in severe distress due to traumatic events like caring for seriously ill COVID-19 patients, responding to a natural disaster or even from the emotional burden that can accumulate in caring for patients over time in any care setting. 

One study into this phenomenon characterized compassion fatigue as a group of feelings and behaviors that include:

• Exhaustion
• Anger or irritability
• Unhealthy coping behaviors, including alcohol or drug misuse
• Reduced feelings of enjoyment or satisfaction in your work
• Increased absenteeism
• Difficulty making appropriate decisions for patient care
• Reduced ability to feel sympathy or empathy for patients and their family members

If you recognize the signs of compassion fatigue in yourself, you may feel helpless or feel that your nursing career is over. That’s not true. You can learn to manage your mindset to avoid developing compassion fatigue – or to eliminate its effects.

Step One: Be Kind to Yourself

If you think you may be experiencing compassion fatigue, first know that it is not some sort of failing. It is not a “character flaw.” Rather, it is an entirely human response to trauma.

The first step in healing from compassion fatigue is to recognize it and then be kind to yourself. 

Step Two: Learn to “Switch Modes” from Work to Off-Work

The Compassion Fatigue Awareness Project recommends learning how to change your mindset and feelings from a “work mode” to an “off-work mode.” Their downloadable pocket card, revised by Dr. Beth Hudnall Stamm with specific guidance related to the COVID-19 pandemic, promotes the practice of a four-step process to learn this coping technique:

1. Make this a conscious process. Talk to yourself as you switch.
2. Use images that make you feel safe and protected (work-mode) or connected and cared for (non-work mode) to help you switch.
3. Develop rituals that help you switch as you start and stop work.
4. Breathe slowly and deeply to calm yourself when starting a tough job.

It’s important to give yourself permission to “switch off” from work when you leave the workplace. As Dr. Stamm points out on the pocket card, this coping strategy is not denial. Allowing yourself to emotionally leave work behind represents self-care.

Other Ways to Cope with Compassion Fatigue

Self-care is a crucial strategy for avoiding compassion fatigue. As with clinical depression, compassion fatigue can feel exhausting and make self-care activities feel impossible to accomplish – but you should do your best to focus on your own well-being every day. Create an off-work routine that includes daily activities like:

• Sleeping and resting
• Eating nutritious foods
• Engaging in some sort of purposeful physical activity, such as walking outdoors
• Indulging in a “guilty pleasure” (spoiler alert: it’s not wrong to do something fun for yourself)
• Keeping a gratitude journal or jar that you fill with slips of paper to review at the end of the year
• Consciously giving yourself credit for all the things you did right that day
• Connecting with a friend or family member
• Meditating, praying or engaging in another spiritual practice
• Doing something nice for someone else – donating or volunteering for a non-medical charity

Nurses sometimes find it difficult to put their own needs ahead of their patients’, employer’s or family’s. Remember that no one can draw from an empty well. It’s OK to put yourself first so that you can continue to serve others.

Changing Jobs to Cope with Compassion Fatigue

If you find you cannot overcome the symptoms of compassion fatigue, then changing jobs may represent the best solution to help you recover on a physical and emotional level. When shopping for a new nursing position to avoid further compassion fatigue, consider these factors:

• Work environment. For example, if your compassion fatigue occurred while you worked in an institution like a hospital, then consider seeking employment in a different setting.
• Favorite aspects of nursing. Take some time to review and list the things you really enjoy (or used to enjoy) about nursing, then seek a position that aligns with your nursing passion. 
• Factors that led to the compassion fatigue. If caring for COVID-19 patients in the ICU led to compassion fatigue, then obviously you should avoid taking a new position with similar duties. But also look for less-obvious factors that caused the compassion fatigue, such as unsupportive coworkers, lack of supplies or poor upper management. 

All nurses should engage in behaviors that help them minimize the risk of compassion fatigue or burnout. By focusing on your own needs and learning how to switch from work mode to off-work mode, you can maintain your empathy and continue to deliver exceptional patient care – without sacrificing yourself in the process.

About the Author

Elizabeth Hanes, RN is ‘the nurse who knows' content. She is a freelance writer who combines her knowledge of nursing with over 20 years in journalism. Her unique background brings credibility and authenticity to her writing.