Expert advice

Compassion fatigue: how to know if you have it and how to support team members

What to do when the emotional and physical toll of caring reduces your ability to empathise

What to do when the emotional and physical toll of caring reduces your ability to empathise

Compassion fatigue is sometimes described as the cost of caring, where emotional and physical exhaustion lead to a reduced ability to empathise or feel compassion for others.

While there is no universal definition, it is often used to describe the experience of healthcare staff. More loosely, it refers to situations where people feel unable to respond to a request for help because they have faced so many demands already.

What are the key signs and symptoms of compassion fatigue?

The Institute for Employment Studies (IES) says it is characterised by emotional and physical exhaustion, and a decrease in the

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What to do when the emotional and physical toll of caring reduces your ability to empathise

Picture: Annette Taylor-Anderson

Compassion fatigue is sometimes described as the ‘cost of caring’, where emotional and physical exhaustion lead to a reduced ability to empathise or feel compassion for others.

While there is no universal definition, it is often used to describe the experience of healthcare staff. More loosely, it refers to situations where people feel unable to respond to a request for help because they have faced so many demands already.

What are the key signs and symptoms of compassion fatigue?

The Institute for Employment Studies (IES) says it is characterised by emotional and physical exhaustion, and ‘a decrease in the ability to empathise and nurture others’. It differs from burnout, the IES says, in that it can arrive suddenly.

There may also be physical symptoms, such as poor sleep or nightmares and physical fatigue.

Some healthcare workers may overeat or use alcohol or drugs to try to cope with their feelings. Others will struggle to escape from their feelings about what they have seen at work when they are at home.

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How prevalent is it in nursing and wider healthcare?

Research on compassion fatigue – much of which was conducted abroad – suggests that intensive care nurses and those working 12-hour shifts may be more prone to compassion fatigue.

Estimated rates have ranged from just over one in five nurses to nearly 45%, with one study of more than 1,000 hospital nurses in China suggesting four out of five nurses have experienced compassion fatigue.

However, rates are likely to be dependent on so many varying factors that it is hard to estimate.

It is often assumed that the pandemic will have led to more compassion fatigue among nurses, due to the tremendous suffering they have seen and the difficult situations many have faced, such as working in unfamiliar and high pressure areas. But there is, as yet, little research published on this.

RCN professional lead for mental health Stephen Jones cautions against people’s experiences being ‘over-pathologised’.

There will be some people who have post-traumatic stress disorder and require therapy, but this may not be beneficial for everyone, he says. Mr Jones says a particular pressure for nurses during the COVID-19 pandemic may have been the conflict between wanting to care for patients and wanting to keep their families – especially older or vulnerable members – safe.

How can nurses safeguard themselves against it?

Coping strategies can include peer support and debriefing – including talking about distressing cases or circumstances – as well as support from managers and more senior nurses.

According to one meta-analysis, this support could include assisting team members at particularly pressurised times and role modelling how they cope with the pressures of the job.

Self-care was also seen as important as a coping strategy among nurses, including taking exercise, in the studies analysed.

In some cases, nurses may seek counselling to help cope with their emotions. Some psychologists stress the importance of compassion satisfaction – concentrating on the positive feelings that arise from caring for people and the difference healthcare work can make.

But Mr Jones points out that employers should be looking at prevention, and creating a culture that supports healthcare workers, as outlined in the King’s Fund publication The Courage of Compassion. ‘Organisations need to be mindful and understanding,’ he says.

One key area may be annual leave: many staff did not take their full allowance of leave in 2020-21 and have carried it forward, he says. Taking that leave as soon as possible may be important in helping them recover.

How can line managers support nurses with compassion fatigue?

Reducing nurses’ exposure to trauma may not have been possible during the pandemic and some nursing roles will always involve this.

But there are things that nursing managers can do to reduce the impact of such exposure and to support nurses who are affected.

This includes ensuring rotas are not too onerous and that nurses take their breaks; research shows compassion fatigue can develop when nurses feel they can no longer deliver safe and high quality care.

Encouraging teams to debrief – perhaps by working this into schedules – and supporting professional reflection will also help, the research suggests.

Many NHS trusts are investing in more psychological support for staff, and senior nurses could facilitate referrals to these services where appropriate.

Line managers can help by ensuring staff can take breaks Picture: Chris Balcombe

I think I have compassion fatigue: what should I do?

If you are considering the possibility that you have compassion fatigue, you have already taken the first step by acknowledging it: denial is common among those who are experiencing it says the Compassion Fatigue Awareness Project.

There are online tests used to ‘diagnose’ compassion fatigue, such as the Professional Quality of Life Scale, which is aimed at nurses and other key professional groups.

Compassion fatigue should not be viewed as a personal failure, but more as a measure of the pressures you have been under and what you have been exposed to.

If you feel you need support, your employer should be able to offer the support of a counselling or occupational health service.

Your line manager may also be able to help, by ensuring you are able to take breaks and access debriefings and supervision.

RCN members can also contact the college’s counselling service for support.


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