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What Is Compassion Fatigue in Nursing?

Compassion fatigue is very common and can lead to unhappy and unhealthy work lives for nurses. Here's what to look out for.

Stethoscope cord in the shape of a heart sitting on blue scrubs
Image via iStock.com/Fabio Balbi

Nurses are good at what they do because they care about people. It’s what gets them through the long shifts, the endless data entry, and working on holidays. But while nurses can endure a lot, there’s only so much suffering someone can witness before they start to develop compassion fatigue.

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What Is Compassion Fatigue?

Put simply, compassion fatigue is the result of caring too much for too long without enough support. Without breaks or healthy ways to cope with the trauma you’re encountering, you can max out on empathy very quickly, and that can have a negative effect on how you feel about yourself, your patients, and your job.

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What Are the Causes of Compassion Fatigue in Nursing?

Any nurse can experience compassion fatigue on the job, but not everyone does. Why? Because we’re all different and bring our own baggage (and support) to work with us every day. That said, there are some things that can increase your chances of developing compassion fatigue, says Charles Figley, PhD, a trauma psychologist, pioneer in compassion fatigue research, and the Paul Henry Kurzweg, MD, Distinguished Chair in Disaster Mental Health at Tulane University.

Things that can increase your chances of getting compassion fatigue include:

  • Being around a lot of suffering for a long period of time
  • Empathizing strongly with other people
  • Having a lot of stress outside of work
  • Having traumatic memories you haven’t fully processed, especially if they’re related to the suffering you’re seeing
  • Not having enough people you can rely on to support you, especially at work
  • Forgoing your own self-care

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What Are Typical Symptoms of Compassion Fatigue?

Compassion fatigue can look different in different people. Often, the effects are subtle and can mimic those of other conditions, making it tough to spot.

Some people with compassion fatigue might experience:

  • Anxiety, particularly on the job
  • Nightmares or dreams about your patients or workplace
  • Upset stomach or gastrointestinal issues
  • Apathy or feeling like you just don’t care about anything anymore
  • Losing your sense of humor
  • Mental or physical exhaustion
  • Being irritable or short-tempered
  • Dropping or gaining weight when you aren’t trying to
  • Isolating yourself from other people
  • Losing your spark or becoming a duller/more robotic version of yourself

Many of these symptoms can be difficult to identify on your own, Figley says. Instead, you might hear from others close to you (like a spouse or close friend) that you’ve changed and don’t seem like yourself.

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4 Examples of How Compassion Fatigue Can Develop

The causes of compassion fatigue can vary, but it’s typically triggered by experiencing a traumatic event — or a series of them — says Stacie Hunsaker, MSN, RN, a long-time ER nurse and associate teaching professor at Brigham Young University’s College of Nursing.

Here are a few examples of how nurses can develop compassion fatigue.

1) Witnessing a series of traumatic events in a short period of time.

For Hunsaker, the trigger was a rough summer in the ER when she saw multiple kids die. The first warning sign she experienced was dread: She dreaded going into work, dreaded seeing pediatric patients. And yet work was constantly on her mind. At night, she would dream about her patients, but when she saw them, she felt disconnected.

2) Losing a patient suddenly and unexpectedly.

Losing a patient is a common trigger for compassion fatigue in nurses, especially if it feels like their death came out of nowhere. The shock from the experience can be so overwhelming that you just shut down. You put up walls between yourself and your patients so you don’t get too close to someone else, only to lose them too.

3) Listening to people share their own traumatic experiences.

Figley experienced compassion fatigue while interviewing combat veterans as a researcher in trauma psychology. He heard story after heartbreaking story from men who had fought in the Vietnam War, and it wore him down. Those he worked with later told him how business-like he was at the time — not mean or uncaring, Figley says, just focused and devoid of humor.

4) Seeing or hearing something that hits too close to home.

Sometimes compassion fatigue is triggered not just by a traumatic event, but by what (or who) that event reminds you of. This can happen when a patient looks like a loved one who died, or when they’ve gone through a trauma you went through yourself. Emotions surface and can throw you off. You start having nightmares and stop taking care of yourself. You go into work with a knot in your stomach and have to force yourself to go through the motions.

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Compassion Fatigue vs. Burnout: What’s the Difference?

The term “burnout” has become something of a catch-all for feeling bogged down or stressed, but in reality, burnout is simply exhaustion, Figley says. It’s the kind of tired you can’t fix with a nap. Compassion fatigue is a special kind of burnout related specifically to your capacity to connect with and care for — and about — other people.

The two are often intertwined, so much so that it can be hard to distinguish between the two. The symptoms, after all, are similar. Both can cause tiredness, irritability, and apathy. You can also experience the two simultaneously, and experiencing one might increase your chances of developing the other.

But while similar, compassion fatigue and burnout are not the same, especially when it comes to their root causes. Burnout is often the result of widespread, systematic stress that leaves you feeling powerless, Hunsaker says. It comes on gradually, and rarely can you pinpoint a single reason behind it.

By contrast, compassion fatigue is typically the result of a traumatic event (or cluster of them) that you witness or hear about second-hand, and it can come on rather suddenly.

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How Does Compassion Fatigue Affect Patient Care?

Compassion fatigue doesn’t just hurt your own well-being: It can affect your capacity to care about your patients and your job, Hunsaker says, and that can have serious consequences. Nurses who are mentally drained or distracted are more likely to slip up in a way that can affect patient safety. Those who are robotic or humorless might miss an opportunity to gain a patient’s trust, potentially making that person less likely to be candid about their symptoms or follow instructions.

One of the biggest risks associated with compassion fatigue among nurses, however, is attrition. Unable to recover or cope, nurses quit their jobs to pursue less stressful careers. And those nurses aren’t always being replaced. According to the American Nursing Association, the U.S. already faces a nursing shortage — a problem that will only get worse as baby boomers age and more nurses are needed to care for them.

As compassion fatigue drives more and more nurses out of the profession, the ones staying behind face long hours, understaffing, and burnout — all of which can negatively impact patient safety or care, not to mention put nurses at greater risk for (you guessed it) compassion fatigue.

Understanding how to prevent and combat this syndrome is essential to protecting both yourself and the patients you care for.

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7 Tips & Strategies for Combating Compassion Fatigue

Once you’ve developed compassion fatigue, it’s hard to recover. The best way to combat it is to prevent it altogether.

Here’s what you can do to try to protect yourself from developing compassion fatigue.

1) Be disciplined about self-care.

Get enough sleep, eat healthy foods, exercise regularly, and do what you need to relieve stress. Self-care isn’t selfish and it’s not indulgent -- it’s essential to your role as a nurse. Your patients need you to be at the top of your game, so it’s crucial that you do what you need to do to get there and stay there.

2) Take breaks.

This isn’t always easy to do, especially when you’re overworked and understaffed. But the more exposure your brain has to suffering, the greater your risk of developing compassion fatigue, Figley says. Don’t take on those extra shifts if you don’t need to. Avoid thinking about work at home. Give your brain some time to recover.

3) Don’t push through.

If you’ve just lost a patient or watched someone go through the unthinkable, don’t throw yourself back into your work as a way to cope. Think about it this way: If you had a patient who broke a leg, you wouldn't tell them that the best treatment is to keep walking on it. When your brain witnesses a trauma, it needs rest and self-care, not more work.

4) Learn to detach.

Learning to detach isn’t about being devoid of all emotional connections; it’s really about breaking the momentum of stress and checking in on yourself. One thing Figley recommends is having a bell that rings (or an alarm on your phone that goes off periodically) to remind you to stop whatever it is that you’re doing to take a deep breath and focus on your stress. How are you doing right now? Are you OK? What do you need?

5) Build your support network.

Both Figley and Hunsaker say that having a strong support system, especially at work, can help protect you from developing compassion fatigue. Find colleagues who understand what you’re going through, and seek out job opportunities with managers who get it.

6) Remember why you’re there.

Nurses who feel satisfied in their work are less susceptible to compassion fatigue. Practicing mindfulness meditation or writing in a gratitude journal a few times a week has been shown to help people be more resilient to life’s challenges. And resilience, Figley says, is key to combating compassion fatigue.

7) Get help if you need it.

Talking to someone about what you’re going through is not weak. Having someone help you process traumatic events — either ones you’ve experienced personally or witnessed on the job — can help protect you from experiencing compassion fatigue later on.


The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice.

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