What Is Compassion Fatigue in Nursing and How Can It Be Prevented?

Working long shifts and addressing complex patient needs, including treating individuals with immense pain and traumatic injury, can cause emotional distress in nurses. According to a survey from the American Nurses Foundation, 81% of nurses reported feeling exhausted and 71% reported feeling overwhelmed in 2021. Over time, these feelings can lead to compassion fatigue: a condition in which the cumulative burden and stress of nursing practice causes individuals to lose their ability to nurture and empathize with their patients.

Fatigue, in general, can affect an individual’s mental and physical functions. In health care settings, fatigue can impair decision-making and slow responses to patients’ needs, which comprises care. For example, nurses must think and communicate clearly to deliver the best patient care and coordinate with colleagues responsible for the same patients.

If left unaddressed, compassion fatigue in nursing can impact an individual’s mental health and lead to post-traumatic stress disorder (PTSD).

Understanding Compassion Fatigue

Compassion fatigue is a process by which nurses become less empathetic and compassionate toward  their patients. It happens over time as feelings of exhaustion and being overwhelmed due to prolonged exposure to trauma increase without intervention. For example, during the height of the COVID-19 pandemic, nurses had to work in understaffed and underresourced environments, adding to the exhaustion already felt before the pandemic.

What are the causes of compassion fatigue in nursing? Examples of physical, emotional, and psychological triggers that can create compassion fatigue are:

• Witnessing extreme issues that patients experience, such as pain and visible signs of trauma, while providing care.
• Interacting with belligerent patients who communicate with verbal and physical threats.
• Facing patients’ threats of suicide or self-harm.
• Managing physical care for patients with depression, PTSD, or anxiety.
• Feeling unsafe due to dangerous environments.
• Providing care for patients with a low likelihood of survival and witnessing the grief and bereavement of family members.
• Caring for children who’ve undergone traumatic and abusive experiences.
• Managing a heavy patient caseload over long shifts.
• Seeing patients with extreme injuries due to fire or car crashes.
• Serving dying or severely ill patients.

Risks of Compassion Fatigue

Typically, the nature of nurses’ and other first responders’ work affects them. When feelings become overwhelming, though, compassion fatigue can creep in, resulting in poor performance. In nursing, examples include making medication errors and calling in sick more regularly. Sometimes, nurses with compassion fatigue take it out on their patients and colleagues by being rude or responding sarcastically to questions or comments.

Compassion fatigue can develop into burnout over time and lead to alcoholism or drug addiction if left unaddressed. Some nurses opt to leave the nursing profession. According to a 2021 report from JAMA Network Open, out of 3.9 million registered nurses in the U.S. surveyed in 2018, 31.5% indicated that nurse burnout was the reason for their leaving the profession.

Resources: What Is Compassion Fatigue in Nursing?

The following links are useful resources for nurses and individuals who know nurses at risk of compassion fatigue to learn more about the condition:

• Nurse Compassion Fatigue: What Is It and How You Can Care for Yourself, Bayada: In addition to describing what compassion fatigue in nursing is, this resource includes strategies for coping.
• Compassion Fatigue and Burnout in Nursing, Daily Nurse: This resource covers topics such as quality of life challenges, as well as areas where workplaces are improving for nurses.
• Healthcare: Wake Up to the Facts About Fatigue, Kronos: This resource shares various facts and statistics about nursing compassion fatigue.
• Compassion Fatigue: How to Know If You Have It and How to Support Team Members, Nursing Standard: This resource discusses how the emotional and physical toll of caring reduces a nurse’s ability to empathize.

Signs of Compassion Fatigue

The physical, emotional, and psychological impact of helping others can affect a nurse’s thoughts, mood, and state of mind. When these thoughts start affecting a nurse outside of work, it’s a telltale sign of compassion fatigue. Another key sign of compassion fatigue is a nurse becoming less empathetic toward patients, co-workers, and loved ones.

Health care professionals need to recognize the signs of compassion fatigue in nursing to help prevent it in themselves and help others overcome it. Major signs and symptoms of compassion fatigue to look for include the following:

• Mood swings. A mood swing is characterized by a sudden or an intense change in an individual’s emotional state. For example, a nurse can quickly switch from feeling upbeat after helping a patient to quickly becoming angry at a colleague.
• Feelings of detachment. A feeling of detachment is characterized by an individual’s inability to connect or engage with other people’s feelings. Other signs of this symptom include ambivalence toward others and difficulty empathizing with other people.
• Compulsive behavior and addiction. Compulsive behavior and addiction sit on different sides of the same coin. An individual with compulsive behavior feels the urge to act on an impulse regardless of the outcome. An individual struggling with addiction has the need to replace anxiety, stress, or discomfort with an addictive substance, such as drugs and alcohol.
• Symptoms of depression. Depression is a mental health condition. Symptoms of depression include loss of interest in an activity that someone used to find enjoyable. For example, a nurse may no longer feel happy when interacting with patients. Other depressive symptoms include difficulty concentrating, decreased energy, and feelings of hopelessness.
• Symptoms of anxiety. Anxiety is generally a debilitating type of worry that leads to irrational thoughts. Symptoms of anxiety can range from difficulty controlling fear to muscle tension and teeth grinding.
• Trouble being productive. An individual having trouble being productive isn’t able to do work effectively due to a lack of focus or interest.
• Insomnia or low-quality sleep. Nurses already work long hours, but when they’re unable to sleep, it can impact patient outcomes. According to a report from the Agency for Healthcare Research and Quality (AHRQ) on fatigue, sleep deprivation, and patient safety, there are “increased nursing errors when shifts last longer than 12 hours.”
• Physical and psychological exhaustion. Compassion fatigue can lead to extreme tiredness, both mentally and physically.
• Feelings of helplessness or hopelessness. Feelings of helplessness or hopelessness are often associated with depression, and if not addressed early, can lead to long-term mental health problems.

Other common signs and symptoms of compassion fatigue in nursing include irritability, sadness, self-blame, a decreased sense of personal and professional accomplishment, or a change in worldview or spirituality. Physical symptoms can include headaches, changes in appetite, and dizziness.        

Compassion Fatigue vs. Burnout

Experiences of compassion fatigue in direct care nurses and burnout are often considered to be the same. However, fundamental differences exist between the causes. For example, compassion fatigue stems from the trauma or overwhelming feelings associated with helping others. It leads to nurses not practicing self-care.

In comparing compassion fatigue vs. burnout, it’s important to understand the onset of each. Compassion fatigue may come on suddenly in unpredictable ways. Burnout typically develops over time.

Factors associated with nurse burnout typically involve too much work or too many responsibilities. For example, a lack of control in a job, unclear job expectations, or dysfunction in the workplace can cause a nurse to experience burnout.

Compassion fatigue can result when nurses focus so much on helping other people that their own needs are not met. This leads to a decrease in activities that bring happiness and provide balance in life, possibly leaving individuals feeling like they have nothing left to give.

Burnout can also increase cynicism, making individuals believe that anything they do won’t make an impact or difference. Nurses experiencing burnout often feel disillusionment about their job and sometimes leave the nursing profession.

How to Prevent Compassion Fatigue in Nursing

Because the onset of compassion fatigue can occur so quickly, nurses need to protect themselves from this condition and help others in overcoming the challenges of compassion fatigue. The following strategies and steps on how to prevent compassion fatigue in nursing can help reduce its impact:

• Learning the signs and symptoms. Understanding what to look out for can help nurses prevent compassion fatigue.
• Practicing self-care. Nurses can do this through a balanced, nutritious diet, regular exercise, and getting enough sleep.
• Finding better work-life-leisure balance. Quality of life is critical. Nurses need to be able to find opportunities to engage in hobbies and cultivate friendships outside of work.
• Boosting self-resilience. Self-resilience means finding ways to equip the mind to meet the challenges. Finding a sense of meaning or purpose as a nurse can help in this effort.
• Developing coping strategies. Coping strategies include activities such as journaling using mindful exercises, such as reframing a situation to a more positive light.
• Going to therapy. Talk therapy with a professional can lighten the psychological load and provide essential feedback to help cope with challenges.
• Practicing yoga and meditation. Yoga and meditation not only help the mind but can also deliver physical benefits.

If these strategies seem to have little to no impact in addressing compassion fatigue, a next step may be exploring medication with a physician or specialist. “

Tools to Help Address Compassion Fatigue in Nursing    

For nurses and individuals looking for resources that provide advice and strategies to deal with compassion fatigue, the following resources can help.

• Compassion Fatigue Assessment, Advisory Board: This tool helps nurses recognize the visible and invisible signs of compassion fatigue and helps them learn when to seek additional help.
• Understand & Overcome Your Compassion Fatigue: An Online Guide, EduMed: Using a nurse’s first-hand perspective, this resource provides insights on how to detect and manage symptoms of compassion fatigue.
• Compassion Resilience Toolkit for Health and Human Services Leaders and Staff, Compassion Resilience: This tool kit includes various guides that provide insight on how to achieve compassion and resilience in the health care field.
• Disaster Behavioral Health Self Care for Healthcare Workers Modules, U.S. Department of Health and Human Services: This resource library comprises current health care system preparedness resources to help professionals at risk of compassion fatigue.
• Compassion Fatigue in Nursing: What It Is and How to Deal With It, Incredible Health: This resource describes how compassion fatigue affects nurses and the patients they treat and provides strategies on how to handle it.
• The Dauntless Nurse: Had Enough Yet? The Latest on Nurse Burnout, American Nurse: This resource includes five suggestions for supporting colleagues with compassion fatigue.

Practicing Self-Care to Address Compassion Fatigue in Nursing

Compassionate care is foundational to nursing practice. However, this caring can come at a cost and lead to compassion fatigue. Nurses normally put the needs of others before their own, so self-care isn’t always innate for nurses. If ignored, compassion fatigue can impact patient satisfaction and safety, and equally as important, affect their mental health. However, recognizing the early signs of compassion fatigue can help nurses refocus and take proper steps to take care of themselves. Addressing compassion fatigue requires self-assessment and a willingness to seek help or improve self-care.