Compassion Fatigue- Bona Fide or B.S.?

I'm not a fan of giving what could be considered normal physical or emotional states labels. If you ask me, it seems like many of the diagnoses listed in medical texts and publications like the DSM are a bunch of crap. Take "Shift Work Sleep Disorder", for example. I don't need a diagnosis to tell me that working weekend overnight shifts is "socially isolating", or that pulling multiple shifts that let out at 3am will result in "excessive fatigue". That's life. It's a choice. And, these symptoms are a natural, proper I might add, result of these choices. 

In a blog post I published last month titled Don't Fall Victim to a Mid-Career Attitude Shift, I discussed how some seasoned nurses  and nurse practitioners become disillusioned. It becomes harder and harder the more comfortable we become in our jobs to remember that for our patients going through personal illness or that of a family member is difficult. We lose our drive to approach these situations passionately, often venturing further than apathy to just plain rudeness. No, this doesn't happen to everyone, I work with plenty of people who excel in their jobs, but it is a noticeable trend among healthcare providers. 

In response to my article, a reader posted a comment posing this question- "Do you think that nurse [who I referenced in my post] suffers from compassion fatigue versus a conscious decision to be negative?". Interesting question. Before reading this comment, I hadn't exactly heard the term "compassion fatigue" although the existence of such a label doesn't surprise me. I decided to look into the concept (thankfully, the word disorder is not attached to the end of the epithet).

Compassion fatigue is described as a sort of PTSD among healthcare workers and emergency personnel that develops in response to witnessing distressing situations. As a result, physical and mental health can suffer ultimately resulting in relationship struggles and burnout. Psychologists say that these individuals commonly dissociate as a coping mechanism. 

I think those of us working in healthcare can all agree we lose some of our sympathy over time, or that we experienced symptoms of "compassion fatigue". The situations we're placed in on a regular basis become routine. When serious, and sometime life or death, situations become just another day at work, it's natural to internalize them, to approach them with more of a laid back attitude, or at least one that doesn't bring tears to your eyes or cause you to squirm on a daily basis. If we didn't develop some sort of coping mechanism for our work environment, our involvement in people's personal dealings, our candid view of life's often harsh realities, we wouldn't make it.

I agree that so-called compassion fatigue exists. I have experienced these feelings myself. As healthcare providers, our work environment makes us easy targets for burnout, especially with the added complication of erratic schedules prone to cause sleep deprivation. But, a label for these feelings, "compassion fatigue", is not an excuse for bitterness. A bad attitude is a conscious choice. As educated adults, we know how to treat people like, well, people. We've been to the DMV or social security office and been treated like a number and know how it feels. I'm not saying we need to approach every situation with sympathy. When you don't have a personal relationship with a patient, you often don't actually feel sympathetic towards their situation. But rather, we must at least recognize that patients may feel a certain way, approach other people with decency and respect, and respond to questions without a tone of annoyance. 

For me, the best way to combat burnout is to address "compassion fatigue" head on. I must consciously realize when I am slipping into a routine, trying to churn patients through the emergency department as quickly as possible without acknowledging them on a more emotional level. It sounds idealistic, and I'm not 100% peppy in each and every situation, trust me. But, my job becomes more fulfilling, and I am frankly less fatigue-prone, when I try to see my interactions from the other side of the table, through the eyes of my patients. Fatigue is not an excuse for treating people poorly.

Thoughts?

 

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Comments

Interesting viewpoint. I too, was unfamiliar with the concept of compassion fatigue until it started showing up at nearly every conference I attended over the last five years ...and now as the topic of my research. Thank you for following up on your prior post.
I work in emergency medicine, in both the ER and prehospital settings. I've noticed, through the years, a shift in the behavior among my coworkers that mimics that of the nurse you described in your post last month. Initially, I attributed it to bad behavior...for some, it likely is. Especially those that work in lower acuity settings, where they're not dealing with critical patients on a regular basis....and maybe even those in the ER who see the patients neatly packaged by the EMS workers. But for those of us on the front lines who are pulling deceased children out of a house fire, arriving at the scene of an MVA to see a teenager partially ejected out of the passenger window who is decapitated after being hit by a drunk driver, and attempting to save a young man in cardiac arrest, in a crack house while the bystanders become violent, and there is no security for your protection, eventually suffer ill effects from the secondary trauma. Compounding factors are the stressors due to considerably low wages, long work hours consisting of 24-40 hour shifts, sleep deprivation, hunger, and lack of self care practices. After working with those types of patients, it may be difficult to show the same level of compassion to a 20 year old system abuser that has stubbed her toe or the drug seeker that calls an ambulance 3 times per week because he sold all of his medication and has come up with a yet another story to replenish his supply. All patients deserve to be treated with respect and a certain level of professionalism, regardless of the scenario. I agree that treating all patients the way you would like to be treated, results in a better day for everyone. Though, I can see how that ability may begin to deteriorate...especially when the provider's basic needs aren't met. All of these factors lead to compassion fatigue and burnout, which are recognized as two separate concepts that often coexist. Studies show that compassion fatigue tends to be highest among those who do not implement self care practices, such as exercise and other stress relieving activities. There is also research that shows with the implementation of these simple lifestyle changes, people whom experience compassion fatigue often improve. So, bona fide or B.S.? It may just be another label from the 'psych people' to explain an obvious consequence of a less than desirable circumstance....but if that label leads to awareness, intervention, and an improved outcome, then I'm okay with that.

Kelly M

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