There is growing awareness of the issue of compassion fatigue in nurses.1-3 “Compassion provides nurses with the will and drive to do right for their patient. However, doing the right thing can be really hard. ‘Fatigue’ is not just a conceptual term,” says Elizabeth Sivertsen, MBE, CCRN, HEC-C, a medical ethicist at Grady Health System.
If compassion fatigue goes unaddressed, serious consequences can result. Lower-quality care is the primary concern, along with increased turnover exacerbating a nursing shortage that is already at crisis levels. “We’ll ultimately see an irreversible pattern of loss of retained wisdom in our bedside staff as we lose nurses to burnout,” warns Sivertsen.
A group of researchers evaluated how a brief mindfulness-based intervention affected compassion fatigue during the COVID-19 pandemic.4 Mindfulness champions led the nurses in a five-minute intervention that included deep breathing and meditation, in 2021-2022. The researchers surveyed 29 nurses before and after the intervention. Post-intervention, the nurses reported less burnout and secondary traumatic stress, both known contributors to compassion fatigue. “A nurse experiencing compassion fatigue may accept systemic or structural barriers to providing optimal patient care as insurmountable or inevitable and may not advocate as hard on behalf of their patient,” says Sivertsen.
Nurses with impaired compassion may lack energy to battle the typical hindrances that frequently occur in care provision — like chasing down a medication not yet delivered from pharmacy or calling to correct an incorrect order placed by the physician. “This results in delayed treatment and care that may materially affect their patient’s outcome,” says Sivertsen. Ethicists can help address compassion fatigue in these ways, offers Sivertsen:
• Ethicists can involve bedside nurses in conversations during ethics consults.
By making a point of asking nurses for input in addition to other members of the healthcare team, ethicists demonstrate respect for nurses’ role in patient care. “This aids nurses in developing and demonstrating moral agency,” says Sivertsen. “All of that goes a long way in fending off feelings of compassion fatigue.”
• Ethicists can include nurses in family meetings.
“Nurses often have the inside scoop on patient and family dynamics,” notes Sivertsen. It is always a challenge to get multiple healthcare providers and family members in the same room for a meeting. Nurses often are omitted, yet nurses’ perspectives are highly valued by families. “Bringing nurses to the table can help combat the mistrust of medicine that we’re seeing more of,” says Sivertsen.
• Ethicists can recognize when nurses are struggling to maintain their compassion.
“Calling the attention of leadership to these instances and organizing moral debriefing sessions for staff to work through nurses’ concerns can foster great appreciation for the moral work that nurses do,” says Sivertsen.
Sivertsen recently consulted on a case that was emotionally difficult for nursing staff. The case involved a young patient presenting for a devastating trauma; however, he was admitted as overflow in the medical intensive care unit. Taking care of him proved to be very hard for nurses, who generally were not accustomed to managing young, dying patients with open head wounds. The ethics consultation itself was not a challenge, since there were no clear ethical questions to be answered. Sivertsen spent a lot of time engaging nurses in talking about the difficult decision-making faced by his family. Nurses offered insights on what family dynamics might be involved. Over the course of the patient’s admission, the frustration initially voiced by nurses faded away. Instead, nurses expressed empathy and understanding. “Ethics can be a lifesaver for nurses when their will to care is otherwise floundering,” says Sivertsen. “It can provide a why when nurses are searching for a reason to keep caring in hard situations.”
- Taşdemir HI, Aydın R, Dursun Ergezen F, et al. Unveiling the burden of compassion fatigue in nurses. Nurs Ethics 2023;Sep 21:9697330231200571. doi: 10.1177/09697330231200571. [Online ahead of print].
- Pehlivan Sarıbudak T. Compassion fatigue in nurses providing palliative cancer care and coping strategies to prevent and manage it. Semin Oncol Nurs 2023;39:151501.
- Garnett A, Hui L, Oleynikov C, Boamah S. Compassion fatigue in healthcare providers: A scoping review. BMC Health Serv Res 2023;23:1336.
- Tripathi SK, Mulkey DC. Implementing brief mindfulness-based interventions to reduce compassion fatigue. Crit Care Nurse 2023;43:32-40.
