RECONCEPTUALIZING COMPASSION FATIGUE AMONG REGISTERED NURSES
Background: The term compassion fatigue was first used to describe the emotional distress and loss of job satisfaction experienced by nurses. Subsequent terms have included secondary traumatic stress, and vicarious traumatization. The most widely used conceptual model of Professional Quality of Life (ProQOL) proposes that burnout, secondary traumatic stress, and compassion satisfaction directly impact compassion fatigue. Burnout stems from interactions within the work environment; secondary traumatic stress is the individual’s negative emotional response from work-related trauma, and compassion satisfaction is the sense of a job well done. Although the model has been utilized to describe work-related emotional distress, the model may not capture the emotional distress experienced by registered nurses.
Method: Two qualitative studies were conducted. The first included semi-structured interviews with hospital-based registered nurses (N=16). Participants were asked to describe their meaning of compassion fatigue, and events or experiences that may have precipitated it. The second study included learning modules on compassion fatigue, burnout, secondary traumatic stress, and means to reduce risk: mindfulness, healthy boundaries, and self-care. Participants (N=59) journaled emotional triggers, physical and mental symptoms of distress, and efforts to incorporate mindfulness and boundary-setting into their nursing practice. Data from both studies were thematically analyzed.
Results: During all interviews and in most of the journals, participants described experiences of burnout. However, the burnout was rarely a significant source of distress but was just perceived as “a normal part of the job”. Numerous examples of secondary traumatic stress were also provided, and themes such as hypervigilance (my kid will not ski after I’ve seen so many freaky things) and fearing for one’s own health (I have a headache, and immediately think neuroblastoma) echoed the concepts within the ProQOL. Four themes emerged that were not well captured by the ProQOL. 1) Life is unfair: bad things happen to good people, and those who abuse their bodies seem to survive. 2) Endless suffering: witnessing distress, grief, loss of hope, feeling powerless to help. 3) Unable to let go: skipping breaks, calling in on days off, thinking or remembering 24/7. 4) Wanting support but pushing away: seeking comfort and support but feeling more distressed when the partner or friend asked too many questions or voiced discomfort. Many participants self-described as a caring nurse with compassion fatigue, and felt the term is stigmatizing.
Implications: Burnout does not appear to be a significant risk factor to compassion fatigue. The emotions associated with secondary traumatic stress (hypervigilance, fear, distress) were strong predictors of compassion fatigue. Additional factors such as the inability to forget or to disconnect, and the interpersonal dynamics of wanting social support while pushing others away are not captured in the ProQOL. The term compassion fatigue was perceived as stigmatizing and shameful, and an unfitting label for nurses who care. A term such as “provider saturation” may be a more fitting term for the nurse experiencing emotional devastation and secondary traumatic stress, who still cares deeply.