Matter for Discussion: Compassion fatigue

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Compassion is a term widely recognised in nursing and health care in each of the UK countries. Compassion is one of NHS England’s ‘6Cs’ (2015), while compassionate leadership is the predominant feature in workforce developments in both Scotland and Wales (Project Lift, no date; NHS Wales and Social Care Wales, 2021). It also features as a component of the five patient standards in Northern Ireland (Nidirect Government Services, 2016). More recently, The Courage of Compassion (The King’s Fund, 2020a) recognised the importance of compassion in care delivery and leadership at every level.

However, compassion fatigue is less understood, perhaps due in part to terms such as burnout being used interchangeably. The literature reviewed appears consistent in two main distinctions: burnout is cumulative and develops over time due to environmental and organisational factors; whereas compassion fatigue is less predictable, sometimes occurring without apparent warning, and is more related to empathy and exposure to patient suffering, giving rise to the informal definition, ‘the cost of caring’ (GoodTherapy, 2020).

Compassion fatigue was first identified by Joinson in the early 1990s (cited by Potter et al, 2010), who characterised it as a ‘unique form of burnout’. Studies have shown that caring for patients with COVID-19 has increased compassion fatigue (Ruiz-Fernandez et al, 2020).

‘Kindness and compassion not only benefit those who receive it but also those who offer it’, according to Lown et al (2019). By implication, therefore, compassion fatigue impacts not only the patient, but creates a potentially self-fulfilling cycle for clinicians because if they are unable to offer compassion, they will not be receiving the associated positive reinforcement.

Where compassion exists within a clinical team, the team is more effective, and patient safety and satisfaction are higher. Teams where staff are suffering compassion fatigue and experiencing the cycle described above, or showing associated behaviours such as avoidance of interaction and increased sickness absence, are therefore likely to be less productive. An impact on the quality of care may be evident (Potter et al, 2010).

As well as taking a toll on those remaining at work (Upton, 2018), compassion fatigue shows a clear correlation with the retention of health care workers, thus impacting on patient safety. Compassion fatigue is also a potential risk factor for caregivers’ own mental health and has led to increased numbers leaving the nursing profession (Nolte et al, 2017).

Studies of the impact of compassion fatigue mainly focus on direct care providers (Wilson, 2019), but the impact on those in a formal leadership role should also be considered (The King’s Fund, 2020b). Nurse leaders suffering from compassion fatigue are less likely to be able to offer their staff the listening, empathy and shared understanding required, due to their own low resources. Therefore, the critical role leaders play in retention may be adversely affected (Heath Education England, 2014).

With recognition, understanding and the opportunity for recovery, compassion fatigue is a potentially preventable and reversible condition (Johnson Moore, 2016). But where it is not prevented, we risk many more nursing staff leaving the profession.

Given the government target to recruit and retain 50,000 nurses to the NHS, can we afford not to raise awareness of compassion fatigue and its impact?

Reading lists for each agenda item can be found here.

References

GoodTherapy (2020) The cost of caring: 10 ways to prevent compassion fatigue. Available at: https://www.goodtherapy.org/for-professionals/business-management/human-resources/article/cost-of-caring-10-ways-to-prevent-compassion-fatigue (Accessed 19 April 2022).

Health Education England (2014) Growing nurse numbers literature review on nurses leaving the NHS. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Nurses%20leaving%20practice%20-%20Literature%20Review.pdf (Accessed 19 April 2022)

Johnson Moore K (2016) Compassion fatigue among nurse leaders. Doctor of Nursing Practice Thesis. Drexel University. Available at: https://doi.org/10.17918/etd-7088. (Accessed 19 April 2022)

The King’s Fund (2020a) The courage of compassion. Available at: https://www.kingsfund.org.uk/publications/courage-compassion-supporting-nurses-midwives (Accessed 19 April 2022).

The King’s Fund (2020b) Covid-19: why compassionate leadership matters in a crisis. Available at: https://www.kingsfund.org.uk/blog/2020/03/covid-19-crisis-compassionate-leadership (Accessed 19 April 2022).

Lown B A, Shin A and Jones R N (2019) Can organizational leaders sustain compassionate, patient-centered care and mitigate burnout?, Journal of Healthcare Management, 64(6), pp. 398–412.

NHS England (2015) The 6 Cs of care. Available at: https://www.nhsprofessionals.nhs.uk/nhs-staffing-pool-hub/working-in-healthcare/the-6-cs-of-care. (Accessed 19 April 2022)

NHS Wales and Social Care Wales (2021) Compassionate leadership principles for health and social care in Wales. Available at: https://nhswalesleadershipportal.heiw.wales/repository/discovery/resource/604d8589-498a-48ae-a2cd-637613078929/en (Accessed 19 April 2022)

Nidirect Government Services (2016) Patient standards. Available at: https://www.nidirect.gov.uk/articles/patient-standards (Accessed 19 April 2022).

Nolte A G, Downing C, Temane A and Hastings-Tolsma M (2017) Compassion fatigue in nurses: A metasynthesis, Journal of Clinical Nursing, 26(23–24), pp. 4364–4378.

Potter P, Deshields T, Divanbeigi J, Berger J, Cipriano D, Norris L and Olsen S (2010) Compassion fatigue and burnout: prevalence among oncology nurses, Clinical Journal of Oncology Nursing, 14(5), pp. E56–E62.

Project Lift (no date) Our ethos. Available at: http://projectlift.scot/about/ethos/ (Accessed 19 April 2022).

Ruiz‐Fernández M D, Ramos‐Pichardo J D, Ibáñez‐Masero O, Cabrera‐Troya J, Carmona‐Rega M I and Ortega‐Galán Á M (2020) Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain, Journal of Clinical Nursing, 29(21–22), pp. 4321–4330.

Upton K V (2018) An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: a mixed methods study, Journal of Compassionate Health Care, 5(1), p. 7.

Wilson R F (2019) Nurse leader compassion fatigue and burnout impact on staff satisfaction, patient satisfaction, and turnover. Available at: https://sigma.nursingrepository.org/handle/10755/16870 (Accessed 19 April 2022).