It’s a typical Wednesday morning heading into work in three-day-old scrubs, coffee in hand, as the sun begins to rise on the horizon. Yesterday was a chaotic shift, so you say a silent prayer that today will be better as you bravely leave the comfort of your car. You take a deep breath and remind yourself to think positive thoughts and remember why you fell in love with healthcare in the first place: to make a difference and heal others by marrying medicine and compassion.
You show up to shift report, and as usual, the unit manager notifies you that today will be short-staffed with several admissions. As you make your rounds with the interdisciplinary team, you notice low stock of PPE on the unit. You turn to your favorite colleague to inquire about what’s going on. “We’re just going to have to re-use masks for now until we get a new shipment in,” she says with a smirk. You only take a minute to realize the weight of the situation you’ve been given; there are too many duties to fulfill to waste any time pondering.
Today, you have five patients to care for. One is vomiting, another is in pain, and a call light has already been pressed for a bathroom trip. You try to recruit help for your patients, but everyone else seems to be busy at the moment, so you begin to mentally map out your day. Two hours pass as if it’s been fifteen minutes and three admissions will be coming shortly. You certainly don’t feel prepared to handle the extra work just yet, but you hustle and do everything in your power to make it happen. Eight hours into your shift, your eyes are bloodshot, your stomach starts to rumble, and you’ve yet to take a bathroom break. However, you care too much about your patients and your colleagues don’t plan on taking a break, so you decide to skip lunch for the greater good. At the end of the twelve hours, you feel mentally fuzzy and beyond exhausted. You still have five items on your daily checklist that never got crossed off, feeling ashamed that you’ll have to pass those responsibilities off to the night shift crew.
You walk back to the parking garage, leaving work feeling drained, unaccomplished, and unappreciated. You let out a huge sigh of relief as you remove your mask, wiping the sweat from your upper lip. You hang up your mask on the rearview mirror, shaking your head in disbelief while reflecting on your day. You blast some music and open your window, letting the cool air caress your face, hoping you’ll be able to stay awake during the drowsy drive home. When you arrive home, you decide you’re too tired to eat or shower, so you plop into bed. Reaching to set your alarm for the next day, you come to the somber realization that you only have seven hours of peace before the madness begins again.
Despite the pandemic, compassion fatigue has been rapidly rising, yet it is has gone unnoticed by some. Recently, the American Nurses Foundation, the philanthropic arm of the American Nurses Association (2021), surveyed the impact of COVID-19 on nursing. The results from 12,881 nurses were disturbing:
- 72% are exhausted
- 64% are overwhelmed
- 67% difficulty sleeping or sleeping too much
- 52% state that work is negatively impacting their health/wellbeing
- On a scale of 1-5 my employer values my mental health only scored 3.1
- 24% have sought professional mental health support
Compassion fatigue is not only emotionally taxing for individuals involved, but it may also have deadly consequences which extend to patients and employers alike. According to research done by the BioMed Research Center in 2017, compassion fatigue has been identified as an occupational hazard for healthcare professionals, linked to decreased job satisfaction, professional burnout, intention to resign, and absence of empathy (Christodoulou-Fella et al., 2017). The negative effects of compassion fatigue commonly lead to mental health crises among healthcare employees, decreased patient safety, decreased patient satisfaction, high employee turnover rates, and career changes among healthcare professionals. If nurses are frequently battling burnout, high stress, exhaustion, and possibly physical pain, could compassion fatigue play a role in medical errors and patient safety?
In addition to decreased quality of care for patients, compassion fatigue may also contribute significantly to revenue loss. According to the 2021 NSI National Health Care Retention & RN Staffing Report, the average healthcare facility can lose $3.6 million to $6.5 million annually due to nurse turnover. In 2020, the average registered nurse turnover rate was 18.7% and it is estimated that for every percent change in turnover, will cost/save the average facility an additional $270,800 per year (NSI Nursing Solutions Inc., 2021).
Now more than ever, healthcare professionals have been stretched thin and exposed to high levels of stress. Unfortunately, the root causes of compassion fatigue are deeply seeded within poorly-run, outdated systems. Although self-care concepts may be woven into educational activities, self-care alone will not resolve the underlying issues which disguise the ticking time-bomb that is compassion fatigue. If there is any hope to improve patient safety and reduce employee turnover rates, conditions need to be drastically improved not only for patients but for all members of the healthcare team.
Nursing professional development (NPD) practitioners are positioned to create awareness, generate dialogue, and investigate potential strategies to combat clinician burnout while promoting the well-being of the healthcare team. For more information, consider the following resources
- Bodine, J. & Russell, J., (Hosts). (2020, May). Combating clinician burnout: NPD implications and strategies [Audio podcast episode]. In NPD Forecast. Association for Nursing Professional Development. https://anpdeducation.libsyn.com/npd-forecast-combating-clinician-burnout-npd-implications-and-strategies
- National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: A systems approach to professional well-bring. The National Academies Press.
- Pappas, S., & Russell, J. A. (2020, August 26). Clinician well-being: What is our role? [Webinar]. Association for Nursing Professional Development. https://www.anpd.org/p/cm/ld/fid=1401&blogaid=1832
References
American Nurses Association. (2021). Year One COVID-19 impact survey. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/
Christodoulou-Fella, M., Middleton, N., Papathanassoglou, E. D. E., & Karanikola, M. N. K. (2017). Exploration of the association between nurses’ moral distress and secondary traumatic stress syndrome: Implications for patient safety in mental health services. BioMed Research International, 2017(1908712), 1-19. https://doi.org/10.1155/2017/1908712
NSI Nursing Solutions, Inc. (2021). 2021 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
Crystal Demaree, BSN, RN
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