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Burnout or compassion fatigue?

May 1, 2010
by Betty MacLaughlin Frandsen, RN, NHA, MHA, C-NE
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At a glance…

Because of the demanding nature of working in long-term care, many nurses, while they enjoy their jobs, run the risk of suffering from burnout and compassion fatigue. By adopting healthy lifestyle choices and focusing on burnout and compassion fatigue prevention, you can minimize work stresses and their toll.

Nurse leaders have demanding jobs, and at times it may feel like you are carrying the weight of the world on your shoulders. Given the pressures of nursing home life, we are susceptible to emotional, mental, and physical exhaustion brought on by continuous demands that include the needs of residents and families, staffing issues, regulatory compliance, and surprise surveys.

Typically, we entered nursing to make a difference in the lives of others, not realizing the extraordinary range of job duties this entails. In addition, we often have to face illness, decline, and the death of the very people we care so deeply about, and for whom we strive so hard to provide high-quality care. Residents and families need support, staff have their coping struggles, bosses can be demanding, and we are expected to step in and know just what to do. Is it any wonder that there are days and even longer periods of time when we wonder why we do what we do?


Recently I discussed this topic with two nurse leaders from different areas of nursing home practice. Both expressed a sense of being overwhelmed, mostly by the feeling that what stresses them most is beyond their control. One was deeply wounded when a colleague whom she revered was suddenly terminated. The other works long hours picking up tasks pushed her way by the administrator, which adds greatly to her workload. Both are experiencing frustration at what seems unfair, yet neither feels in a position to change the situation.

Add to that the “normal” demands of leading, directing, and overseeing care for large numbers of residents, and it becomes hard to consistently inspire others. One nurse said, “I love my job and I love working here. But right now I am struggling because of what happened. I decided I have to just accept it, but my heart hurts, and being a DON is a matter of the heart.” So is burnout-it causes us to waiver in our journey of the heart. The circumstances facing each of us in our jobs may be different, but we are all susceptible to that one additional event that brings us to the point of burnout. Consider the following example:

Drowning in responsibilities

“Janet” led her team to make numerous improvements in quality of care and quality of life for their residents. Despite their success, lately she was struggling to cope with her workload. Her assistant “Sheila” noticed the change and asked what was wrong. Janet admitted she felt exhausted, overwhelmed, and had trouble sleeping and concentrating. Sheila encouraged her to see her doctor. Her doctor determined Janet was experiencing burnout syndrome and made recommendations to help reverse the problem. He explained that burnout is long-term exhaustion resulting in diminished interest in things previously enjoyed.

Healthcare workers, especially those at a professional level, have a higher than average proportion of burnout caused by prolonged stress that places extreme physical and psychological demands on them. Janet's burnout occurred when her stress load made her feel like she was drowning in responsibilities without hope of a positive change. Her physician explained that negative outcomes of burnout include job performance decline, health-related bad outcomes from increased stress hormones, and mental health problems such as depression.

Work-related causes of burnout for individuals like Janet include feeling little or no control over their workload, a lack of recognition or rewards for good work, and working in a high-pressure environment. Lifestyle causes include working too much without time for relaxing, taking on too much responsibility without adequate help from others, not getting enough sleep, and lack of supportive relationships. Personality traits make some individuals more likely to experience burnout and include perfectionist tendencies, a pessimistic view of self, reluctance to delegate, and a Type A, high-achiever personality.

Compassion fatigue

While burnout such as Janet experienced is a commonly understood term, the concept of compassion fatigue is a variation often experienced by nurses. It occurs as caregivers consistently give out more energy and compassion than they receive, and manifests itself as physical, emotional, and spiritual exhaustion. Nurses and other healthcare workers are continually exposed to negative events experienced by their residents/patients, and over time an accumulative state occurs as the nurse is overwhelmed by this secondary exposure. Chronic exposure to the stress and loss experienced by residents for whom they care, if not managed, results in a sense of helplessness or even hopelessness. Although the symptoms of compassion fatigue are typically the same as burnout, the cause is based on how we respond to losses experienced by our residents and their family members.