Burnout or compassion fatigue?

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.

In nursing school, many of us were trained not to get emotionally involved with our patients, but by working in long-term care settings it is natural to establish emotional relationships with residents and their family members through the very nature of our ongoing interactions. The culture change movement encourages relationship building as we practice holistic nursing that honors resident choice and seeks to implement resident preferences. We strive to learn who our residents really are, not just to care for their diagnoses and related problems. In this new way of relating to residents and their families, we must keep a healthy perspective that allows us to deeply care without taking in their negative events and problems as if they were our own.

The answer then to the question of how to avoid burnout and compassion fatigue is to watch for warning signs and practice self-care. Setting boundaries that allow us to show compassion without becoming overwhelmed requires awareness. This awareness is key to our success in avoiding or overcoming these syndromes. Knowledge about the topics creates an understanding of how to establish healthy patterns in both our work life and personal life.

Janet’s physician explained this process to her, sharing that warning signals are subtle at first, but increase as time goes on. He gave her an article entitled, “Preventing Burnout” by psychologists Herbert Freudenberger and Gail North who identified the following 10 phases of burnout: A compulsion to prove oneself, working harder, neglecting one’s own needs, displacing conflicts by ignoring the root cause of the distress, revision of values in which friends or hobbies are ignored, denial with emergence of cynicism and aggression, withdrawing from social contacts and/or using alcohol or substances to cope, inner emptiness, depression, and actual burnout syndrome.

Prevention steps Janet’s physician said would help get life back under control include:

  • Start each day with a relaxing ritual such as 15 minutes for meditating, journaling, stretching, or reading something inspirational.

  • Adopt healthy eating, exercising, and sleeping habits.

  • Set boundaries to avoid overextending yourself.

  • Take a daily break and set aside time to completely disconnect.

  • Nourish self-creativity by choosing fun activities that have nothing to do with work.

  • Learn to manage stress.

Janet took the following additional actions:

  • Slowed down-cut back commitments and took the time to rest, reflect, and heal.

  • Got support and avoided isolation-sharing feelings with another person relieves pressure.

  • Re-evaluated goals and priorities-burnout is the opportunity to rediscover what makes you happy.


The American Association of Nurse Assessment Coordinators (AANAC) is a nonprofit professional association representing nurse executives working in the long-term care industry. AANAC is operated by nurses for nurses and is dedicated to providing members with the resources, tools, and support they need in their specialized role of leaders and managers in long-term care.

AANAC offers the nurse executive:

  • The opportunity to discuss common challenges and problem-solve with peers and experts from across the country via a widely attended online discussion group

  • Quick and easy access to current long-term care news, regulatory updates, manuals, and publications

  • Weekly e-mail reminders about important dates, deadlines, and current events

  • Educational programs and CEs encompassing the essential job functions of the long-term care nurse executive

  • A weekly newsletter addressing tough issues and topics of current interest on the impact of regulation on facilities

AANAC is the organization chosen by successful leaders in long-term care. To join or get more information about AANAC, visit https://www.aanac.org or call (800) 768-1880.

Ten Phases of Burnout

  1. Compulsion to prove oneself

  2. Working harder

  3. Neglecting one’s own needs

  4. Displacing conflicts by ignoring the root cause of the distress

  5. Revision of values in which friends or hobbies are ignored

  6. Denial with emergence of cynicism and aggression

  7. Withdrawing from social contacts and/or using alcohol or substances to cope

  8. Inner emptiness

  9. Depression

  10. Actual burnout syndrome

Janet took her physician’s advice and through a proactive approach trained her staff to take more responsibility. She spoke with her boss regarding responsibilities that really weren’t hers, and several duties were reassigned appropriately to others. Janet took a complete break by going on vacation to recharge her batteries and renew her perspective. To help others on her team prevent or reverse burnout, she asked the staff development coordinator to teach stress reduction methods to staff and fostered a focus on a supportive environment to mediate the negative aspects of stress. As a nurse leader she modeled a positive image by improving communication-involving employees in decisions impacting their jobs, offered praise for good performance, and incorporated the organization’s values into daily operations.

We can learn much from Janet’s experience. By adopting healthy lifestyle choices and focusing on burnout and compassion fatigue prevention, we will stay on course in the important work that has become the journey of our hearts.

Betty MacLaughlin Frandsen, RN, NHA, MHA, C-NE, is Regional Director for the Bridgewater Center for Rehabilitation and Nursing in Birminghamton, New York. She can be reached at (607) 722-7225.

For more information, go to https://www.bwrehab.com. To send your comments to the editor, please e-mail mhrehocik@iadvanceseniorcare.com.


  1. Job Burnout: Understand Symptoms and Take Action. Available at: https://www.mayoclinic.com/health/burnout/WL00062/METHOD=print
  2. Kraus C. Compassion Fatigue-What Is It and How Can You Avoid It? Alabama Nurse. December 2005-February 2006. Vol. 32, Issue 4. Available at: https://proquest.umi.com.
  3. Mulligan L. Overcoming Compassion Fatigue. Kansas Nurse. Topeka: Aug 2004. Vol. 79, Issue 7. Available at: https://proquest.umi.com.
  4. Preventing Burnout. Available at: https://www.helpguide.org/mental/burnout_signs_symptoms.htm.
  5. Stress at Work. Available at: https://www.helpguide.org/mental/work_stress_management.htm.

Long-Term Living 2010 May;59(5):50-52

Topics: Articles