Understanding and Addressing Burnout and Compassion Fatigue in The Healthcare Workplace

Compassion is defined as “sympathetic consciousness of others' distress together with a desire to alleviate it” (Merriam-Webster’s Collegiate Dictionary, 2019). To elaborate, compassion is a complex and abstract idea that is described as an emotional response to another’s individual’s vulnerability and suffering. This response, in turn, motivates an individual to strive for the best outcome for the one who is in distress (Lee, Daugherty, Eskierka, & Hamelin, 2019). Although compassion is a key trait to have in order to provide high-quality patient care, nurses are often exposed to many work-place stressors caused by institutional challenges that can lead to negative outcomes for nursing professionals.

What is Nursing Compassion Fatigue and Burnout?

In response to the work-place stressors that nurses face in the hospital setting, many have developed ineffective comping mechanisms demonstrated by detachment and relationship distancing while others have fallen victim to compassion fatigue and burnout (Lee, Daugherty, Eskierka, & Hamelin, 2019). Compassion fatigue occurs when nurses unknowingly internalize the anxiety, trauma, and distress of their patients, further leading to nursing burnout. Burnout can be described as a prolonged response to physical and emotional stressors that result in feelings of exhaustion, a sense of being overwhelmed, insecurity, anxiety, cynicism, and inefficiency (Henry, 2014). Burnout symptoms for nurses include irritability, frequently calling in sick, change intolerance, physical exhaustion, and being mentally “checked out” (Nursing.org, 2019).

Compassion fatigue and burnout can be caused by overall negative hospital work environments. Three main contributors to an unhealthy workplace are bullying and lateral violence, understaffing and long work hours, and continued exposure to illness and death. Consequences, as a result of the three contributors, include nurses leaving the profession, decreased patient satisfaction, decreased positive patient outcomes, medical errors, depression, and suicide.

The first contributing factor to nursing compassion fatigue and burnout is bullying and lateral violence. Lateral violence is explained as an abusive or disrespectful situation between individuals who are at the same level. Some examples of lateral violence include nurses being disrespectful to one another, seasoned nurses not offering to assist other nurses, and new graduate nurses being ignored. Bullying is described as an abusive situation when the perpetrator is at a higher level than the victim. Examples of bullying include managers being openly disrespectful in front of colleagues, nurses being singled out inappropriately during meetings, nurses consistently being assigned the most difficult patients or being floated to other floors more than other nurses, and being mocked in regard to and ADN vs BSN degree (Gillespie, Grubb, Brown, Boesch, & Ulrich, 2017).

Many consequences arise as a result of lateral violence and bullying in the healthcare workplace. These include nurses leaving their positions, changing careers, and experiencing depression and anxiety that can lead to suicide. Approximately 60% of new nurses leave their first position within six months due to some form of verbal abuse or harsh treatment from a colleague while 32% of new graduate nurses have experienced bullying (Colduvell, 2017; Additionally, nurses surveyed about bullying and lateral violence reported reduced mental health, decreased collaboration with team members, ineffective communication with the team and patients, diminished work productivity, and poor job commitment (Gillespie, Grubb, Brown, Boesch, & Ulrich, 2017).

The second contributing factor to nursing compassion fatigue and burnout is inadequate nurse staffing. This insufficient nurse staffing issue is described as being causes stress due to long work hours, understaffing, and inappropriate nurse to patient staffing ratios (Garrett, 2008). Additionally, nursing work environments have gained attention due to staffing shortages, high absenteeism, and cutbacks in hospital funding. Long work hours are generally discussed as working more than 8 hours per day, taking call, or participating in mandatory overtime to covering staffing shortages and coworker vacations (Garrett, 2008). Understaffing and mandatory overtime can perpetuate long work hours as nurses are required to work longer shifts or work additional shifts in order to provide appropriate floor coverage during times of additional need. Long, tiring, and frequent shifts highly contribute to burnout for nurses throughout their career (Eriksen, 2018).

Several consequences arise as a result of insufficient nurse staffing. These consequences include nurses hurrying during tasks, increased nursing mistakes, nurses’ feelings of being overwhelmed, poor patient care, and decreased patient satisfaction (Eriksen, 2018). Unrealistic nursing workloads also result in chronic fatigue, poor sleep quality, burnout, absenteeism, and decreased job satisfaction (Garrett, 2008). Similarly, nurses who work overtime reportedly have a measurable increase in medication errors, resulting in decreased patient outcomes while, comparatively, higher staffing ratios have been shown to improve patient outcomes due to a decrease in medication errors. Furthermore, hospitals with inappropriate nursing staff resulted in a high level of adverse patient outcomes. These negative outcomes include increased instances of patient urinary tract infections, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stays compared to patients in hospitals with proper nurse to patient staffing ratios (Garrett, 2008).