Jillian Kenney, BSN, RN, OCN
Compassion fatigue ... burnout … job-related stress. Whatever the term used to describe it, most oncology nurses will have experienced the feeling themselves or witnessed it in their colleagues, and more than likely, both.
Burnout is a word that many people use to describe what they feel when they can no longer work effectively. It is a reaction to external forces, such as overwork, difficult working conditions, or conflicts with bosses or coworkers, and results in a breakdown in the ability to stay focused and on task.1
People from all walks of life and all professions can experience burnout, but it can go deeper among people who work in caring and giving professions like nursing. These professionals can also develop compassion fatigue (CF).
Charles Figley, PhD, now the director of the Tulane University Traumatology Institute, formally defined CF
in 1995 as a combination of burnout and secondary traumatic stress, the type of stress experienced by people who care for others who are traumatized or are suffering.2
Compassion fatigue affects 16% to 39% of registered nurses. And although all nurses can experience it no matter where they practice, those at highest risk are nurses working in emergency, oncology, hospice, and pediatric settings.3
“In general terms, burnout is more of a personal experience, whereas compassion fatigue is a relational experience,” Jillian Kenney, BSN, RN, OCN, explained. “While some of the symptoms may be the same, the motivation behind those symptoms is the biggest difference.
“Someone suffering from professional burnout may feel that they don’t have adequate resources, they don’t have adequate compensation, and that leads to a dislike of their place in their company or business, whereas compassion fatigue results from the perceived lack of ability to attain a shared goal.”
That goal is the well-being of the patients. “If your patient isn’t doing well, there’s almost a subconscious sense of failure on the part of the nurse,” continued Kenney, a clinical nurse in oncology at the UCLA Medical Center in Santa Monica, California.
Compassion is a vital part of a nurse’s role, and compassion satisfaction is the positive side of being in a helping profession.4
When compassion satisfaction rates remain high, this is positive for both nurses and their patients. Patients who feel satisfied with the care they received reported better overall satisfaction with their hospital experience. But the flip side of compassion satisfaction is CF, and when satisfaction drops, risk of CF follows, as does the risk of lower quality patient care.5
Oncology Nurses at Risk
Inpatient oncology units often follow the mixed-model setting. In the course of one shift, nurses may provide care to patients who are receiving active curative treatment, while at the same time helping patients who are receiving palliative or end-of life care, depending on their assigned patient load.
Patricia Jakel, RN, MN, AOCN
By moving continuously from one situation to another, if a nurse does not feel in control or supported, he or she is at risk for CF. Patricia Jakel, RN, MN, AOCN, a clinical nurse specialist also at UCLA Santa Monica Medical Center, shared this story:
“One of my young nurses came to me. He’s a great nurse. He said to me, “The patient dies. I do what I have to do with the family, but then I have to go next door and begin the chemo on a newly diagnosed lymphoma patient, and I have to put on my happy face.” That’s really hard in a fast-paced environment. You can take 10 minutes at work, but most of us cry in our cars on the way home.”
Nurses who experience CF usually dread going to work, may have difficulty concentrating, feel nervous, anxious, or pessimistic, and have low self-esteem. Anger towards coworkers is not unusual. At first, the signs may be brushed off as having a bad shift or not feeling up to par, but as the feelings continue or intensify, this could point to CF.