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Compassion Fatigue: How Nurses Can Care for Themselves

Practicing gratitude and setting intentions is another form of self-care. Gratitude journals can help nurses focus on themselves and the positive things that are in their life. Hawkins believes that the act of physically writing down three gratitudes at night sets the stage for your brain to relax, allowing  you to wake up with a positive mindset. This is followed by starting your day with your intention. “This is the day I’m going to….”

Changing the Culture

The issue of CF cannot be dealt with by the nurses alone. According to Hawkins, part of the problem in dealing with CF among nurses starts with acknowledging that it is happening. “Half the workforce is burned out,” she said. “It’s interesting, because what other industry allows people to participate in the job when they’re impaired [from burnout]? It’s been shown over and over again in the literature that when you’re burned out, there’s a higher risk for errors, there’s more sickness, etcetera.”

Now that we know that CF is a problem, we have to start taking care of ourselves and each other. “That means we have to acknowledge what is hard in healthcare,” Hawkins explained.

“What is hard about oncology nursing? What do we do with all of the suffering we have born witness to? Where do we put that?” The leadership needs to put programs into place that allow the nurses to express their feelings and to help them deal with them. The leadership needs to hear what the nurses are saying without getting defensive, Hawkins said. Those in charge have to be able to listen when their nurses are talking, without thinking that the nurses are being disloyal or disgruntled.

Can Compassion Fatigue Be Avoided?

There is a school of thought that says that you cannot develop compassion fatigue if you take care of yourself and practice mindfulness.

In a personal reflection piece published in the Journal of Palliative Medicine, palliative care physician Lisa Marr asks, “Can compassion fatigue?” According to Marr, in order for there to be compassion fatigue, there must be a finite amount of compassion in the first place. When this finite amount runs out, it needs to be replenished, and it starts over again.

“I believe that if we are truly engaged in that moment, not focusing on ourselves or worrying about where I should or could be at that moment, but truly engaged in the interaction with the other person, then compassion cannot fatigue, and frankly, burnout is less likely to occur.”8

This brings us back to mindfulness: “If we are wholeheartedly engaged in each moment, responding to what is in front of us, not judging or labeling ourselves or others, then I believe compassion cannot fatigue. Compassion can arise anew in each situation, each moment, since it is a response to what is in front of us. It’s what we do, not who we are,” Marr concluded.

Takeaway Points

  • Compassion fatigue (CF) is estimated to affect 16% to 39% of registered nurses, and especially affects those practicing in emergency, oncology, and hospice settings.
  • Moving continuously from one situation to another can increase risk for CF.
  • The Professional Quality of Life Measurement (ProQoL) is available online and can help assess for CF.
  • To avoid CF, practice self-care and self-compassion, eg, gratitude journals, taking regularly-scheduled vacations, and mindfulness “in the moment”.
  • “Acknowledge what is hard in healthcare”—engage institutional leadership to improve the culture and support nurses.


  1. US Library of Medicine. PubMedHealth. Depression: What is burnout syndrome? Accessed April 2, 2016.
  2. Figley CR. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Levittown, PA: Brunner/Mazel; 1995.
  3. Potter P, Deshields T, Berger JA, et al. Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncol Nurs Forum. 2013;40(2):180-187.
  4. Stamm BH. Compassion Satisfaction and Compassion Fatigue. April 26, 2012. Accessed April 2, 2016.
  5. Potter P. Compassion Fatigue: Prevalence Among Oncology Nurses. Presented at: Missouri Oncology Society Spring 2015 Membership Meeting; April 14, 2015. Accessed April 2, 2016.
  6. Professional Quality of Life Scale (PROQOL). Compassion Satisfaction and Compassion Fatigue. Accessed April 2, 2016.
  7. Jon Kabat-Zinn: Defining Mindfulness. Mindful. January 11, 2016. Accessed April 2, 2016.
  8. Marr L. Can compassion fatigue? J Palliat Med. 2009; 12(8):739-740. Accessed April 2, 2016.

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
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