THE COST OF CARING TOO MUCH COMPASSION FATIGUEBURNOUT

THE COST OF CARING TOO MUCH: COMPASSION FATIGUE/BURNOUT Practice implications for Nurse Managers By Julie Maher RN, BA, MA Whitireia NZ.

Te Kura Hauora Faculty of Health: Providing professional education to prepare graduates for the global environment of health and social care

OBJECTIVES Define the terms Compassion Fatigue (CF) and Burnout Discuss how both CF & Burnout presents Identify Burnout how to reduce and manage both CF & Highlight Discuss and discuss Authentic Leadership the importance of selfcare for Nurse Manager’s

COMPASSION FATIGUE “Loss of ability to nurture” (Joinson as cited in Boyle, 2011).

COMPASSION FATIGUE Associated with the cost of caring There is a preoccupation with the experienced by patients (Figley, 2002) trauma/suffering Emotional unease, to compassion discomfort to compassion stress to compassion fatigue Significant negative psychological and physical effects Results from Crossing professional boundaries patients close interpersonal contact with suffering

WHO IS AT RISK OF COMPASSION FATIGUE All health professionals Nurses No – particularly vulnerable (Aycock & Boyle, 2009) literature to support Nurse Managers at risk of CF Nurse Mangers more at risk of Burnout Social Workers Counsellors Doctors 6

BURNOUT Nurse Managers may be more at risk of Burnout than CF. A state of physical, mental and spiritual exhaustion caused by excessive & prolonged stress. Overwhelmed, overburdened, unable to meet constant demands Loose interest in job & motivation Occurs gradually Causes staffing issues, workload, managerial decisions, inadequate resources Results in decreased empathic responses, withdrawal, overwhelmed. May resign or transfer

COMPASSION FATIGUE Presents as: Apathy, sad, no longer finds activities pleasurable Feeling guilty for loss of compassion Excessive blaming & complaints about management Bottled up emotions Reoccurrence of nightmares & flashbacks to traumatic event/suffering patients Avoidance of situations related to patient suffering Isolation from others Substance abuse to mask feelings Compulsive behaviours such as overspending, overeating, gambling etc

FURTHER PRESENTING FACTORS Poor self-care (i. e. hygiene, appearance) Chronic physical ailments such as G. I. problems and recurrent cold Difficulty Mentally concentrating and physically exhausted/depressed Preoccupied In denial about problems

History of CF in nursing Historically lack of recognition and under-researched on CF in nursing (Sabo, 2006) Not been formally defined in nursing Nor explored /explained that allows nurses to identify & prevent CF in the workplace (Coetzee & Klopper (2010)

SUPPORT FOR COMPASSION FATIGUE Self care Self reflection Separate Use from work at the end of day of Relaxation/Meditation/Reflective Journal Attend professional development in CF/Burnout Support from Managers, Support Services EAP, Pastoral Care, Peer Support Clinical Supervision

MANAGER’S CAN Reduce risk of Compassion Fatigue Create open supportive work environ. Create a culture of mutual support Offer education in CF Share patient load amongst Team Members, partic. those with high needs Make time for social contact among teams, social events, social cohesion & trust Encourage healthy self care/regular breaks Reward efforts & offer training with focus on self-care & work/life balance to build resilience (Portnoy, 2011)

MANAGER’S CAN Reduce risk of compassion fatigue Be informed of CF & recognize in staff Encourage Work work – life balance with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

AUTHENTIC LEADERSHIP Nursing leadership impacts on the quality of the nursing environment Imp. to create a healthy work environ. new grads. & experienced nurses This ultimately effects the quality of care provision Empower nursing staff – by Nursing Leadership Quality supports and resources Authentic Nsg. Leadership – nurses will respond positively Involves Access to info; grow Support; Resources to do the job; Opports. to learn and Higher work engagement/greater trust in Management Leadership training for Nurs. Managers likely help support development of empowering work environ. (Spence, Wong & Ashley, 2013)

MANAGER’S CAN Reduce risk of CF Be informed on CF & recognize in staff Encourage Work work – life balance with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

MANAGER’S CAN Reduce risk of compassion fatigue Be informed CF & recognize in staff Encourage Work work – personal balance with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

HOW DO YOU CARE FOR SELF/ NURSE MANAGERS Wearing two hats, professional and managerial role (Cassie, 2014) Multiple stresses/meat in the sandwich effect Own care takes 2 nd place to others – at risk of Burnout? Heightened sense of responsibility Attend Professional Development in Authentic Leadership/Effective Leadership styles & other supportive PD e. g Conflict Management Regular Clinical Supervision – important Attention to own selfcare – Mindfulness, Meditation, Reflective Practice, Relaxation Use of humour and a Peer Supporter/ trusted colleague from within your workplace Use other resources available to you EAP Services Try and create a work space and a home space (if possible) Take annual holidays and at least 3 long weekends a year Selfcare is to be Selfaware Remember you Matter

MANAGER’S CAN Reduce risk of compassion fatigue Be informed CF & recognize in staff Encourage Work work – personal balance with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

References Adcock, N. , & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13, 195 -214/ doi: 10. 1080/17496530902951988 Boyle, D. A. (2011). Countering Compassion Fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16. Retrieved from Pubmed http: //nursingworld. org/Main. Menu. Categories/ANAMarketplace/ANAPeriodicals/OJIN/ Tableof. Contents/Vol-16 -2011/No 1 -Jan-2011/Countering-Compassion-Fatigue. aspx Cassie, F. (2014) Wearing Two Hats at One Time: Nurse Managers on the Ward, Nursing Review, 14(6), http: //www. nursingreview. co. nz/issue/december-2014 -vol-14 -6/wearinghats-at-one-time-nurse-managers-on-the-ward/#. WBE 3 q_l 97 IU two- Coetzee, S. K. & Klopper, H. C. . (2009). Compassion fatigue within nursing practice: a concept analysis. Nursing and Health sciences, 12, 235 -43. doi: 10. 1111/j. 1442 -2018. 2010. 00526. Hooper, C. , Craig, J. , Janvrin, D. R. , Wetsel, M. A. , Reimel, E. , & Anderson, S. C. (2010). Compassion Satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialities. Retrieved from Science Direct http: //ac. elscdn. com/S 0099176709005534/1 -s 2. 0 -S 0099176709005534 - main. pdf? _tid=56 ff 7 f 5 a-9 bec 11 e 6 -ae 9500000 aacb 360&acdnat=1477535185_8 ce 14 e 7253 c 1690 d 416 c 434 f 01 e 871 ed. S

References Portnoy, D. (2011). Burnout and Compassion Fatigue. Watch for the signs. Health Progress, 9(4), 47 -50. Retrieved from Proquest. http: //search. proquest. com/docview/880955816? pq-origsite=summon Sabo, B. (2011), Reflecting on the Concept of Compassion Fatigue. The Online Journal of issues in Nursing, 16(1), 8 -14. Retrieved from Proquest http: //search. proquest. com/docview/878059711? pqorigsite=summonreferences Spence Laschinger, H. K. , , Wong, CA. & Ashley L. Grau. (2012). Authentic leadership, empowerment and burounout: a comparison in new graduates and experiences nurses. Journal of Nursing Management, 21, 541 -552. doi: 10. 1111/j. 1365 -2834. 2012. 01375