Can a Nurse Care Too Much?

By Jordie Papa

Image courtesy Public Domain Pictures

When it comes to TLC, nurses are practically the poster children.  They are usually the first people we see when we walk into the doctor’s office or are wheeled into the ER.  They care for us before, during and after a medical procedure.  Then they are there from the moment we come out of anesthesia right up to the moment we are discharged.  When it comes to caring, nurses are caring incarnate.  The question is not one of whether nurses care for patients in their care.  Rather it’s one of whether nurses can care for their patients too much. 

Soldiers sometimes get PTSD.  Nurses can come down with Compassion Fatigue.

Nursing can be a tough profession.  Not only do nurses work long, hard shifts, many times they are exposed to life-threatening trauma and death.  When a nurse has a patient in their care die, it’s not always easy to rationalize the death as just another part of life.  Being human means feeling something when someone you know dies, even if you’ve only known the person for a short period of time.  Although nurses are trained to distance themselves from losing patients, even the best of them tend to internalize the loss.  How this affects many nurses is to cause emotional stress that can degrade their ability to deal with the other stresses associated with doing their jobs.

In a blog entitled Compassion Fatigue: A Nurse’s Primer, case studies were presented for both nursing students and experienced nurses who had experienced compassion fatigue. 

Nurse #1 began working on a busy Cardiac Unit. Several patients on this unit experienced multiple admissions. Nurse #1 seldom took breaks; she quickly acquired the skills needed to work on this unit and soon became a leader on the unit. Within a short timespan three of her primary patients died. The patient census remained high and the workload remained intense. Nurse #1 soon began viewing her work as drudgery. Her co-workers observed her changing behavior as she struggled to find some kind of work-life balance. This changing behavior was also noted by the nurse manager who attempted to adjust her schedule. After a period of time Nurse #1 started working in the outpatient clinic at the hospital. Although Nurse #1 attempted to adjust to this new setting, she still continued to care for patients with end-of-life, cardiac-disease processes. Eventually, she left this position to pursue a less stressful work environment.

Image by Uniform Destination

The article goes onto relate the three core relationships that are tied to compassion fatigue: A nurse’s relationship to their patients, their relationship to other staff members and their relationship to themselves. Of the three, the most important when it comes to stemming the onset of compassion fatigue is their relationship to themselves. It was noted during the study that one of the first signs of compassion fatigue was a marked lack of self-care, where nurses who were experiencing severe emotional stress on the job began to neglect their own well-being.  It was almost as though affected nurses viewed their act of self-sacrifice as being a way to make up for their inability to control the fate of their patients.  Soon theses symptoms spiraled into everything from mood swings and job burnout to disillusionment that eventually led to either asking for another assignment or quitting altogether.

Detection is the First Step to Intervention

As difficult a job as nursing can be, what makes it even tougher is when a nurse winds up falling onto the slippery slope that leads to compassion fatigue.   The first step to helping nurses avoid the worst effects of the debilitating condition is for their supervisors and coworkers to detect the early symptoms.  These include on-the-job indications that can include avoiding certain patients (particularly those with life-threatening conditions), undue fatigue, moodiness, showing up for work late, and/or frequently calling in sick.  From a physical perspective, the onset of the condition can cause headaches, digestive problems, insomnia, and even chest pains.  Emotional disturbances can include grouchiness, depression, loss of appetite, unexplained bouts of anger, and/or lack of concentration.

If a nurse shows several of these symptoms, the next step is to have a supervisor recognize the problem and take steps that will reduce the psychological stresses that will only escalate if left unchecked.  Aside from acknowledging that a staff member is possibly suffering from the onset of compassion fatigue, the most important early intervention steps is to reduce further stress while providing an affected nurse with support and counseling as soon as possible.

Many hospitals have addressed the problem by creating what is known as an Employee Assistance Program that is specifically set up to provide counseling necessary to define a plan of action that can help employees address such conditions as compassion fatigue.  Aside from helping staff members deal with the traumas associated with their profession, these programs can also be invaluable to teaching nurses how to cope with other job-related stresses.  They are also a great help in finding a way to interface with other nurses who have been in a similar situation in order to let off steam in a positive manner.  Sometimes this involves group therapy sessions, while other remedies include teaching affected staff members relaxation techniques that can help deal with stress without being overwhelmed by it.

While nurses can’t care too much, they should care about the effects of dealing with those in their care.

Jordie Papa owns and operates Uniform Destination in Jacksonville, Orange Park and St. Augustine, Florida.  For more information on her locations go to http://www.uniformdestinations.com