Many nurses have likely found themselves in similar situations. Even if they don’t specialize in palliative care, RPNs routinely face death, dying and suffering in the hospitals, long-term care institutions and homes where they work. And there is growing recognition that nurses are at risk of emotional burnout, stress, high blood pressure, depression and a host of other serious consequences as a result of working in such emotionally tense environments.
“It is a result of the emotional intensity of the work, there’s no doubt about that,” says Trueman, who is the President of the Canadian Hospice Palliative Care Nurses Group, as well as a nurse practitioner with extensive experience in hospice care. “We cope with the emotional burdens of our work very differently and that can create a lot of problems.”
Mounting evidence is starting to confirm what nurses have long known: being witness to another person’s suffering and death can have lasting consequences. It’s a serious issue that can not only affect how well nurses are able to perform at their jobs, but can also impact their long-term mental health. Experts often refer to this condition as ‘compassion fatigue’, described by Christina Melvin, a clinical associate professor of nursing at the University of Vermont, as a debilitating weariness.
“It’s really the result of repeated exposure to the trauma of others,” Melvin says. “It’s nurses being continually exposed to the pain, really the pain and the suffering of other human beings.”
For instance, a 2006 study published in the Journal of Hospice and Palliative Nursing found that nearly 80 percent of nurses caring for end-of-life patients are at risk for compassion fatigue because of their constant exposure to trauma, anxiety and feelings of empathy.
Melvin has also conducted extensive research on the topic of compassion fatigue. And she has discovered that in many cases, nurses have a hard time recognizing when they are at the brink. That is because, for the most part, nurses tend to keep these emotions to themselves and instead focus their attention on providing patient care. The problem is that over time, stifling these emotions can cause nurses to eventually lose empathy for patients, develop sleeping problems, depression or other serious side effects.
While it’s not possible for nurses to avoid the emotional intensity that is often a daily reality as part of their roles, there are some coping strategies that can help them to avoid emotional burnout and compassion fatigue. For Trueman, the saving grace was a col-league who noticed that he was being uncharacteristically curt at work. At first, he didn’t even realize he was experiencing burnout. It was only after taking a vacation and doing some intense self-reflection that Trueman recognized he had a problem.
Having a strong team comprised of members who watch out for each other can be vital to identifying potential problems and avoiding serious long-term consequences.
Melvin notes that it can be difficult for some nurses to show their vulnerabilities to team members that can act in supervisory roles. In those cases, it may be better for nurses to talk to other staff members in the organization, like a social worker or psychologist. When she was doing clinical work, she and fellow nurses would meet with a social worker on a weekly basis, something that was a major source of support. Health care institutions are increasingly turning to that system, which is referred to as ‘debriefing’, says Melvin.
It’s also important that nurses have an outlet to deal with the daily stressors and challenging emotional scenarios they encounter at work. Trueman recommends exercise, meditation, even getting together with family or friends and finding ways to laugh.
Melvin, who also spent much of her clinical career working in a hospice before becoming a nursing educator, agrees that engaging in a healthy activity is essential to preventing com-passion fatigue and burnout from setting in. In her case, she used to go for a long walk after a tough shift, something that helped to clear her mind and help her reflect.
Finding time to sit in a quiet room or go for a long walk might seem like an impossible task in between juggling the priorities of work and home life. But nurses have a responsibility to their patients to ensure they are providing the best care possible and that may not be possible if a nurse is feeling psychologically distressed or emotionally drained.
“You need to make time for self-reflection in this business or you will not be providing good or safe patient care,” Trueman says. “I’m there for my patients. They’re not there for me.”
