Everyone understands fatigue on some level, whether you work in healthcare or not. The dictionary defines it as “extreme tiredness resulting from mental or physical exertion or illness”, but we know that doesn’t really capture the full experience of fatigue. It is more than just “extreme tiredness”. There is even an ICD-10 code for it:
Exhaustion, exhaustive (physical NEC) R53.83
Lack of energy R53.83
Lethargy R53.83
Overstrained R53.83
Overworked R53.83
Prostration R53.83
Tiredness R53.83
Vitality, lack or want of R53.83
When we look at this list it gives a glimmer of the mental suffering that can accompany physical exhaustion. If we look at the research, the most common words and phrases used to describe fatigue include the following:
disruptive, subjective, distressing, debilitating, exhaustion, persistent, overwhelming, lack of energy, and not relieved by rest or sleep 2021 (Billones et al., 2021)
Sounds great…and familiar.
It begs the question, in the absence of physical disease, why do so many healthcare providers experience fatigue. Is it from a job well done?
Yes. Well, yes and no.
We have all had experiences where we are physically fatigued from completing a difficult job. However, when this is the type of fatigue we are dealing with, it IS typically relieved by rest and sleep. And yet so many of us struggle with the fatigue associated with mental exhaustion, we wake up fatigued, we are fatigued throughout our day and we find ourselves struggling at times to drum up enough motivation to do the other things that are important to us.
What is different about this type of fatigue? Why doesn’t a good night sleep and a vacation reset us the way we hope it will.
The answer lies within the concept of Compassion Fatigue, the not talked about cousin of good old “regular” fatigue.
Compassion fatigue is described as the cost of caring. Like everything else in life, compassion can come with a cost (it doesn’t mean it’s not worth it).
To understand this experience, we need to understand compassion on a technical level, not just an emotional one. We need to understand the definition.
Compassion is “The emotional sensitivity to understand other people’s suffering and the combined willingness to help them solve their problems” (Lee, Lee, & Jang, 2021).
It’s not only the empathy, it’s the desire and willingness to help. For people in other fields, compassion may not be a core part of their daily routine, it may be something that they draw on only when a family member has a crisis, or a colleague needs a hand.
This is not the reality of nursing. Compassion is literally what drives every action, it’s what we rely on while we are constantly exposed to the trauma and the suffering of our patients. This continued exposure can result in secondary trauma of the nurse, a normal physiologic response to something that is “too much, too fast” for the nervous systems to adapt to. As we get more worn out, we can start feeling that the care is futile, that the patient issues are too much, that we don’t have what we need to make a difference. We unintentionally withdraw in an attempt at self-preservation. This depletes us further, robbing us of the restorative connection with our patients and our peers.
Most nurses were never taught about this in school.
Most continuing education programs don’t mention it.
Caring for people can be costly, especially when you really care.
We start to look around for something to blame, the lack of resources, the lack of time, the lack of system support, using the blame as a lifeline to combat the sense of failure that can come from compassion fatigue. We don’t want to feel like this.
This is important to know, it’s important information to share with your colleagues. Otherwise, we can start to think that something is wrong with us, that somehow we can no longer do this, day in and day out, that somehow we are flawed.
We are not flawed. We are not alone.
And we aren’t powerless.
Here’s the good news (there is always good news).
Compassion fatigue is not a death sentence to the career that you have poured your heart and soul into. Compassion fatigue is treatable, once it is properly diagnosed we can take the appropriate treatment steps. We don’t even have to get rid of the secondary trauma in order to treat compassion fatigue.
The treatment is rooted in building Compassion Satisfaction, the antidote to compassion fatigue. Compassion satisfaction is just what it sounds like, the fulfillment, meaning and pleasure that nurses get from their work. This leads to an increase in resilience, an increase in the resources necessary for us to keep doing the work that we feel called to do.
Satisfaction is an emotion, a mindset, a feeling. As such it is something that we can significantly impact just by manipulating how we are thinking about something. Simple but not always easy. Compassion satisfaction has a direct inverse relationship with compassion fatigue and with secondary trauma. And we can directly affect it by using our brains.
One of the easiest steps to take toward compassion satisfaction is retelling the story about the futility of care (and by futility of care I don’t mean that the patient is going to necessarily die or have terrible outcomes, I mean the idea that we aren’t doing enough, that it doesn’t make a real difference, that it isn’t meaningful).
What if the care you give ISN’T futile?
What if just because in a perfect world you could potentially give BETTER care doesn’t mean that the current care is less valuable?
I hate to break it to you, we aren’t living in a perfect world, so we need to stop measuring ourselves against an alternate reality.
If this is part of the solution, how do we make the care we are giving now not just satisfactory but really good?
We stop telling ourselves it isn’t good enough. We look for the good. We write down the good. We focus on how it does matter. We share the good stories with each other, not just the devastating ones. We tell this story.
Today I saw the humanity in the person in front of me. I listened to them, without judgement. That may be more care than they have had from anyone in years. I gave them my attention, even though I was tired. I used my education and experience to try and find a way to help decrease their suffering and improve their health. I explained things in a different way than I explained it last time so maybe they could understand better. I acknowledged that making changes are hard AND that we could work on it together. I believed in them when they couldn’t. I discussed their case with a colleague to see if there was anything else I could have offered. I did all this for another human being and it was worth it.
And then I did it again…
And again.
There are other stories about today that could be true, ones that include all the stressors. Those stories don’t build satisfaction and we don’t need help telling them.
What story can you tell about your day?
My hope is that this will start your inquisitive mind stirring, that you will research this further, for your own growth and healing, for your own wellbeing and the wellbeing of your patients.
There are lots of resources about compassion fatigue and compassion satisfaction out there, let's start by being a resource for each other.
If this speaks to you and you don’t want to combat the compassion fatigue alone, I am here for you. Reach out for a free consult call and let’s do this together.
I don’t usually include references but this time I thought I would. These are just the tip of the iceberg. This link is a compassion satisfaction/fatigue and burnout scale. Maybe you want to try it 🙂
Billones R, Liwang JK, Butler K, Graves L, Saligan LN. Dissecting the fatigue experience: A scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain Behav Immun Health. 2021 May 21;15:100266. doi: 10.1016/j.bbih.2021.100266. PMID: 34589772; PMCID: PMC8474156.
Rayani A, Hannan J, Alreshidi S, Aboshaiqah A, Alodhailah A, Hakamy E. Compassion Satisfaction, Burnout, and Secondary Traumatic Stress among Saudi Nurses at Medical City: A Cross-Sectional Study. Healthcare (Basel). 2024 Apr 17;12(8):847. doi: 10.3390/healthcare12080847. PMID: 38667609; PMCID: PMC11049928.
Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016 Jun 22;13(6):618. doi: 10.3390/ijerph13060618. PMID: 27338436; PMCID: PMC4924075.
Lee HJ, Lee M, Jang SJ. Compassion Satisfaction, Secondary Traumatic Stress, and Burnout among Nurses Working in Trauma Centers: A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Jul 6;18(14):7228. doi: 10.3390/ijerph18147228. PMID: 34299686; PMCID: PMC8307372.
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