Compassion fatigue and burnout are adding to the cost of healthcare by personally affecting the nursing workforce, and in turn, the patients they care for and the workplace milieu. In their session on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Sue Childress, MN, RN, OCN®, of the Huntsman Cancer Institute in Salt Lake City, UT, and Pamela Bowman, MSN, RN, OCN®, of Duke Cancer Institute in Durham, NC, discussed defining, identifying and reversing compassion fatigue and fostering resiliency in today’s nursing workforce.
A Plan for Compassionate Care
Compassion fatigue is unique to caregiving professionals and is a natural and normal response to long-term caring for those who are suffering, in pain, or are traumatized, Childress explained. Compassion fatigue progresses to burnout when nurses reach physical and emotional exhaustion and experience an inability to feel empathy for patients, coworkers, and even their own families. Employees feel overwhelmed and powerless to make changes. Cynicism occurs, work is no longer enjoyable, and workplace communications become uncivil. As patients become exposed to this environment, they report decreased satisfaction with their care, a lack of trust in their caregivers, and a reduced propensity to recommend the institution to others. The institution suffers with decreased productivity and quality and increased legal risk, absenteeism, turnover, and cost of care.
Huntsman developed a five-year action plan to address compassion fatigue at the institution, Childress said. It started with a retreat to educate clinical leaders about the concepts and form an interdisciplinary committee to strategize ideas for reversal. Surveys revealed staff’s biggest stressors: staffing issues, high patient acuity, heavy workload, lack of lunch breaks, poor communication, small workspaces, and patient deaths. Huntsman implemented specific strategies to address each stressor, such as significantly increasing the number of personnel and adding self-care activities like lunch break exercises and massage chairs.
Year two built on prior work by adding more retreats, Schwartz Rounds, and a website redesign to connect staff with additional resources. A follow-up staff survey showed strong support for what had been done but additional focus on staff civility was needed, so year three’s priority was a commitment to change communication patterns throughout all levels of the cancer center. Classes on corporate culture were assigned followed by training and reporting of unacceptable communication events with follow up for accountability. Year four added a different commitment theme each month under the umbrella of “PROMISE”:
- P = patient centered
- R = respect
- O = ownership
- M = making a difference
- I = innovation
- S = safety
- E = excellence
Now in year five, Huntsman is focusing on how to maintain and solidify its new culture of compassion and civility.
Fostering a strong and resilient workforce contributes to long-term employee retention, which keeps costs down and promotes patient satisfaction. Bowman shared several strategies for fostering resilience:
- Promoting social connections and positivity
- Highlighting individual strengths
- Nurturing growth
- Encouraging self-care and mindfulness
- Conveying altruism
Supporting staff by debriefing after traumatic workplace events was a crucial step in fostering resilience for both organizations. Staff engagement was also critical to the success of both programs.
Other interventions Bowman recommended were:
- Ethics lunch and learns
- Healthy work environment
- “Going the Extra Mile” bulletin board
- Themed lunches
- Staff birthday recognition calendars
- Neck and shoulder massages for staff during shifts
- “A Shot in the Arm” debriefings after traumatic and challenging situations
- Welcome bags for new graduate RNs
- Team time with the chaplain
- Team building events (e.g., Habitat for Humanity, bowling, community volunteering, fundraising, socializing outside of work)
- Random acts of kindness
- Join patients for craft time