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Running Head: THE OBLIGATION TO COMBAT COMPASSION FATIGUE: AN

INVESTMENT FOR THE FUTURE

The Obligation to Combat Compassion Fatigue: An Investment for the Future


Sarah Glickman
Northeastern University

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Abstract
This paper looks into the relationship between nurses, their mission to support and heal patients,
and the resulting stress this can cause. Nurses are continuously giving of themselves, and are
therefore at a high risk of developing compassion fatigue. Compassion fatigue in nurses can have
serious consequences, such as anger, hopelessness, decreased desire to nurture, and thus, often
quality of patient care diminishes. In order to decrease the impact of stress, and subsequently the
likelihood of developing compassion fatigue, there are a variety of possible self-care
interventions. These techniques are useful, but place a burden on nurses to take care of the
problem by themselves. Because hospitals have an ethical responsibility to their staff, as well as
patients, they should offer nurses training related to mindfulness and stress-reduction. These
classes would help nurses learn effective ways to manage stress, allowing for less compassion
fatigue, and better patient care. This paper explores this notion, and demonstrates the idea that
although hospitals face budget constraints, these trainings are worthwhile and cost effective.
Introduction
Nursing is a caring and compassionate profession; nurses tend to have an innate desire to
nurture and embrace another persons suffering as their own. While they perform many concrete
functions, the essential service nurses deliver is themselves, as they are sought out for support,
healing, and encouragement during difficult times of distress. Overexertion of oneself puts
nurses at high risk for developing compassion fatigue, which is defined as emotional, physical,
and spiritual exhaustion related to chronic exposure to trauma or difficult situations (Harris &
Griffin, 2015). Compassion fatigue results in a decline of ones desire and ability to care for
those who are suffering. There are several clinical manifestations associated with the condition,
such as: anger, irritability, impaired concentration, fatigue, absenteeism, hopelessness, boredom,

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accident proneness, decreased acuity, diminished performance ability, isolation, and poor
judgment (Boyle, 2011).
Recently, compassion fatigue and stress due to working in the nursing profession are
becoming more prominent. A survey by the American Nursing Association reported in 2011,
74% of nurses felt the effects of stress and overwork (ANA, 2011). Nurses have to bear the
physical and emotional tax that comes with long hours, frequently being understaffed, and a
demanding job. Although nurses maintain high regard for the intrinsic rewards of the
profession they also identify workplace, relationship, and stress issues as major contributors to
frustration and exhaustion (Pipe, et al., 2009). Therefore, persistent and intense stress negatively
impacts the nurse-patient relationship, as well as the healing environment. A nurses opportunity
to connect with and advocate for the patient [in order to promote] safe and optimal care
outcomes may also be inhibited (Pipe, et al., 2009). There is a significant and harmful impact
of nurses who experience compassion fatigue. They themselves, and their quality of work, suffer
as a result of poor stress management. Therefore, implementation of mandatory stress-reduction
programs to combat compassion fatigue is critical to maintain a high level of patient care,
providing direct benefits to the nurses, patients, and the hospital itself.
Compassion Fatigue Interventions
In order to combat compassion fatigue, and continue to offer the best quality of care,
nurses need to be aware of and attend to their own personal health needs. Early symptom
recognition and improved self-care, both at home and in the workplace, is key to reducing
compassion fatigue (Harris & Griffin, 2015). There are a plethora of self-care techniques nurses
can and should employ in order to relieve stress.

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Maintaining a healthy lifestyle through diet and regular exercise are helpful as they
promote wellbeing. Learning effective coping strategies and obtaining a sufficient amount of
sleep is beneficial to fend off compassion fatigue. Taking breaks while working helps to unwind,
and allotting time for oneself is another method to alleviate stress. Finding a balance between
work and personal life is an important aspect to self-care. Helping nurses find ways to minimize
the negative effects of a difficult work environment will foster healthier lifestyles, both
professional and personal. Additionally, nurses should seek professional or medical help if the
symptoms of compassion fatigue become too much to handle on their own.
These discussed methods can be critical in the battle against compassion fatigue, but can
only be most effective when nurses are educated about the condition, its consequences, and
methods of treatment. Further, these interventions place much, if not all, of the responsibility on
the nurses. Should it be the case that nurses are the only ones working towards decreasing the
prevalence of this condition, or should the hospital be involved as well? And is it the
responsibility of the individuals to research and learn about the condition, or does the employer
have an obligation to educate? Looking further into the topic reveals it is beneficial for all parties
when the hospital takes an active role in education and assistance around alleviating compassion
fatigue.
Hospitals Obligation to Help
Currently, the self-care strategies previously outlined are the primary intervention nurses
can utilize to combat compassion fatigue. As important and impactful as self-care can be, it
places the onus onto nurses to tackle the problem themselves. To work toward an ideal solution,
hospitals must play a role in helping to relieve stress in the workplace, as the performance and
success of nurses directly reflects onto them; nurses may provide diminished care to patients

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when fatigued, leaving the hospital liable. Patients have a right to quality care, and both the
hospital and staff are accountable to uphold that mission. In order to maintain the required
optimum degree of patient care, hospitals must be active participants in the reduction of
compassion fatigue. By offering their nurses stress-reducing interventions, hospitals would be
investing in their employees and their own reputation to provide quality medical services.
Not only is it in a hospitals best interest to maintain a high level of patient care, but they
also have ethical liabilities to do so. In order to achieve morality, each hospital follows a specific
mission statement, ethical code, and set of goals concerning how patients and employees should
be treated in and by the hospital. The American Hospital Association states that a hospitals first
priority is to provide the care [one] needs, when [one] need[s] it, with skill, compassion and
respect, in an effort to set the standard of high quality patient care (American, 2003). Because
hospitals are subject to the moral principles of beneficence and nonmaleficence, they have a
requirement to reduce harm in all capacities (Carroll, 2009).
Similar to the ethical obligation hospitals have to their patients, nurses also have a
professional code to govern their practice. This code allows patients to have significant trust in
the medical treatment they are receiving. One provision listed in the ethical code is that nurses
must promote, advocate for, and strive to protect the health, safety, and rights of the patient
(Code, n.d.). Nurses also owe the same [duty] to self as to others, including the responsibility to
preserve integrity and safety, which expresses the importance of self-care (Code, n.d.). Thus,
nurses and hospitals alike have an ethical obligation to deal with compassion fatigue, as if left
untreated, would negatively impact the quality of care and break the ethical conditions that bind
them.

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Despite the clear desire to have a high level of patient care, there has been a recent
emphasis on the necessity of reasonable costs. These budget constraints serve as considerable
limitations on the healthcare system, as the responsibility, the social expectation, [and] the
ethical imperative for hospitals is to maintain and if possible, to improve, the quality of care in
the face of cost containment (Rorty, 2000). Consequently, hospitals cut costs through
reductions in staff size and limitations of programs. This leads to an increased demand for
remaining nurses to maintain the hospitals status quo, while being understaffed, overworked,
and having increased inpatient populations (Horner, et al., 2014). Hospitals must function within
the boundaries of their budget, but cannot increase the pressure and workload of an already
stressful job without compensating with stress-reduction strategies. In order to adequately
address this issue, and subsequently maintain both the required levels of employee health and
patient care, hospitals must implement stress-management programs to be available to all nursing
staff.
While hospitals have an obligation to provide education and care to staff members
regarding compassion fatigue, fiscal constraints make it vital to utilize the most effective
methods. There is an array of studies demonstrating the value of stress-reduction interventions
provided by hospitals. The Mindful Nursing Pilot Study explored the impact of mindfulness
training for nursing staff on levels of mindfulness, compassion satisfaction, burnout, and stress
(Horner, et al., 2014). The curriculum had three main focuses: breathing techniques, developing
awareness of thoughts and feelings, and how to be fully present when interacting with patients
(Horner, et al., 2014). In order to maximize the efficiency of implementation, classes lasted only
thirty minutes and were held once a week for ten weeks during both day and night shifts. This
schedule provided the least amount of disruption to patient care relative to the positive impact

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associated with the training. The intervention group, who participated in the mindfulnesstraining program, showed improvement in levels of mindfulness, burnout, and stress, as well as
patient satisfaction; a control group demonstrated no change. One of the participants said,
because of this class, [I] realize that there are easy and practical ways to diminish [my] stress
level with breathing exercises and getting more focused to what is going on. Another member
said being mindful and aware has given me control over my stress and emotions, [allowing me
to] find meaning and reward in everything I do (Horner, et al., 2014). The optimistic results of
this study reveal mindfulness training within the hospital may be beneficial for not only the
nurses, but also patients. Further, the relatively minimal use of hospital resources and time
needed for program administration makes the positive outcomes look even more desirable from
the hospitals perspective.
Another intervention, NURSE (Nurture nurse, Use resources, foster Resilience, Stress
and Environment management), is a model designed for nurses to employ during stressful
situations (Delaney, et al., 2015). The development of NURSE was based on Watsons theory for
human caring: Watson believes that loving, caring for, and respecting self is the first step in
enlightened caring for others (Delaney, et al., 2015). The intervention focuses on the idea of
pausing and using simple practices such as centering, breathing, and mindfulness to embody selfcare. Pausing allows for self-awareness, self-reflection, and self-care, as well as time to utilize
stress management strategies. These self-care occasions can change the energy of nurses,
facilitating a sense of revitalization. NURSE sessions help each nurse to find which modality is
right for each individual. By the end of the study, nurses were able to integrate new ways of
responding to stressful situations, illustrating that a program rooted in stress-management
techniques is effective in reducing self-reported stress symptoms (Pipe, et al., 2009). Because

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this model is based in the implementation of self-care, the only costs associated with the program
are that of educating the nursing population. As this can be accomplished in relatively short time,
the hospital, nurses, and patients all reap the rewards without applying unnecessary pressure to
the hospitals budget.
An Alternate Perspective to Implementation
Stress-reducing and mindfulness training seems like a simple way to combat compassion
fatigue, however, there are significant problems regarding budget and time constraints. It is
relatively easy to look at this issue as a third party and see the benefits of implementing stressreduction programs. But, when pressed with the burdens of tight budgets, high cost of
equipment, insurance policies, and other miscellaneous costs, the picture is not quite as clear.
How is a hospital director to quantify the numerical impact of stress reduction against the
purchase of a new patient bed or an MRI machine? A serious issue facing the argument for
implementation is the challenge of impact evaluation. Conceptually, the logic is clear that
reduction of stress on nurses, or ways to better manage the stress, leads to improved patient care
and an overall better hospital experience. Despite this, it is quite difficult to measure just how
much the patient care improves, or even how effective the stress reduction strategies are on
nurses. When faced with shrinking budgets and expanding costs, it is not a clear-cut decision to
invest in a program that holds a fair amount of immeasurable uncertainty. While hospitals do
face tight budget constraints, chronic stress can lead to burnout, compassion fatigue and a lack
of engagement, potentially resulting in staff turnover which creates an additional cost to any
organization (Horner, et al., 2014). Thus, investments in these programs would likely create
more breathing room for the hospital through dramatically increased productivity.

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Even if hospitals decide to fund a program along these lines, the limitation of time
restrictions still looms. Nurses have extremely busy schedules and little time to allocate towards
a training session. For both of the interventions discussed above, the studies faced challenges
regarding attendance and scheduling; no employee was able to be present at every session. This
was especially due to the fact that patient care is priority over mindfulness training. One
participant went on to say that it was stressful to schedule a time to talk about stress (Delaney,
et al., 2015). Programs can only be as effective as their ability to be successfully implemented,
and if nurses do not even have the time to show up, the information and strategies cannot be
effectively passed along.
Conclusion
When approaching any problem the best method is to understand all relevant research,
weigh the costs and benefits, and make the best educated decision based on ones constraints.
The relevant research is clear in its message: compassion fatigue is a serious issue facing a
significant portion of the nursing population, and can have harmful repercussions. The costs of
implementing stress-reduction programs are relatively minimal, with the biggest burden being
time allocation and paying the educator of materials. Since compassion fatigue leads to a drastic
decrease in a nurses efficiency, a small investment of time in training is far less costly than the
prolonged decrease in their productivity.
While it is true that the benefits of these programs are difficult to quantify, the accounts
of study participants demonstrates there is a level of tangible benefit to those enrolled in such
programs. The magnitude of the benefits are uncertain, but due to the low cost of implementation
and the output of less stressed and more competent nurses are significantly likely to outweigh the
input of time and a small amount of capital. An investment in the health and wellbeing of nurses

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through the implementation of stress-reduction programming to combat compassion fatigue is a
crucial course of action for healthcare providers and those they serve.

Reflection Note:
I will use my research paper The Obligation to Combat Compassion Fatigue: An
Investment for the Future in my professional portfolio, as it demonstrates my research skills,
ability to write for a professional audience, as well as develop an argument on a relevant topic.

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