Compassion Fatigue: Beyond Burnout

By Katie O’Neill

When we think about burnout in the workplace—the mental, emotional, and physical exhaustion caused by prolonged stress—what comes to mind? Overactive calendars, piles of emails, deadlines, meetings, and long hours? While these can certainly lead to burnout, for people in caregiver roles, such as health care and social workers, the strains of the job can go far beyond typical burnout. Known as “compassion fatigue”, this condition is the result of caring for sick or traumatized people over long periods of time. Along with the symptoms of burnout, people also experience emotional withdrawal and depletion. This can lead to not only decreased productivity and employee morale, but can also cause the people who are most well versed in providing care to neglect their own needs.

It can be easy to confuse burnout and compassion fatigue, and they can co-exist. While both conditions can present with intense physical and mental fatigue, isolation, and a loss of a sense of accomplishment, people suffering from compassion fatigue might also seem to change from their core self. They are susceptible to feelings of overwhelm and loss of hope in the world and their belief systems, problems with controlling their emotions or having changes in their emotional state, changes in their sleep or eating patterns, disconnection, and feelings of self-loathing. Unlike burnout which tends to build up over time, these symptoms can develop suddenly and with less predictability. Caregivers are also less likely to ask for help from others, and feel that their needs come last.

In 2008, the Unites States Army Institute of Surgical Research at Fort Sam Houston launched their “Care for the Caregiver” program, designed to assist people who were providing care to wounded service members. This program was designed specifically for compassion fatigue, after it was observed that these caregivers were exhibiting signs of post-traumatic stress, but without having experienced first-hand trauma. According to the Military Families Network in collaboration with Brian Bride Ph.D., addressing compassion fatigue is approach of “A-B-C’s”: awareness of the signs and symptoms, balance of emotional and physical health, and connection with community, family, and life purpose.

Compassion fatigue certainly is more likely to impact people working in health and social service professions, but can also impact people who are providing care for family members.  It is becoming more common to have employee who are part of the “sandwich generation” of workers; they are caring for ailing parents as well as their own children. People with high levels of empathy are also at risk, as increased access to constant information about traumatic or violent events on a daily basis can lead to secondary trauma.

The different behaviors and changes resulting from compassion fatigue can impact physical and emotional health, productivity, work life, and relationships.  Becoming irritable or having emotional outbursts can occur, along with disconnecting from colleagues and patients. Deteriorating self-care and unhealthy coping habits (such as binge eating, overspending, smoking, and substance use) can all contribute to decreased quality of life and increasing medical costs.

Properly addressing compassion fatigue requires on-going awareness, engagement and recognizing it as a potential occupational health risk.  People experiencing the symptoms might feel confused and isolated, and the onset can be so insidious that they don’t understand why they are feeling the way that they do. Providing education, increasing awareness, and assisting employees in accessing resources can prove to be a valuable strategy for total employee well-being and improving workplace culture. Because caregivers provide an invaluable service to communities, investing in their care and well-being has many positive effects on both individuals and organizations as a whole.

Signs and Symptoms

Physical

• Insomnia
• Feeling ill or in pain often
• Decreased self-care (hygiene, appearance, fitness)

Mental and emotional

• Apathy
• Feeling hopeless
• Feelings of numbness and isolation
• Violent thoughts
• Substance abuse
• Difficulty regulating emotions
• Impairments in judgement and cognitive abilities
• Struggles with beliefs, feelings of security, trust, and intimacy

Encouraging awareness:

• Administer the Professional Quality of Life Questionnaire (PROQOL), developed specifically to measure compassion fatigue (available in 17 different languages at www.proqol.org)
• Provide signage, lunch and learns, and email campaigns to educate employees on resources available (resources available from www.proqol.org and employee assistance programs)
• Recognize that all industries can be afflicted with compassion fatigue, as many employees are caring for children and aging family members

Environment

• Review policies, mission statement, and company values to ensure they are conducive to employees practicing self-care and achieving adequate work/life balance
• Provide comprehensive well-being programs for activity, stress management, and healthful eating
• Organize company events and clubs for hiking/ walking, yoga, gardening, and other activities that promote stress relief and reflection
• Make the healthy choice the easier choice by encouraging healthy cafeteria/vending options, breaks for physical activity, and tobacco free workplaces
• Provide a quiet area for employees to have a mental “time out”

Consider the addition of the following benefits:

• Digital, telephonic, and on-site emotional resilience programs and programs specialized in compassion fatigue
• Services to make day-to-day life easier (back-up child care and elder care services, subsidies for healthy meal delivery programs)
• PTO day for self-care