I can't recall the number of times human suffering, violence, and death touched me when I was an emergency/trauma nurse. I now understand that the emotional and psychological ailments I experienced were indicative of compassion fatigue, a form of secondary traumatic stress experienced by health care workers. I often withdrew, emotionally detaching myself from patients as a way to get through a shift. Sometimes I relived a traumatic event for weeks or months, even when I thought I had dealt with my feelings.
Nurses in EDs may believe themselves immune to the effects of secondary traumatic stress, but as my own experience taught me, survival shouldn't be confused with self-knowledge and healthy coping strategies.
Joinson used the term compassion fatigue in 1992 to describe burnout and the loss of a caregiver's nurturing capacity in emergency room nurses. And in 2011, Lombardo and Eyre wrote that witnessing continuous suffering can leave nurses emotionally, spiritually, and physically exhausted.
Unsurprisingly, nurses who have previous unresolved traumatic experiences may be more vulnerable to secondary traumatic stress. As I discovered, reexperiencing traumatic events is common in secondary traumatic stress—ED nurses often have distressing dreams, feelings, hallucinations, flashbacks, and psychological distress. A small 2009 study of secondary traumatic stress in ED nurses by Dominguez-Gomez and Rutledge found that 52% of the 67 nurses they surveyed avoided their patients, 43% experienced “diminished activity level and emotional numbing,” and 46% reported intrusive thoughts about their patients even when not at work.
Seminal research by Figley and others identified a wide range of psychological symptoms in those exposed to continuous traumatic events, including fear, irritability, anxiety, melancholy, and lack of compassion. Physiological symptoms may include insomnia, nausea, tachycardia, headaches, and muscle tension.
It's imperative that we understand the effects of compassion fatigue and recognize its signs and symptoms. Nurses aren't always aware of the effects that others’ suffering is having on them. Compassion fatigue is a frequently mentioned factor in nurses’ decisions to leave the profession. For a variety of reasons, nurses are often afraid to share such feelings with colleagues or supervisors or to seek help for symptoms of emotional and psychological stress.
It's the responsibility of institutional leaders and educators to ensure that resources and support systems are available to promote nurses’ well-being. In addition, nurses must become knowledgeable about these phenomena. The Accelerated Recovery Program is a five-session protocol that focuses on helping trauma workers deal with and resolve symptoms of compassion fatigue. Other programs and tools exist as well.
Yoder, in a 2010 article in Applied Nursing Research, reiterates that nurses must identify and expand personal coping mechanisms so they can use them when needed. These might include humor, friendships, spiritual practices, exercise, expressive writing, and many others. If nurses identify prayer or meditation as an effective coping mechanism, for example, managers might provide space and opportunity for its practice during a shift.
Debriefing does not always occur immediately following a traumatic event. Structured, regular debriefing may encourage nurses to seek further assistance through an employee assistance program if their employer has one.
On a daily basis, ED nurses witness devastating illness, suffering, and trauma; we often shut down our emotions in order to survive recurring feelings of helplessness, guilt, sadness, and anger. If we hope to continue working as nurses, we must be aware of the effects of compassion fatigue