Compassion Fatigue vs Burnout

What’s the difference?

Whilst most Health Professionals are aware of the symptoms of Burnout perhaps fewer know of the concept of Compassion Fatigue. 

Burnout is defined by the WHO as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It’s identified by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy. 

Compassion Fatigue (C/F) has many shared factors, but whilst Burnout can occur in any profession, C/F occurs only in the caring professions. Additionally, one must possess compassion to experience C/F,whereas in contrast those experiencing Burnout need not have the prerequisite of compassion! 

Healthcare professionals are often drawn to the profession because of their high levels of compassion and desire to care for others.

Whilst Burnout builds over time and encompasses many of the symptoms listed below, Compassion Fatigue can happen quickly, especially in newly trained Healthcare staff. 

The coronavirus crisis however has led to higher levels in all staff as some of the factors that make C/F more likely are: sleep deprivation, working long hours and caring for large numbers of patients – particularly those who are seriously ill and unlikely to recover despite being given all treatment and care available. 

Other factors predisposing the occurrence of C/F include previous experience of Burnout, difficulty expressing emotions, and lack of a robust support system. 

Compassion fatigue is a preoccupation with absorbing trauma and emotional stresses of others, and this creates a secondary traumatic stress in the helper. … Burnout is about being ‘worn out’ and can affect any profession.

How common is Compassion Fatigue in healthcare?

Sadly, the Compassion Fatigue Awareness Project found that between 25% and 50% of USA Healthcare professionals suffer from it.  Its impact is real and debilitating – but unfortunately it often gets missed in a busy Healthcare setting.  

The sufferer themselves may not have the awareness that this is what they are experiencing, and may need to rely on those around them to point out that they are not OK, and to encourage them to seek support.  

Everyone from long-term care workers to family caregivers to emergency room nurses to police officers may find themselves taking on others’ trauma. The Caregiver can suffer from any of the following wide range of distressing symptoms:

• Feelings of anxiety, failure, guilt, self-doubt, self-criticism, sadness, powerlessness, irritability, anger, pessimism.

• Bottled-up emotions

• Apathy and emotional numbness – lack of empathy/sympathy

• Loss of sleep

• Reduced sense of efficacy on the job

• Difficulty concentrating

• Feeling overwhelmed by obligations

• Secretive addictions or self-medicating in a variety of ways (for example, alcohol)

• Isolation and withdrawal

• Exhaustion

• Intrusive thoughts, vivid dreams or nightmares

• Hyper-arousal

• Trepidation of working with some patients

How can we manage Compassion Fatigue?

The ways to mitigate these potentially damaging effects of being on the front-line are to ensure basic human rights and needs are attended to – which clearly should be happening at all times, not just at times of crisis.

Simple yet crucial strategies to help avoid C/F occurring (and to help those suffering to recover) are ensuring front-line staff can share, connect and make contact with each other, as well as building on individuals’ self-care and self-compassion skills. 

Professional counselling should be provided and used if appropriate, but being able to share feelings and experiences with colleagues has been found to be a more significant factor in avoiding C/F.  

Research suggests that supportively acknowledging the existence of Compassion Fatigue, and ensuring it’s put on meeting agendas as something requiring monitoring helps to reduce its occurrence. 

This, combined with acknowledging worker contributions at all levels in the team, rotating care so that there are periods away from the front-line, short time-outs (even 5 mins to share experiences with a colleague is valuable), and debriefing can all help the risk of staff developing C/F.

Who should be responsible for managing Compassion Fatigue?

Both the Organisation and the Individual play a part in protecting Healthcare staff from the added burden of Compassion Fatigue at this time of crisis.

Individuals can protect themselves by ensuring they talk to colleagues and close friends/family about how they are feeling, by taking short periods of regular exercise, and by practising self-care and self-compassion. 

Self-compassion is associated with reduced self-criticism, blame and worry (Gilbert & Procter, 2006). Studies indicate that high levels of self-judgement lead to higher levels of C/F, but that high levels of Self -Compassion reduce levels of C/F.  

Self-Compassion Exercises have been shown to reduce cortisol levels and increase heart-rate variability, which are linked with an ability to self-soothe when stressed (Rockliff, et al., 2008). 

Results of research reinforce the idea that when student midwives judge themselves unsympathetically, they become less compassionate towards self, and others, which results in reduced wellbeing, greater burnout – and Compassion Fatigue. 

Colleagues can help remind each other (and if necessary those further up the hierarchy) about the necessity of ensuring these simple basic principles in place to reduce the incidence of Compassion Fatigue.  

C/F and Burnout may have severe professional consequences in addition to affecting a Healthcare professional’s personal well-being, and can affect staff retention, patient safety, and patient satisfaction (Burtson & Stichler, 2010; Potter et al., 2010).  

No one benefits if care is not taken of the carers.