When the tank is empty: What causes medical professionals to feel drained of compassion?

FSU professor’s study shows causes, consequences and remedies of nurses’ dwindling compassion at work

TALLAHASSEE, Fla. — Across the United States, there is a shortage of employees to fill critical jobs, such as front-line health care providers – positions that historically have had ample numbers of applicants. The ANA predicts there will be more unfilled nursing jobs than any other occupation in the United States, at least through 2022. In many states, nurses of retirement age are receiving incentives to stay in their jobs longer to offset shortages. Patient to staff ratios have increased leading nurses to strike until proportions are improved at several facilities.

A study by Wayne Hochwarter, the Jim Moran Professor of Management in the Florida State University College of Business, and research colleagues, doctoral candidate Joshua Palmer and undergraduate senior Lauren Moran, found that the emotional toll nurses experience on a daily basis can explain how the nursing profession arrived at this point. Many nurses choose their profession career because they want to help patients enjoy better physical and mental health. Often, however, doing so comes at the expense of their own wellbeing. As a result, compassion for their patients is the most visible unwanted effect when emotional demand is high.

Hochwarter and his colleagues examined how compassion fatigue, a form of burnout experienced when caregivers invest emotional resources in others’ pain and suffering, affects nurses’ work and quality of life. They conducted in-depth research with more than 170 registered nurses (RNs), who provide direct care to patients an average of 38 hours per week.

• 46% acknowledge that patient problems "wear me out."
• 34% acknowledge feeling sad/depressed after working with "difficult cases."
• 39% acknowledge feeling hopeless when faced with patients with little hope of recovery.
• 47% acknowledge difficulties leaving work at work after an emotionally challenging day.

According to the survey respondents, compassion fatigue increases when nurses feel bullied by coworkers, when dealing with emotionally fragile patients, when politics influences supervisors’ decision-making and when there is ambiguity in protocols for providing care.

As expected, compassion fatigue predicted health outcomes, including exhaustion, sadness, tension, callousness and conflict at home. However, compassion fatigues had little effect on overall job satisfaction and willingness to exert effort toward patients. Finally, compassion-fatigued nurses were three times more likely to consider quitting their jobs – a statistic that underscores documented shortages and unfilled vacancies.

The research identified two important remedies. First, compassion-fatigued nurses who were allowed to make decisions regarding patients’ care without criticism from their supervisor reported fewer negative health effects. Second, adverse effects were lessened when nurses’ supervisors were aware of daily fluctuations in compassion and offered resources (e.g., time away, personnel) supporting a return to positive health.

This research is being prepared for publication.