March 25, 2018 by Sarah Stromsdorfer, OTR/L

The Cost of Caring: Managing Compassion Fatigue in Healthcare

My Story (as told by Katie Tietz, MS, OTR/L)

In 2014 I began my career as an occupational therapist; full of newly absorbed knowledge and bursting with excitement to get out there and use it to make a true difference in the world! I set my sights high (as I’m sure many of you can relate to) and applied to my local children’s hospital, where I had always wanted to work. It was (and still is) my dream job!

I ended up being offered the position on a medically fragile long-term care unit. I got to tour the unit and it was like nothing I had seen or heard of before – likely because it is one of the few pediatric skilled nursing/sub-acute facilities in the U.S. I fell in love with the children who live there and the staff who came together to create beautiful moments for them. I wanted to be a part of that, so I proudly accepted the position.

About a year and a half into my dream job, experiencing many highs and many lows along the way, I found myself facing some difficult questions they didn’t teach us about in school. How do you cope when a child you’ve grown to love passes away? How do you disconnect when a child you’ve bonded with for 2 years is now well enough to live outside of the hospital and is going home?

As these thoughts and questions ran through my head, I began to isolate myself. I found myself filled with a sadness that I just didn’t know how to deal with. It was then that I started wondering… if this is the way this career is making me feel, why am I even here?

I’m one of the lucky ones.

Before I was able to let my negative thoughts and fears run away with my dream job and ruin everything I worked so hard for, I was introduced to the Professional Quality of Life Scale (PROQOL) at a continuing education course. This simple, 30-question survey is what opened my eyes to what I was experiencing.

It wasn’t a question of whether or not I was cut out to be in this profession, it was a question of how well I was managing my own self care. Which, as you might have guessed, was terribly! Using the PROQOL, I found myself with high ratings of burnout, secondary trauma stress, and compassion fatigue. I didn’t fully understand what that meant at the time, so I did some research.

What is compassion fatigue?

It was Dr. Charles Figley who coined the term ‘compassion fatigue’, stating that:

“Compassion Fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

As I experienced, and you may have too, we sometimes take on the pain and suffering of our patients/clients and make it our own. That is secondary traumatic stress. That is what causes compassion fatigue and burnout if we are not simultaneously practicing integrated self-care.

What are the symptoms of compassion fatigue?

1. Isolation – We get to a point were we are continually giving to others and not filling our own cups. At this point we have nothing left to give, and in a world were everyone wants something from you, isolating yourself might seem like the only viable option.

2. Physical Ailments – We may experience headaches, muscle tension, gastrointestinal issues, irritability, or anxiety. This is your body telling you to stop. This is your body warning you that something is not right. Pay attention.

3. Sadness & Apathy – We may carry an overall feeling of sadness over us, no matter what our day looks like. This is because we are not living up to our full quality of life, and subconsciously we know that.

What causes compassion fatigue?

1. Pattern of other-directedness – As healthcare providers, it is pretty safe to assume that the majority of us hold caring for others in high regard. This is a wonderful quality, however, holding the belief that it is more important to care for others can be damaging. Viewing self-care as selfish leads to compassion fatigue and burnout.

2. Lack of personal boundaries – We are all helpers. We wouldn’t be in this profession if we weren’t! However, realistic expectations of our selves and adhering to personal boundaries can make all the difference! If you find yourself struggling with setting boundaries, I highly recommend this Ted Talk by Sarri Gilman, entitled “Good Boundaries Free You.”

3. Over-developed sense of responsibility – We may carry these patterns from childhood experiences. Growing up myself, my mom was in and out of hospitals and skilled nursing facilities often. As a young adult I took on responsibilities that were not necessarily mine to take on. However, these early-established patterns follow you into adulthood and it is something we must be aware of.

Steps to reverse the symptoms of compassion fatigue:

1. Make your own self-care plan – These days it is hard to find the time for anything, let alone self care, that is why we don’t find the time, we make the time. In order to truly serve others to the best of our ability, we must make the time to fill our cups first. Waking up just 20-30 minutes earlier to get in a walk or some yoga or meditation will significantly impact your day for the better.

2. Learn your triggers – I think self-awareness is probably the most important thing for gaining a balanced and successful career in healthcare. Learn what makes you tick; the people, the statements, the environments, and set appropriate boundaries to establish a healthy energy.

3. Ask for help – As much as I hate to burst your bubble, you are not super man or super woman – you are human. We are all in this human experience together, which means we will struggle at times and need other’s support. Do not be afraid to ask for help. Your team is your greatest resource; utilize them.

Overcoming compassion fatigue

I am happy to say that today, four years into my career, working at my same dream job, I have established a much healthier self-care routine that contributes to my success both on and off the clock. If you find yourself identifying with any part of my story, I encourage you to use any and all of the resources available to you.

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About the Author: Katie is a pediatric occupational therapist, #1 international best selling author, speaker and certified mindset coach. She is the founder of Health Pro Mindset, LLC – a mindset coaching business teaching hundreds of healthcare professionals (and soon to be professionals) how to use mindfulness-based practices to overcome burnout, compassion fatigue, and secondary trauma stress, so they may serve others at their highest potential.