Te Kura Hauora Faculty of Health:

1. THE COST OF CARING TOO MUCH: COMPASSION FATIGUE/BURNOUTPractice implications for Nurse ManagersBy Julie Maher RN, BA, MAWhitireia NZ.

2. Te Kura Hauora Faculty of Health: Providing professional education to prepare graduates for the global environment of health and social care

3. OBJECTIVES • Define the terms Compassion Fatigue (CF) and Burnout • Discuss how both CF & Burnout presents • Identify how to reduce and manage both CF & Burnout • Highlight and discuss Authentic Leadership • Discuss the importance of selfcare for Nurse Manager’s

4. COMPASSION FATIGUE “Loss of ability to nurture” (Joinson as cited in Boyle, 2011).

5. COMPASSION FATIGUE • Associated with the cost of caring • There is a preoccupation with the trauma/suffering experienced by patients (Figley, 2002) • Emotional unease, to compassion discomfort to compassion stress to compassion fatigue • Significant negative psychological and physical effects • Results from close interpersonal contact with suffering patients • Crossing professional boundaries

6. WHO IS AT RISK OF COMPASSION FATIGUE • All health professionals • Nurses – particularly vulnerable (Aycock & Boyle, 2009) • No literature to support Nurse Managers at risk of CF • Nurse Mangers more at risk of Burnout • Social Workers • Counsellors • Doctors

7. BURNOUT Nurse Managers may be more at risk of Burnout than CF. • A state of physical, mental and spiritual exhaustion caused by excessive & prolonged stress. • Overwhelmed, overburdened, unable to meet constant demands • Loose interest in job & motivation • Occurs gradually • Causes staffing issues, workload, managerial decisions, inadequate resources • Results in decreased empathic responses, withdrawal, overwhelmed. • May resign or transfer

8. COMPASSION FATIGUE Presents as:- • Apathy, sad, no longer finds activities pleasurable • Feeling guilty for loss of compassion • Excessive blaming & complaints about management • Bottled up emotions • Reoccurrence of nightmares & flashbacks to traumatic event/suffering patients • Avoidance of situations related to patient suffering • Isolation from others • Substance abuse to mask feelings • Compulsive behaviours such as overspending, overeating, gambling etc

9. FURTHER PRESENTING FACTORS • Poor self-care (i.e. hygiene, appearance) • Chronic physical ailments such as G.I. problems and recurrent cold • Difficulty concentrating • Mentally and physically exhausted/depressed • Preoccupied • In denial about problems

10. History of CF in nursing Historically lack of recognition and under-researched on CF in nursing (Sabo,2006) • Not been formally defined in nursing • Nor explored /explained that allows nurses to identify & prevent CF in the workplace (Coetzee & Klopper (2010)

11. SUPPORT FOR COMPASSION FATIGUE • Self care • Self reflection • Separate from work at the end of day • Use of Relaxation/Meditation/Reflective Journal • Attend professional development in CF/Burnout • Support from Managers, Support Services EAP, Pastoral Care, Peer Support • Clinical Supervision

12. MANAGER’S CAN Reduce risk of Compassion Fatigue • Create open supportive work environ. • Create a culture of mutual support • Offer education in CF • Share patient load amongst Team Members, partic. those with high needs • Make time for social contact among teams, social events, social cohesion & trust • Encourage healthy self care/regular breaks • Reward efforts & offer training with focus on self-care & work/life balance to build resilience (Portnoy, 2011)

13. MANAGER’S CAN Reduce risk of compassion fatigue • Be informed of CF & recognize in staff • Encourage work – life balance • Work with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

14. AUTHENTIC LEADERSHIP • Nursing leadership impacts on the quality of the nursing environment • Imp. to create a healthy work environ. new grads. & experienced nurses • This ultimately effects the quality of care provision • Empower nursing staff – by Nursing Leadership • Quality supports and resources • Authentic Nsg. Leadership – nurses will respond positively • Involves Access to info; Support; Resources to do the job; Opports. to learn and grow • Higher work engagement/greater trust in Management • Leadership training for Nurs. Managers likely help support development of empowering work environ. (Spence, Wong & Ashley, 2013)

15. MANAGER’S CAN Reduce risk of CF • Be informed on CF & recognize in staff • Encourage work – life balance • Work with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

17. MANAGER’S CAN Reduce risk of compassion fatigue • Be informed CF & recognize in staff • Encourage work – personal balance • Work with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

18. HOW DO YOU CARE FOR SELF/NURSE MANAGERS • Wearing two hats, professional and managerial role (Cassie, 2014) • Multiple stresses/meat in the sandwich effect • Own care takes 2nd place to others – at risk of Burnout? • Heightened sense of responsibility • Attend Professional Development in Authentic Leadership/Effective Leadership styles & other supportive PD e.g Conflict Management • Regular Clinical Supervision – important • Attention to own selfcare – Mindfulness, Meditation, Reflective Practice, Relaxation • Use of humour and a Peer Supporter/ trusted colleague from within your workplace • Use other resources available to you EAP Services • Try and create a work space and a home space (if possible) • Take annual holidays and at least 3 long weekends a year Selfcare is to be Selfaware Remember you Matter

19. MANAGER’S CAN Reduce risk of compassion fatigue • Be informed CF & recognize in staff • Encourage work – personal balance • Work with HR re Psychosocial Resources + individually + group such as Defusing/debriefing (Hooper et al, 2010)

21. References Adcock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13, 195-214/ doi:10.1080/17496530902951988 Boyle, D.A. (2011). Countering Compassion Fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16. Retrieved from Pubmedhttp://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-16-2011/No1-Jan-2011/Countering-Compassion-Fatigue.aspx Cassie, F. (2014) Wearing Two Hats at One Time: Nurse Managers on the Ward, Nursing Review, 14(6), http://www.nursingreview.co.nz/issue/december-2014-vol-14-6/wearing- two- hats-at-one-time-nurse-managers-on-the-ward/#.WBE3q_l97IU Coetzee, S.K. & Klopper, H.C.. (2009). Compassion fatigue within nursing practice: a concept analysis. Nursing and Health sciences, 12, 235-43. doi: 10.1111/j.1442- 2018.2010.00526. Hooper, C., Craig, J., Janvrin, D.R., Wetsel, M.A., Reimel, E., & Anderson, S.C. (2010). Compassion Satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialities. Retrieved from Science Direct http://ac.els- cdn.com/S0099176709005534/1-s2.0-S0099176709005534- main.pdf?_tid=56ff7f5a-9bec- 11e6-ae95- 00000aacb360&acdnat=1477535185_8ce14e7253c1690d416c434f01e871edS

22. References Portnoy, D. (2011). Burnout and Compassion Fatigue. Watch for the signs. Health Progress, 9(4), 47 -50. Retrieved from Proquest. http://search.proquest.com/docview/880955816?pq-origsite=summon Sabo, B. (2011), Reflecting on the Concept of Compassion Fatigue. The Online Journal of issues in Nursing, 16(1), 8-14. Retrieved from Proquest http://search.proquest.com/docview/878059711?pq-origsite=summonreferences Spence Laschinger, H.K.,, Wong, CA. & Ashley L. Grau. (2012). Authentic leadership, empowerment and burounout: a comparison in new graduates and experiences nurses. Journal of Nursing Management, 21, 541-552. doi: 10.1111/j.1365-2834.2012.01375