What is Compassion Fatigue in Nursing? (PLUS, Causes, Symptoms, & How To Manage)

Written By: Sarah Cruzan RN, BSN

Are you a nurse who cares deeply for your patients? Do you sometimes feel impacted by what your patients experience, as if what they are going through affects you on a personal level? Have those experiences ever impacted you profoundly enough that you felt overwhelmed or disconnected at times when providing care? If so, you may have experienced compassion fatigue in nursing.

Maybe you heard of compassion fatigue but wonder, “Exactly, what is compassion fatigue in nursing?” This article will explore everything you need to know about compassion fatigue in nursing. I will share some information about the causes and symptoms of compassion fatigue and give you some tips on how to prevent it.

What Exactly is Compassion Fatigue in Nursing?

As a nurse, it is your job to care for patients and be empathetic. However, there are times when providing care and demonstrating empathy and compassion can become overwhelming, resulting in compassion fatigue. Compassion fatigue in nursing is defined as the condition that results when nurses who engage in too much authentic empathy and compassion for patients gradually become emotionally challenged by and less passionate about their patients' traumatic experiences or medical challenges.

How Prevalent is Compassion Fatigue Among Nurses?

Unfortunately, compassion fatigue is a common occurrence in nursing. According to NurseJournal, it affects between 16 and 39% of nurses across all specialties. Many experts believe the number of nurses impacted by compassion fatigue may be higher due to unreported cases.

Which Nursing Specialties Have the Highest Rate of Compassion Fatigue?

Nurses in any specialty can experience compassion fatigue, but some specialties are at higher risk. Because compassion fatigue in nursing often results from exposure to extreme medical challenges or traumatic events, nurses who work with high-risk or critically ill patients are more prone to experiencing compassion fatigue. A few examples are nurses in ICU, oncology, or hospice care.

I remember when I was a nurse on a high-risk maternal-fetal medicine unit, I began to experience compassion fatigue after caring for several fetal demises in a period of a few months. I cared for every family as if they were my own, and the weight of the losses began to drain me. I began to dread going to work and took as many sick days as possible to avoid dealing with the emotional strain of my job.

Compassion Fatigue vs. Burnout in Nursing: 3 Key Differences That Nurses Must Know

Although nursing burnout and compassion fatigue are terms often used interchangeably, they are two different things. Nursing burnout is a serious issue characterized by physical, emotional, and mental exhaustion, which results from prolonged or repeated exposure to work-related stress. The following are a few differences between nurse burnout and compassion fatigue in nursing.

Difference #1: The Time of Onset Varies

Burnout in nursing typically has a slower onset compared to compassion fatigue, which often has more of an acute onset. For example, if you care for a child who was the victim of trauma or abuse, your feelings of empathy could quickly lead to compassion fatigue. Burnout typically occurs over several weeks or months after experiencing stressful or overwhelming shifts, poor working conditions, or strained work relationships. It is important to note that nurses who experience compassion fatigue are also at higher risk of developing burnout in nursing.

Difference #2: Compassion Fatigue and Nurse Burnout Have Different Causes

One of the differences between nurse burnout and compassion fatigue in nursing is what causes them. Nurse burnout occurs as the result of work-related stress that is prolonged and unrelieved. Issues such as having too many responsibilities, high workplace turnover, and workplace bullying or harassment often lead to burnout.

Compassion fatigue, on the other hand, occurs as the result of caring for another person who experienced a traumatic event, such as a serious injury or illness, or the unexpected death of a patient, especially under traumatic circumstances.

When I was a new nurse on a postpartum unit, I cared for a mother who passed away unexpectedly a few days after delivering her baby. This experience triggered the beginning of compassion fatigue, which was something I struggled with for a while afterward.

Difference #3: The Ability to Feel Compassion for Others

Another difference between nursing burnout and compassion fatigue in nursing is that compassion fatigue results in a nurse having a decreased ability to feel compassion or express empathy for patients. While nurse burnout may alter one’s emotional well-being, it typically does not hinder one’s ability to feel compassion for others.

6 Main Causes of Compassion Fatigue in Nursing

Every nurse responds to emotional stress and trauma in a different way, which means there are many things that can lead to compassion fatigue in nursing. Knowing possible causes will help you be more aware and cautious to prevent the risk of being affected by compassion fatigue. The following are the six main causes of compassion fatigue in nursing.

Cause #1: Heavy Caseloads or Understaffed Units

Although nurses are used to working under pressure, heavy caseloads, or working on units where there is a staffing shortage increases the chance of being exposed to severe or traumatic patient events. In these situations, nurses often become mentally overwhelmed because there are fewer nurses to offer relief. The need to rush through patient care and tend to multiple patient needs can lead to feelings of being emotionally disconnected, which is a symptom of compassion fatigue.

Cause #2: Working With Patients Who Are Terminally Ill or Whose Health Is Rapidly Declining

Caring for patients on a day-to-day basis who have no hope for improvement can be incredibly emotionally exhausting. One of the most common causes of compassion fatigue in nursing is working with critically ill patients or those whose health takes severe downward turns. You may find yourself taking on your patients’ or their family's trauma and pain, which can cause compassion fatigue.

One example I can think of is working in the NICU. No matter how much I tried to remain objective, caring for critically ill, fragile newborns and seeing the trauma and heartache their families experienced was very overwhelming. There were times when, although I wanted to show kindness and compassion, I felt like a zombie with no feelings because the trauma I witnessed affected me so deeply.

Cause #3: Experiencing Personal Stress Outside of Work

Everyone likes to go home after a hard day of work and relax. However, if you have added stress or problems at home, you may be unable to recover from the trauma you experienced at work. As a result, your chances of developing compassion fatigue in nursing increase.

When I was a new bedside nurse, I was stressed at work and dealing with a family member in ill health at home. Even when I came home after a shift, I could never fully relax because I had to care for my family. I was never able to escape the endless stress in my life, which caused me to feel emotionally drained, leading to worsening symptoms of compassion fatigue.

Cause #4: Inability to Set Healthy Boundaries

Are you one of those people who hates to say “no” when your manager asks you to work an extra shift or take on extra patients? While it’s great to want to be a team player and help when needed, it is also essential to know when you need a break. If you work too much, the emotional and mental overload you experience could ultimately lead to compassion fatigue.

I remember I had a coworker who always said yes to extra shifts and worked overtime hours because she was uncomfortable setting boundaries to protect her own well-being. She ultimately found herself working close to fifty hours of work each week. After weeks of working extended hours, she experienced a traumatic experience with a patient that led to her developing compassion fatigue and needing some time off for self-care.

Cause #5: Past Traumatic Experiences You Have Not Processed

As nurses, we learn that it is important to empathize with patients, often imagining ourselves in their situation so we can provide more personalized care. While that is a good practice, if you have experienced a past trauma that you have not yet processed, it can increase your chances of developing compassion fatigue, especially if you are caring for a patient who is experiencing a situation similar to what you went through.

For example, one of my friends, who is a nurse, was in a car accident years ago, and a passenger in her vehicle was killed. She tried to resuscitate her friend but was unsuccessful. She took time off work, went to counseling, and eventually returned to work. One night, she was working in the emergency room, and victims of a vehicle accident were brought in. My friend began having flashbacks of her accident and was unable to perform her duties. Although all instances of compassion fatigue are not this severe, it can still happen if you experience trauma and do not process it in a healthy way.

Cause #6: Increased Stress at Home

Compassion fatigue in nursing is not only caused by things that happen on the job but can also result from things that begin at home. If you experience intense or continuous stress at home, your stress response at work will likely be heightened, which could result in a higher chance of developing compassion fatigue. In some cases, this type of compassion fatigue is referred to as residual compassion stress, and it is a common occurrence among nurses who are helping patients cope with ongoing trauma.

What are the Most Common Symptoms of Compassion Fatigue in Nursing?

(The following are the 8 most common symptoms of compassion fatigue in nursing and how to effectively manage them.)

Symptom #1: Anxiety

About the Symptom:

We have all experienced anxiety at some point or another in our lives. However, when a sudden onset of anxiety begins to impact your work, this could be a sign of concern. Anxiety can be described as a feeling of nervousness or being emotionally unsettled. You can also experience physical signs of anxiety, such as feeling like your heart is beating out of your chest or maybe your hands begin to shake and sweat.

How to Effectively Manage It:

If you find yourself experiencing anxiety at work, you can try closing your eyes, focusing your mind on your breath, and taking five deep breaths to calm yourself. You may need to take a break for a few minutes. If so, talk to your supervisor or charge nurse and ask for a short break to gather yourself. Suppose anxiety continues to be a problem even after taking self-care measures. In that case, you may want to consider going to a support group or talking with a therapist about your anxiety.

Symptom #2: Insomnia or Hypersomnia

About the Symptom:

If you notice you are having trouble falling or staying asleep, you may have insomnia. On the opposite side of the sleep spectrum, if you notice that you are sleeping excessively, meaning that you are sleeping more than 10 hours at night and still feeling excessively tired throughout the day, you may have hypersomnia. Both insomnia and hypersomnia, which are symptoms of compassion fatigue in nursing, can lead to excessive daytime sleepiness and fatigue, which can negatively impact your personal and work life.

How to Effectively Manage It:

There are several ways to overcome sleep disruptions caused by compassion fatigue. If you are experiencing insomnia due to racing thoughts, you could try doing a "brain dump" of all your thoughts before bedtime to empty and calm your mind. Taking a relaxing bath, listening to meditation music, and turning off all electronic devices at least an hour before bed may also help. If self-care measures are not working, consider talking to your doctor to see if they recommend a natural supplement or a prescription medication to help deal with your sleep issues.

Symptom #3: Dreading Work or Calling Off Work Frequently

About the Symptom:

Another common symptom of compassion fatigue in nursing is dreading work, frequently calling in sick, or missing work. Don’t get me wrong; we all have days when we don't want to go to work. However, if you begin feeling you have these days more often than not, especially if other symptoms of compassion fatigue accompany them, it is important to address the issue.

When I was a bedside nurse, I went through a period of compassion fatigue. I finally realized how serious the issue was when I realized how often I was calling off work. I would literally take every opportunity I could to not go to work or to work a hall with a low census. It got to a point where I was only working one of three shifts each week!

How to Effectively Manage It:

If you find yourself dreading work, it is essential to remind yourself why you are a nurse! Identify the things you enjoy doing at work. Make a list of as many positive features of your job as you can think of, so that you can focus on these experiences as they happen.

One way I overcame dreading work was by journaling after work and identifying at least three positive experiences I had that day. By journaling, I could think about positive things and reflect on them to help encourage myself.

Symptom #4: Loss of Hope, Feelings of Helplessness

About the Symptom:

Compassion fatigue in nursing is caused by feeling emotionally drained or overwhelmed, which leads to feelings of helplessness or a loss of hope. As a result, nurses can experience a decline in self-esteem.

How to Effectively Manage It:

It is not always easy to talk about feelings, especially when you feel all hope is gone. As nurses, we are so pressured to find the positive in everything that we often push our own thoughts and feelings aside until we simply cannot anymore. If you feel overwhelmed or hopeless, reach out to a friend, loved one, coworker, or supervisor and discuss your feelings. Sometimes, the best way to find hope is through the comforting words of someone who cares. If your emotional issues are severe, it may be a good idea to seek professional help and talk with a counselor.

Symptom #5: Cognitive dysfunction

About the Symptom:

Cognitive dysfunction is a broad term that describes various changes in your thought processes that affect things like your memory, concentration, verbal and nonverbal communication, and judgment. Changes in cognitive dysfunction may cause you to feel as if your brain is in a “fog” all day or as if you are constantly forgetting what your patients or coworkers have said. You may have trouble concentrating on your charting or feel unable to finish a basic task, such as restocking the crash cart. You may experience difficulty making critical decisions, leading to mistakes that jeopardize patient and team safety.

How to Effectively Manage It:

If you are experiencing cognitive dysfunction symptoms, it is crucial that you acknowledge it immediately. Talk to your supervisor and discuss the fact that you feel you are experiencing compassion fatigue and what symptoms you have. You may want to visit your primary care provider and get a referral to a therapist specializing in cognitive behavioral therapy (CBT). CBT will not only help you with your cognitive dysfunction symptoms, but it will also help you get to the root cause of your compassion fatigue and help you begin the healing process.

Symptom #6: Substance Abuse

About the Symptom:

We have all felt the need to blow off steam after work, but for some nurses, uncontrolled compassion fatigue leads down a path of substance abuse. Substance abuse may begin with binge drinking after a hard day at work, chain-smoking cigarettes, or smoking marijuana to relax. Unfortunately, many nurses who turn to substance abuse to handle compassion fatigue often turn to harder drugs instead of stopping.

How to Effectively Manage It:

The first step to managing substance abuse is admitting you have a problem. The next step is getting help. Talk to your manager or coworker if you feel comfortable doing so. If you feel uncomfortable talking to someone at work, call the American Addiction Center at 866-685-9481. The Center has a program designed specifically for medical workers to find help for substance abuse.

Symptom #7: Numbness Towards Patients

About the Symptom:

As nurses, we are expected to be friendly, engaging, and empathetic while working with patients. However, if you are experiencing compassion fatigue in nursing, you may find it difficult to empathize with patients. It may be challenging to feel joy in situations that generally bring happiness. Compassion fatigue can drain your energy and make you feel like a shell of yourself, and those feelings will be reflected in the way you respond to patients.

How to Effectively Manage It:

If you feel less responsive or numb towards patients or feel the care you provide is not up to the standard you are used to, it may be time to ask for help. It is always important to keep your supervisor or director informed of what is going on. If the situation is bad enough, you may need to seek help from a counselor or therapist. Seeking professional assistance is one of the best things you can do for your personal and work health to overcome compassion fatigue in nursing.

Symptom #8: Decreased Job Satisfaction

About the Symptom:

Another common symptom of compassion fatigue in nursing is decreased job satisfaction or poor employee morale. Nurses experiencing compassion fatigue who were previously happy with their jobs begin feeling disconnected from their jobs and purpose. Some nurses feel anger, frustration, or resentment for having to work. Others experience depression or a negative outlook.

How to Effectively Manage It:

No matter how good your job is, if you are experiencing compassion fatigue, it will likely impact your job satisfaction if it is not handled. As with every symptom of compassion fatigue in nursing, acknowledging it exists is the first step in managing it. When you admit that you have compassion fatigue, you can get to the source of why you have it, and then developing a plan to overcome it becomes possible, which makes managing the symptoms easier.

5 Things Nurses Must Do to Prevent Compassion Fatigue

Once you understand the causes and symptoms of compassion fatigue in nursing, knowing ways to help prevent your risk of experiencing it is essential. There are several interventions to help reduce the chances of experiencing compassion fatigue. The following are five things you can do to help prevent your risks.

Thing #1: Prioritize Self-Care

One of the most important things you can do for yourself and your patients, and an essential step in combatting compassion fatigue in nursing, is practicing self-care. Self-care is any activity that is beneficial to your physical, emotional, mental, or spiritual well-being. For example, a few ways to practice self-care include eating a healthy, well-balanced diet, getting regular exercise and plenty of sleep, avoiding stress, and engaging in activities you enjoy.

A few self-care rituals I like to perform are daily exercise, meditation, and journaling. I also like an occasional massage to help when I feel worn down or stressed.

Thing #2: Use Emotional Intelligence Tactics

Emotional intelligence is the ability to use, manage, and understand our emotions so that we can promote empathy, resolve conflicts, and reduce stress. One way to implement emotional intelligence is to take the time to recognize your thoughts and feelings and take control of them before they overcome you. By identifying the things that cause you to feel emotionally triggered and learning effective ways to respond to those triggers, you can reduce the risk of developing compassion fatigue in nursing.

Thing #3: Talk to a Mentor or Supportive Friend

Another vital step to help prevent compassion fatigue in nursing is to share what you are experiencing with someone. If you keep all your emotions and experiences hidden, it will eventually begin to weigh you down. However, talking about your thoughts, feelings, and experiences with a friend or mentor you feel safe with can take a load off of you mentally and emotionally. Even if you don’t feel comfortable talking about your experiences, just being around friends and loved ones can help provide emotional relief from the stressors and trauma of work.

Thing #4: Learn to Set Boundaries and Be Okay with Saying "No"

Compassion fatigue in nursing often occurs because of the sensory overload nurses experience due to being overworked or overwhelmed by repeated stressors or traumas. One thing you can do to help reduce your risk of developing compassion fatigue is to know what you can handle and set boundaries for the amount and type of work you are willing to accept. For example, if you begin feeling burned out at work, refrain from accepting an extra shift or offering to stay and work overtime. Learning to say “no” is one of the best ways to protect yourself from feeling emotionally overwhelmed and developing compassion fatigue.

Thing #5: Seek Help When You Need It

As nurses, we are known for helping others. You may feel like you need to be cheerful or happy all the time and that it is your responsibility to smile, even if you don't feel like it. Some days, you may be able to pull that off, but it is not so easy when compassion fatigue creeps up on you. It is imperative for you to identify when you begin to feel overwhelmed and to admit when you need help. Most hospitals and larger healthcare facilities provide free-of-cost employee assistance programs (EAPs). Ask your manager or human resources for more information on the types of services that your EAP provides. These programs are designed to support staff and offer free counseling, therapy, or classes to help get you back on your feet after experiencing trauma or compassion fatigue in nursing. You may find that you need additional assistance from a counselor or therapist to prevent or manage compassion fatigue. Remember, to be a good nurse, you must take care of yourself first!

My Final Thoughts

If you are a nurse who has experienced what it feels like to see patients suffer or who has gone through traumatic events in your personal life or at work, chances are, your ability to feel compassion has been pushed to the limits at times. Many nurses get to that point and experience compassion fatigue. Some nurses are unaware that compassion fatigue occurs and wonder, "What is compassion fatigue in nursing?”

In this article, I discussed some information to give you a firm understanding of compassion fatigue, what causes it, the symptoms, and ways to protect yourself. While all cases of compassion fatigue in nursing may not be prevented, being aware of the signs and symptoms and taking measures to care for yourself can certainly reduce your risk. If you feel you are experiencing symptoms of compassion fatigue, do not be afraid to reach out to a supervisor, mentor, or friend and ask for help.

List Of Sources Used For This Article

1. “How Nurses Can Combat Compassion Fatigue” (NurseJournal)
2. “Self-Care for Nurses-25 Proven Strategies to Take Better Care of Yourself” (nursingprocess.org)
3. “Compassion Fatigue in Nursing: A Concept Analysis” (National Library of Medicine)
4. “12 Simple Tips to Improve Emotional Intelligence in Nursing” (nursingprocess.org)
5. “Compassion Fatigue: A Nurse’s Primer” (The Online Journal of Issues in Nursing)
6. “Common Causes of Compassion Fatigue in Healthcare” (Joyce University of Nursing & Health Sciences)
7. “Trauma, Compassion Fatigue, and Burnout in Nurses” (National Library of Medicine)

Sarah Cruzan, RN, BSN
Sarah Cruzan is a registered nurse with 6 years of hospital, sales, and education experience. She is passionate about engaging clients and providing exceptional care. Sarah was a competitive swimmer for 15 years. She received a scholarship to The Ohio State University and swam varsity for 4 years.