Nurses & Mental Health: Coping with Compassion Fatigue, Burnout, & Resilience

I recently celebrated my 50th birthday. A normal person, at this age, has likely only ever seen a handful of dead people. I’ve seen dozens… perhaps even hundreds. I know that seems like a gross exaggeration, but I spent nearly 20 years working in the ED, so it’s probably closer than you think.

For most people, these encounters would have been painstakingly prepared and arranged with courtesy for the living and respect for the dead. My encounters were often violent, loud, and sudden.

Having spent so many years in the ED, my experiences may be more extreme than others. Still, nurses deal with this sort of thing every single day. If you worked through COVID as a nurse, then you experienced things that I didn’t, since I was working as an educator at the time. Regardless of your experience as a nurse, you carry a mental weight that many people can’t understand, unless they do what we do.

But, there’s hope. The mental and emotional trauma we have experienced doesn’t have to define us, and we don’t have to carry it for the rest of our lives.

Understanding Mental Health Struggles in Nursing

The sort of stressors that I mentioned above can lead to significant issues for nurses. This can include:

What is Compassion Fatigue in Healthcare?

Dr. Charles R. Figley, PhD, defines this as when we “take on the suffering of patients who have experienced extreme stress or trauma.” (1) While I agree that working with people who have thes extreme experiences can lead to compassion fatigue, for nurses I think it doesn’t even have to be something extreme. Dr. Figley is specifically speaking to psychologists in his definition. I would argue that, for nurses, it’s not just the moments of extreme stress or trauma that lead to compassion fatigue, but could include the exposure we have to the smaller, day-to-day stress and trauma of others.

Dr. Figley goes on to say that this is a risk for “any professionals who use their emotions, their heart.” This certainly sounds like nurses to me.

The irony of compassion fatigue is that it results from the very thing that makes nurses so great, empathy. Empathy gives us the ability to not just understand the circumstances that others are going through, but to understand how it FEELS. Unfortunately, our empathy often goes beyond simply understanding it to actually feeling it, even if on a smaller scale.

Burnout

Burnout is a bit of a buzzword these days. Many of us feel burned out, even if we can’t really define what it is, or describe how it feels. As high as 50% of nurses in America show signs of burnout (2). These signs may include emotional exhaustion, depersonalization, and decreased personal accomplishment(3). I’d add compassion fatigue, as listed above, to the list.

And more

While compassion fatigue and burnout can result from the sort of big things we looked at earlier, I think they can also result from a bunch of smaller things that stack up over time. Such as:

Dealing with patients’ families and other visitors
Poor staffing
Conflicts with providers, other nurses, and healthcare workers
Higher demands from our employers
Etc, etc, etc

Practical Strategies for Supporting Mental Health

Mindfulness

I remember when I started working on my master’s degree. The first class they made me take was on mindfulness. I went into it thinking this was the dumbest thing ever. I was ready to get into the meat of the program and start learning how to become an amazing nursing educator, but they wouldn’t let me start any other classes till I had completed this one.

Well, after the first session or two, I was convinced. This turned out to be one of the best classes I completed and is something I use on a regular basis today.

Mindfulness can sound like some woo-woo, new age silliness. The truth is, it can be like that for some folks. However, it can also be a powerful tool that can help you understand yourself better and gain more control over how you respond in a wide variety of situations.

“Between stimulus and response, there is a space. In that space is our power to choose our response.” Viktor Frankl

I learned this quote in my mindfulness class, and I’ve never forgotten it. Mindfulness gives us the power to open that space to give us even more capability to choose our response. If you’re interested in learning more about mindfulness, I’m planning a Mindfulness Workshop. You can learn more and sign up HERE.

Stress Reduction

Ok, I know this one may leave some of you feeling like, “Duh, Matt. I know I need to reduce stress. Stick with me. This isn’t simply about avoiding things that cause you stress, like your bills, job, or spouse. I mean, some of these things we simply can’t avoid. This is more about learning ways to release stress.

Here are some ideas:

Deep breathing
Meditation (I tried 4 times to type that and typed “medication” the first 3 times. You may need medication to get you through a season, but I can’t prescribe that.)
Exercise
Spend time outside
Sleep – 7-9 hours of high-quality sleep most nights of the week.
Rest – This is different than sleep. This is about intentionally taking time to do nothing.
Declutter your home – clutter in your home or even your workspace can add stress.
Spend time with friends or family… unless they cause you stress. LOL
For more ideas, here is a free list of 101 Free or Cheap Self-Care Ideas.

Build Resilience Through Self-Care

Resilience is kind of a dangerous word. I mean it’s a good thing to work on, but it’s sometimes used by our industry as a way to push nurses to take on more, to do more, and to shame us if we don’t or won’t.

Merriam-Webster defines resilience as “an ability to recover from or adjust easily to misfortune or change”. With that definition, it’s kinda strange that hospitals or the nursing industry would encourage this in nursing. It’s like they’re saying that our work is “misfortune”. Merriam-Webster gives another definition, “the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress. I think we can agree that sometimes our jobs feel like “compressive stress.”

To put it in normal words, resilience is the ability to “bounce back”. We build this through self-care. In my book, The Restored Nurse, I outline 6 pillars of self-care:

Work Health
Physical Health
Mental Health
Spiritual Health
Relational Health
Financial Health

Each one of these is worthy of an entire article of its own. For now, I’ll just ask, what are you doing regularly to improve your health in these 6 areas?

Building Strong Support Networks in Nursing

I finished my RN-BSN in 5 months and then my MSN in 8 months. I spent almost 20 years in the ER. I went through nursing school while working full-time. All of these things, and more, I was only able to do because I had a strong support system… mostly my amazing wife.

Building a strong support system is VITAL for nurses. This can include your spouse/partner, but shouldn’t just be them. This can be a group of close friends, but please don’t limit it to people you work with. Those relationships often end or fade when one of you leaves that employer.

This can also be connecting with friends online, especially other healthcare workers. Two of my closest friends live over 1000 miles away from me and have for the entirety of our friendship of more than a decade. We message back and forth several times a week. We have gone through some difficult times in each other’s lives, even though we have never lived any closer than this. You can have amazing friendships that life far away, thanks to the internet.

There are also some great online networks for nurses. Here are a few created and run by nurses whom I know personally:

Regardless of where you find it, seek out community and connection so that when the hard days come, and they will, you’ll have the support you need.

Conclusion

Several years ago, I sought out a counselor. I drove over an hour each way to meet with someone I trusted. I met with her weekly for a while, then monthly, and eventually stopped meeting. This came from a realization that my mental health was not in a good place, and worse, the people that meant the most to me, my family, were suffering because of it. It cost me some time and money, but it changed my life.

Your mental health matters too. Somehow, mental health has become a taboo subject in nursing. It’s almost become a source of shame if we admit that we struggle with mental health or that we’ve sought help. I’ve shared my mental health struggles quite a bit over the years, and every time I do, I get people who tell me that my story made them feel like they weren’t alone. Trust me, whatever you are struggling with, there are others struggling too. And, if you truly aren’t struggling, then now is the time to put habits into place that maintain your mental health.

Here’s a startling statistic: nurses die from suicide at a rate 18% higher than the general public (4). I’ve read studies that put this number as high as 21%. You may not be there, but many of our brothers and sisters in nursing are. If that’s you, seek help, please. If nothing else, email me at matt@restoringnurses.com.

Even if you are not on the verge of doing something final, make your mental health a priority. It matters.

REFERENCES

Nurses & Mental Health: Coping with Compassion Fatigue, Burnout, & Resilience

Understanding Mental Health Struggles in Nursing