Nursing is often described as one of the most rewarding professions, but it is also one of the most emotionally taxing. For many nurses, the very compassion that draws them to the field becomes the source of deep emotional strain. In a study titled “Compassion Fatigue as Bruises in the Soul: A Qualitative Study on Nurses,” researchers explored the lived experiences of nurses who grapple with compassion fatigue. The findings are both profound and heart-wrenching, offering insights into the hidden wounds many nurses carry.

What is Compassion Fatigue?

According to the International Council of Nurses (ICN), Compassion is a necessary value that all nurses should hold as important to the profession. It is described as an innate ability people are born with, and that cannot be taught or acquired. Compassion is what motivates people to act when we see someone else suffering, to try and end that suffering. It’s what allows us to demonstrate kindness to our patients, even when we are drowning in work. The act of compassion to our patients can lead to a positive feeling within ourselves, but what happens when we are exposed to too much suffering on a daily basis?

Compassion fatigue is the emotional and physical exhaustion that arises from the constant exposure to the suffering of others. As the study notes, compassion fatigue is “a phenomenon that can occur when the amount of compassion spent exceeds the capacity to cope or recover.” Unlike burnout, which is often linked to work-related stressors like long hours or poor management, compassion fatigue is more personal. It stems from the empathy and emotional investment that nurses bring to their roles. The study’s metaphor, describing compassion fatigue as “bruises in the soul,” captures the invisible yet deeply felt toll of caring for others.

Key Findings from the Study

The study revealed that compassion fatigue often manifests as:

• Emotional Exhaustion: Nurses described feeling drained and unable to “refill their cup” after emotionally intense shifts. Eventually many reported that this led to a lack of compassion towards their patients.

• Detachment and Cynicism: Some nurses reported becoming emotionally numb as a coping mechanism, leading to feelings of guilt. They build a wall to prevent themselves from becoming emotionally engaged with their patients in order to protect themselves, which in turn leads to negative emotions, about both themselves and their patients.

• Lingering Sadness: Witnessing patient suffering or loss often leaves a lasting emotional imprint, described by one participant as “a sadness that never fully leaves.”

• Fatigue: All of their energy was saved for their patients and work, and in their time off, they were left with no energy to spend time with family and friends, or do the things that they love. Sleeping doesn’t help. Many end up isolating themselves due to this exhaustion.

Why Does Compassion Fatigue Happen?

Compassion fatigue is an occupational hazard for nurses due to the nature of their work. The study identified several contributing factors, including:

• Frequent Exposure to Suffering: Caring for critically ill or dying patients on a regular basis.

• High Workload: Heavy patient loads and understaffing leave little time for emotional recovery.

• Lack of Support: Limited acknowledgment or support from management can exacerbate feelings of isolation and fatigue. Management often denies us time to recover; even asking for time off can lead to guilt.

The Ripple Effect of Compassion Fatigue

Compassion fatigue doesn’t just affect nurses; it impacts patient care, team dynamics, and the broader healthcare system. Nurses struggling with compassion fatigue may:

• Have difficulty maintaining focus or empathy during patient interactions. Some even reported ‘repugnance’ at even meeting a new patient.

• Experience conflicts with colleagues due to increased irritability.

• Many reported feeling negatively about themselves as a result, emotions such as shame, guilt, and inadequacy were mentioned more than once.

• Problems at home as a result of taking out their bad feelings on their family.

• Increased absences from work.

• Consider leaving the profession altogether, contributing to the growing nursing shortage.

What Can Nurses Do?

While compassion fatigue is an inherent risk in nursing, there are ways to address and mitigate its effects:

1. Prioritize Self-Care

• Set boundaries to separate work from personal life.

• Engage in activities that bring joy and relaxation outside of work, whether that is going to church, reading a book, or picking up some hobbies you haven’t touched in a while.

• Sleep. Exercise. Stop self-medicating. Take care of your physical self.

2. Seek Peer Support

• Share experiences with colleagues who understand the unique challenges of nursing.

• Participate in support groups, whether in-person or online.

3. Access Professional Help

• Therapy or counseling can provide tools to process emotions and build resilience.

• Look into employee assistance programs (EAPs) offered by your workplace.

4. Advocate for Change

• Advocate for systemic improvements, such as better staffing ratios or wellness programs for healthcare workers.

• Encourage leadership to recognize and address compassion fatigue as a workplace issue. 

In Better News…:

Some nurses who recognized the symptoms of compassion fatigue and reflected on why they became a nurse, and what experiences led them to their current state. That new self-awareness allowed them to recognize the symptoms early and take action if they found it happening again in the future.

My experiences and thoughts

While I was reading this paper, I began having flashbacks. I have always called my experiences burnout, but maybe it was compassion fatigue. I have had times when I was so tired that no amount of sleep helped and I spent my days on the couch zoning out to the television; when I didn’t want to see or talk to anyone, to the point where I wouldn’t answer the phone when anyone called; and when it felt hard to care about my patients- I worked in oncology, I needed to care! It seems I may need to do my own reflections on my experiences. 

I chose to eventually leave patient care in order to protect myself, and that too seems to support this paper. My quality of life and happiness improved dramatically after leaving clinical nursing. If you currently find yourself with these feelings, please take some time off, find a professional to talk to, and consider changing jobs if necessary. Even if you don’t want to leave patient care, sometimes changing your role to a difference setting or patient population can be a reset. 

Also, I know this paper focuses specifically on nurses, compassion fatigue is a reality for anyone in caregiving roles, from physicians to social workers. If you are feeling these emotions related to caring for anyone, please try and get help.

Breaking the Silence

Compassion fatigue is often overlooked, with many nurses suffering in silence. By bringing awareness to this issue, we can foster a culture that supports emotional well-being rather than stigmatizing it. If you’re a nurse experiencing compassion fatigue, know that you are not alone, and help is available. If you would like to read the entire paper, you can find it here.

Have you experienced compassion fatigue? What strategies have helped you cope? Share your thoughts in the comments below—your story might help someone else feel less alone.