Helping Hands

Compassion Fatigue

Strategies for managing the worst of times

Compassion fatigue is the mental and physical exhaustion affecting healthcare providers as a result of the work we do. In the ED, we're especially vulnerable; factors that contribute to compassion fatigue include high volume, high acuity, crowding, performance metrics, boarding, interruptions, and patients who are rude, aggressive, and present frequently (anecdotally, pandemics do not seem to help). We can and should work together to mitigate as many of these factors as possible, but the fact that they are so difficult to rectify actually contributes to the problem.
 
Compassion fatigue is separate from but can contribute to burnout – a state of exhaustion, emotional fatigue, depersonalization, and perceived lack of accomplishment.
 
You almost certainly experience some degree of compassion fatigue in your work; how you manage these stressors is something learners are paying attention to and learning from.
 
Factors that help mitigate compassion fatigue include:

  • Discussing positive aspects of emergency medicine work

  • Supportive supervisors

  • Access to mentors

  • Role and skill acquisition

  • Emotional resilience

  • Positive departmental culture

  • Interdisciplinary respect

As you work and confront drivers of compassion fatigue with your team, reflect on the role you play in setting an example for residents, students, and other members of the ED team. How will you help them embrace the positive aspects of our work? Consider shared reflection, open discussions of how difficult interactions with patients and each other affects patient care, and modeling conversations with patients and families that increase provider-patient connections. 

Ready to take even more of a leadership role in mitigating compassion fatigue? Consider giving one or more of these evidence-based strategies a try.

Group reflection – Shared reflection encourages shared mental models, goals, and strategies to optimize the functioning of the team for patient care and learning. Members of the team can work together to identify positive aspects of EM work and generate meaning from negative experiences by developing future strategies. Team-membership and camaraderie also help combat the isolation of compassion fatigue and burnout. 
 
Debriefing – Make the time to discuss complex or difficult cases. An opportunity to reflect and converse can improve everyone’s emotional state – and improve patient care for subsequent patients. An organized debrief only takes a few minutes and pays back major dividends. 
 
Seeking connection – How can you encourage learners to abandon a “move the meat” mindset and have more meaningful interactions with patients and families? One attending I know offers coffee shop gifts cards as rewards for the resident or student who uncovers the most interesting fact about a patient or family member for that shift. 
 
Meaningful service – Learners often struggle to balance service and education, and at times the service – documentation and administrative demands for example – can seem overwhelming. What strategies can you share with them to decrease these burdens? How can you reframe variation and efficiency as important aspects of training?
 
Gratefulness – It seems hokey, but identifying aspects of your life or work for which you are grateful has been demonstrated to improve satisfaction and happiness. Can you start or end a shift on the right note by taking a moment to engage in positive thinking?
 
Emergency medicine is a challenging specialty that exposes us to the best and worst of humanity. Especially when our work is most emotionally draining, it is important to be intentional about role modeling the sort of positive behaviors that will help learners throughout their careers. 

Crowe L. Identifying the risk of compassion fatigue, improving compassion satisfaction and building resilience in emergency medicine. Emergency Medicine Australasia 2016;28(1):106–8. 

Hamilton S, Tran V, Jamieson J. Compassion fatigue in emergency medicine: The cost of caring. Emergency Medicine Australasia 2016;28(1):100–3.

 

Ross S, Liang L, Rose C, Chou A. Battaglioli N. Strategies to enhance wellness in emergency medicine residency training programs. Annals of Emergency Medicine 2017;70(6):891–7. 

 

Schmutz JB, Eppich WJ. Promoting Learning and Patient Care Through Shared Reflection. Academic Medicine 2017;92(11):1555–63.