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By Rachel Basham, RN, CCRN

“Compassion fatigue” is a phrase thrown around easily when talking about the health care professions. It is often spoken in the same breath as “burnout” and “turnover” while discussing the crisis of a diminishing workforce and increasing demand in health care.

The phrase brings to mind the burnt-out nurse who doesn’t have the emotional energy to care anymore. I can see her: deep frown lines, flat facial expression, dimmed eyes.

The light is gone.

She receives a report at shift change with a shoulder shrug and an apathetic response, “OK, fine. I don’t care.”

She won’t smile or laugh with a single patient today — simply completing tasks robotically for her allotted shift bracket. She’s learned that emotions take energy. And she’s all out.

Nurses are on the frontlines of this new buzz phrase of “compassion fatigue.”

The frontlines of the health care crisis in America that has so many dimensions it could make your head spin. The crisis where patients who make too much for assistance but cannot afford the luxury prices of health care in America present to the emergency department again and again for treatment because no one else will see them.

The patient on state-funded health care with perfectly manicured nails, a brand-new iPhone and a designer handbag who checks her whole family into the ED for cough and runny nose.

“How long is this going to take?” she asks irritably as the triage nurse crouches down to chat with one of the kids.

The severely mentally ill patient who comes to the ED in acute psychosis and is legally petitioned to inpatient psychiatric treatment — who sits in the ED for days. He’s waiting for placement at a psych facility that takes petitioned patients, which is a very, very short list. While in the ED, he is confined to his room with a sitter staring at him 24 hours a day, all his belongings removed from his possession.

He is not allowed to smoke or chose what he eats, only finger foods allowed. Sometimes he can watch TV, but no guarantees that his room placement will allow that to happen. He becomes intermittently agitated and threatens the staff, swinging his fists and spitting until he is tied down to the bed and chemically restrained with medications.

The nurses are as frustrated with this scenario as they are saddened. In nursing school, we learned that taking power from someone is emotionally detrimental; powerlessness is a profoundly traumatizing experience.

Yet, here we are — forced to do just that. We also fall victim to the broken system.

The expectations placed on nurses’ shoulders are more than any human being could accomplish.

When I hear the words “compassion fatigue,” certain patients come to mind.

The patient who is 90 years old and has been diagnosed with cancer — metastases everywhere. He comes into the ED with difficulty breathing. “Do everything!” the daughter says. “Hang on, grandpa!” they yell at the patient from the hallway as the breathing tube is passed into grandpa’s trachea. His heart changes into a lethal rhythm.

The family stands outside the door watching, horrified. The frail man lies cold and naked on the white hospital sheets. The nurse climbs up on a stool and begins pushing down on the middle of his sternum. His ribs crack like strands of uncooked spaghetti under the weight of her hands. Each compression breaking more and more ribs.

At some point, the chest feels more like mush, no bones left to break. The nurse keeps pushing, “hard and fast” just like she practiced in ACLS class. She knows these are his last moments on earth, as she feels his last two ribs crack under her hands.

The doctor calls time of death 20 minutes later. After caring for the family and performing post-mortem care, she places him in a body bag, walking down the hall to see her new patient. He came to the emergency department complaining of a sore throat and ear pain. He checked himself in while holding a McDonald’s bag and a 32-ounce soda.

When the nurse finally walks into her room, the patient screams in the nurse’s face, “It took you long enough. I’ve been waiting for two hours. This hospital is terrible!”

Twelve long hours later, the nurse drags her aching feet out to her car. She climbs into the front seat and sits in silence for a few minutes. The mental weight of the day washes over her. Tears come slowly. She pushes them back, thinking to herself, “I better get home, I’m back in 11 hours.”

Compassion fatigue is the result of the incessant demands placed on health care workers that create an environment where they are inundated with unresolved ethical conflicts, verbal and physical abuse, poor administrative support, and patients who demand more. More! More!

Can I speak for the nurses? We are tired.

We are so tired of being called names and being treated like we are hotel workers all while we are trying to provide highly technical and complicated clinical care to improve the quality of our patient’s lives.

If we want to improve nurse burnout, let’s remember that they are human beings.

Nurses need mental health support to build and maintain resilience. We need breaks! Physicians need the confidentiality that other patients receive — if they are suffering from depression, they should be able to seek treatment without losing their job or being ostracized by their colleagues.

How can we possibly endure such endless trauma and stress without participating in rigorous and constant self-care? The answer is easy: we can’t. We need respect. We need safe workplaces. We need to have a team that respects each other and listens. We need people behind desks who listen to us and advocate for us.

The answer to the growing nursing and physician shortage? Keep the great ones that are already here — take care of them.