Compassion fatigue and specialty care: the real cost of compassionate service

Much can be asked of a care provider, such as a nurse, certified nursing assistant (CNA), social worker, psychologist or psychiatrist throughout a typical shift. It can be a shift full of ups and downs. Even with all the advancements within modern client and specialty care, there is little doubt that it takes a special kind of person to handle the daily workload that sometimes includes anxiety, trauma and life-altering circumstance. This ‘cost of caring’ can have a profound effect on businesses and individuals within the client care or assisted living sector by turning a personal struggle into a potential liability.

As a proud segment of Nationwide, the Specialty Care Services team wants to highlight compassion fatigue in an effort to help community organizations recognize it, safeguard your staff and facilities against it, and provide support to the people who spend their days caring for others.

What is compassion fatigue?

The fine line these helping professionals must walk between service and selfish can be detrimental to even the most tenured professionals. Occupations within community and social work can also be prime incubators for compassion fatigue. Usually categorized by a feeling of intense stress, changes in mood, chronic tension and complete emotional exhaustion, compassion fatigue disorder is a seldom recognized ailment within what is a very client-centric industry.

These changes can affect both their personal and professional lives with symptoms such as difficulty concentrating, intrusive imagery, loss of hope, exhaustion and irritability. It can also lead to profound shifts in the way helpers view the world and their loved ones. Additionally, helpers may become dispirited and increasingly cynical at work, they may make clinical errors, violate client boundaries, lose a respectful stance towards their clients or coworkers and contribute to an overall toxic work environment.¹

Here are some processes and factors which can contribute to compassion fatigue:

• Exposure to suffering
• Concern
• Detachment
• Traumatic memories
• Other life demands

These can all lead to residual compassion stress, which ultimately leads to compassion fatigue.²

Despite some belief to the contrary, there is a significant physical and emotional ‘cost of caring’. It can often be misdiagnosed as depression or even general exhaustion, but there is much more at play here than just needing a better night of sleep. It can cause physical and emotional exhaustion linked to illness, headaches, poor job performance, and even declining personal relationships. Recently, increased turnover rates on staffs which causes an ever-increasing workload on current care employees is forcing the industry to recognize compassion fatigue as a legitimate market factor.

Signs of compassion fatigue and burnout

• Increased stress: Chronic feelings of stress, immense anxiety and tension that is either directly job-related or cumulative.
• Social isolation: Insulating oneself from harm or further demands for aid usually categorized by withdrawing from family, friends, responsibilities or job-related duties.
• Declining job performance: Noticeable and reduced productivity, missing work, becoming a negative influence on co-workers and/ or a loss of passion for the job.
• Disinterest or apathy: Loss of a favorite passion, feelings of apathy or ‘burnout’ and a loss of emotional investment. Can alter the sense of duty to workplace responsibilities over time.
• Physical ailments: A sudden decline in wellness that is not easily explained. Exhaustion, weight-loss, physical aches and pains or chronic headaches are also common.
• Substance abuse: A noticeable increase in self-medicating and is often used as an ‘escape’. Using drugs or alcohol can become a way of coping with these painful psychological feelings and can make the problems even worse.

From a small group home to the largest assisted living facility, this disorder can interrupt a functional and successful organization in a heartbeat. All it takes is ignoring the symptomatic circumstances and clues that help to identify this hardship. However, it is worth noting that ‘burnout’ can easily be mistaken for compassion fatigue in many cases, the main differences being that burnout can manifest itself throughout the course of a career or over a prolonged amount of time. Compassion fatigue sufferers experience a much more sudden and immediate onset.

Professional perspective

Dr. Mark Segal has been practicing in the Columbus, Ohio area for over 30 years and is board certified in Hematology and Medical Oncology. During that time, he’s seen the full range of emotions and circumstances the profession can offer, and it’s not for everyone. "You’re essentially guiding people through the good and the bad. Especially for those who can be new to the caring and service mindset, if you’re not prepared and conscientious, that empathetic response can get worn out."

This sense of emotional exhaustion can also have some significant consequences on a care facility and its overall staff if not properly detected and managed.

An individual with compassion fatigue can represent a significant ‘care gap’ within any specialty care operation. Those suffering from compassion fatigue are simply less likely to deliver quality and efficient care for those who need it most. It has the potential to transform a once vigilant and mindful caregiver into a negligent and apathetic figure, which poses a threat to any operation of good standing. Lawsuits, irreparable damage to reputation and public investigations are common legal consequences of decreased quality of care.

“It really can become a serious liability in any organization that deals with the community at large on a personal level. If an individual is not performing job duties to standard, that can potentially have some concerning implications on overall client safety,” says Segal.

Curbing this phenomenon may not be just about achieving relief; but rather examining a complex societal issue that is rarely formally addressed. The specialty care industry must remain sensitive to the needs of their caring professionals, no matter the case. Following professional tips like these can potentially help lessen the cost of compassionate caring.

Ways to combat compassion fatigue

• Meditation
• Regularly scheduled time-off or vacation
• Therapy or regular counseling sessions
• Developing hobbies or personal pursuits
• Regular exercise
• Plenty of sleep and physical rest
• Eating right and drinking plenty of water
• Avoiding depressants (alcohol)

Industry trends

Recent studies indicate that quality of care is suffering due to industry stagnant wages driven by reliance on government funding and the need for caregivers to seek supplemental employment to pay their bills. This adds strain on management to consistently train new staff to properly care for those they are advocating for and protecting. These financial stressors when in concert with overall job demands can make for an overworked or under-paid work force. This contributes to the high levels of staff turnover we see today in facilities across the country.

As senior living and retirement homes become less affordable, we see an increase of individuals within lower-level care facilities, widening crucial staff-to-client ratios even further. This can create broadened ‘care gaps’ and potential exposures overall due to understaffing. More seniors are opting for private in-home care; however, staff fatigue can still be an issue depending on the nature of that individual’s needs. Whenever a nurse, care technician or physician becomes tired and disengaged from the duties and gravity of their position, it means more stress and exposure for any remaining staff. It’s a detrimental cycle that can wear-down even the most robust facilities. Staff shortages are just one of the more concerning trends within specialty care facilities today.

With an aging population, rising incidence of chronic illnesses, and the retirement of around one-third of current nurses, a shortage of skilled nurses is particularly worrisome. Barriers to entry in the field, such as high education requirements and limited nursing school capacity and available hospitals/clinics for training, further compound the problem.⁵

Unfortunately, the American healthcare industry is not a model of tremendous success or sustainability. Years of long waits at care facilities and growing costs have put a serious strain on consumer confidence. More is now being asked of care professionals than at any other time in modern history. Versatility, flexibility and affability are crucial traits to possess when working in the care sector today.

Researchers suggest that it will be difficult for organizations to prevent compassion fatigue because there are so many demographic and organizational variables that contribute to the stress and burnout. Instead, they suggest administrators work to improve the work environment and provide interventions that increase satisfaction via professional development and recognition.³

Preserving these selfless individuals, so that they have long, productive and impactful careers is essential for the future of global healthcare. How do we take care of those who care for others?

Insurance for Specialty Care Services

In a mission to educate, recognize and support those who are in the business of caring, Nationwide has always been open to an exceptionally large client base, for both non-profit and for-profit organizations. As a provider of specialty care services, we know you have unique needs. Our exclusive OthersFirst® program provides a wide range of basic and optional coverages to meet the needs of your industry. We invite you to learn how this program can help you serve the greater good of your community by providing insurance coverage tailored to organizations that are in the business of caring for others.

"For almost 10 years, Nationwide Specialty Care Services has set out to protect, educate and serve our clients and partners who put the needs of others first," says Cheryl Tamasitis, AVP Human Services. "Putting the needs of others before your own is a true calling; a calling that we support every day."

Specialized coverage and organizations supported include, but are not limited to:

• Adult and senior day services
• Intermediate care centers for physical or intellectual disabilities
• Outpatient or residential mental health programs
• Day care centers for children with and without special needs
• Emergency shelters and transition homes
• Addiction treatment counseling (outpatient and residential)

As one of the nation’s leading carriers across multiple lines of business, we understand the unique challenges and exposures of your clients, and offer a broad suite of solutions to help protect them and you. If you would like to learn more about this topic, please communicate with your local agent or the Specialty Care Services Consultant assigned to your region.

For more information and general inquiries, please contact humanservices@nationwide.com.

¹ Françoise Mathieu, M.Ed., CCC., Compassion Fatigue Specialist © WHP-Workshops for the Helping Professions, March 2007.

² Figley CR, editor: Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner-Routledge: New York, p. 252, 1995-2001.

³ Mulero, A. (2015). Factors that influence nurse compassion fatigue | FierceHealthcare. [online] Fiercehealthcare.com. Available at: https://www.fiercehealthcare.com/healthcare/6-factors-influence-nurse-compassion-fatigue [Accessed 15 Jan. 2018].

⁴ Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. The Joint Commission. 2010.

⁵ The Atlantic, “The U.S. Is Running Out of Nurses,” February 2016, https://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/