Combating Compassion Fatigue and Burnout through Wellness Activities

Health care workers have one of the most demanding professions. They are expected to work long hours while demonstrating compassion and care for the patients that they serve (Greshon, 2014). These expectations create additional stressors, and if these stressors are ignored, they can exasperate, causing physical and emotional harm for the nurses and patients. The nurses working at the Satellite Campus have experienced many of these stressors and they are exhibiting symptoms of compassion fatigue and burnout. The symptoms of burnout & compassion fatigue affect the nurse’s ability focus and care for the patients. The organization offers activities to help decrease the level of compassion fatigue and burnout; however, the activities are only offered at the Main Campus, which is an hour away from the Satellite Campus. In an effort to meet the needs of the employees working at the satellite campus, the Holistic Wellness quality improvement project will provide education and training to help decrease the symptoms of compassion fatigue and burnout and ultimately improve compassion satisfaction for the nurses working at the Satellite Campus. The project design is an analytical, observational, fixed, cohort project. The theoretical model supporting the project is Jean Watson’s Theory of Human Caring. The literature review identifies the growing demands on nurses and supports a variety of wellness activities for combating compassion fatigue and burnout. The Holistic Wellness Project provided the education and activities to help decrease the nurses stress levels and improve their ability to care for their patients and themselves. COMBATING COMPASSION FATIGUE AND BURNOUT THROUGH 3 Combating Compassion Fatigue and Burnout through Wellness Activities Background The occurrence of burnout, and compassion fatigue are a common in today’s health care industry. The potential losses for the organization are extensive and may include employee turnover, extended sick leaves, and increased incidence of work related injuries. The hospital environment further impacts these issues with the need to provide 24-hour coverage for the patients. The stressors of the hospital include long work hours, high patient acuity, and challenging work environments. All of these challenges have a negative financial impact on the organization; they influence job satisfaction, employee engagement, patient safety, and patient satisfaction. Because of these influences, it is imperative that the issues contributing to burnout and compassion fatigue be addressed. The influences of compassion fatigue and burnout have a direct effect on employee performance, patient satisfaction, and overall wellness. Gallegar (2013) describes compassion fatigue as secondary trauma, which results from stressful relationships between the clinician and the patient. It is also described as parallel post-traumatic stress disorder and it affects the nurse’s ability to care for the patient. If the symptoms of compassion fatigue are not recognized and dealt with appropriately, they will further impact the nurses’ personal and professional life, possibly leading to symptoms of burnout. Burnout is identified by symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment. According to Maslach 1996, in 1974, Freudenberger, developed the term “burnout” to describe the workers response to chronic-stress, such as that experienced in the nursing profession. Maslach, described burnout as being multifaceted, encompassing three dimensions: COMBATING COMPASSION FATIGUE AND BURNOUT THROUGH 4 emotional exhaustion, depersonalization, and reduced personal accomplishment. The demands of the hospital environment impact the nurse’s with the need to provide 24-hour care for the patients Nurses often work 12-hour shifts and can feel emotional exhausted, they are depleted, overextended, and fatigue and susceptible to suffering the symptoms of burnout. According to Phiri, et al. (2014), this type of work environment may lead to disruptive sleep patterns, and can influence the potential for mental and physical exhaustion, increasing the risk for compassion fatigue and burnout. The 24-hour shift coverage creates abnormal sleep patterns, which influence the nurses’ susceptibility to non-communicable diseases such as high blood pressure, obesity, and diabetes (Phiri, 2014). If these stressors are ignored they can lead to physical and emotional symptoms which can influence the nurses’ ability to focus, resulting in medical errors, absenteeism, and job burnout. All of these challenges have a negative impact on the organization; they impact employee engagement, patient safety, patient satisfaction, influence financial stability, and threaten the success of the organization. Because of these influences, it is imperative to create awareness and support a system that provides healthy opportunities for decreasing stress. Roberts, Grubb, & Grosch, (2012) state that nursing is one of the most rewarding professions; however, it is also considered one of the most stressful professions. The needs of the patients and the expectations of the employers are contributing to the growing stressors of the job. These stressors contribute to an increase in burnout and compassion fatigue for many nurses. According to Roberts, et al. (2012), nurses seem to be overexposed to a range of psychosocial stressors, including the following; lack of control, long work hours, shiftwork, interpersonal conflicts, insufficient resources, poor reward systems, inadequate structure of COMBATING COMPASSION FATIGUE AND BURNOUT THROUGH 5 communication flow in hospitals and other healthcare settings, bullying and physical violence (pg. 3). It is difficult for the nurse to maintain a focus when they do not take time to step away from the chaos to take care of them self. Influenced by the stress of the profession, they are vulnerable to experiencing symptoms of compassion fatigue and burnout. They become tired and distracted. According to Lazuerus & Folkman (1984), stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding their resources, and endangering their well being. Jennings (2008) reported that in 1960, Menzies first assessed the work stressors of the nurses when she wrote about the unique stressors of the hospital. She believed that the hospital created an anxiety and disconnect for the individuals working in them. The individual may respond by creating a protective shell, projecting negative attitudes, or having defensive behavior against anxiety. Jennings identifies four sources of the nurse’s stressors, which include: the influences of patient care, decisionmaking, taking responsibility, and constant change. Patient care has become more taxing, as the patients who are admitted into the hospital have a higher acuity of illness, require a higher level of nursing skill, and create additional stressors. As primary the caregiver, the nurse is often the decision maker of the patients’ needs and has the responsibility for making life-changing decisions for the patients. The continuous changes in health care have included moving from paper charting to computer charting, the stressors of the affordable care act, expectations to meet discharge times, patient satisfactions scores, productivity, committee work, and increased patient acuity. The increased workload and turbulence in the profession adds to the stress of COMBATING COMPASSION FATIGUE AND BURNOUT THROUGH 6 the profession, and nurses are at high risk for suffering symptoms of compassion fatigue and burnout (2008). Identifying the Practice Change The current wellness opportunities offered by the organization are not available at the Satellite Campus. The Main Campus offers activities such as JUMBA, yoga, smoothie days, healing touch, and renewal rooms. The Satellite campus is located an hour north of Main Campus, and the nurses working at the Satellite Campus do not have an opportunity to benefit from the activities offered at the Main Campus. The Holistic Wellness Project provides the opportunity to create a policy that will support wellness activities extending to the staff working at all Satellite Campuses. The identified practice change is to create a wellness program for the satellite campuses. The QI Project The PICOT statement for the Holistic Wellness Project was, For pediatric and NICU nurses working at the hospital located at the Satellite Campus, will the implementation of a Holistic Wellness Program, as compared to current practices (no wellness support at the Satellite Campus), decrease compassion fatigue and burnout, and improve compassion satisfaction, when measured via a pre & post survey, over a 10 week period of time. Participants The Satellite Campus was the focus group for the Holistic Wellness Project. It is a 17-bed pediatric unit/12 bed NICU. It partners with the host facility, but is employed by a larger medical system located 45 miles away. The payer mix for the project includes 32% Medical, 48% COMBATING COMPASSION FATIGUE AND BURNOUT THROUGH 7 commercial, 18% Tri-Care, and 2% self-pay. Over 92% of the patients receive their care at the Satellite Campus; the other 8% require a higher level of care, and are transferred to the Main Campus for their care. The nurses were chosen on a volunteer basis. There are total of 52 employees that work on the unit; and 30 individuals volunteered and participated in the project. Some of the inclusion criteria for the group included, all participant must work in the NICU/ pediatric unit on the Satellite Campus, they must volunteer for the project, and they must commit to participate in all meetings. The exclusion criteria included, those not working in the unit, those who did not volunteer, those who volunteered but were unable to continue will be excluded from the project. Measuring Tool The fourth revision of the 30-item Professional Quali