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Tips for Healthcare Professionals:

COPING WITH STRESS AND COMPASSION FATIGUE

As a healthcare professional, you may face 

stress on the job under usual conditions due 

to long shifts, competing responsibilities, and 

witnessing or hearing about difficult patient 

experiences. As a responder on the front lines 

of the coronavirus disease 2019 (COVID-19) 

pandemic, you are likely working longer hours, 

seeing loved ones less, and working in a more 

stressful environment. At the same time, you 

may be coping with the mental health effects 

that all types of disasters, including public health 

emergencies, often have. As such, you may be 

noticing signs of stress and distress in yourself 

and your coworkers.

This tip sheet explores stress and compassion 

fatigue, as well as signs of distress after a 

disaster. It identifies ways to cope and enhance 

resilience, along with resources for more 

information and support. 

Stress and Compassion Fatigue

Stress encompasses the ways that your body 

and brain respond to something you perceive as 

a demand in your environment. As a healthcare 

professional, your career requires you to respond 

to multiple demands at once, and you are likely 

already experienced in stress management. 

SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov
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TIPS FOR HEALTHCARE PROFESSIONALS: COPING WITH STRESS AND COMPASSION FATIGUE

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov

Issues can arise, however, when you run short of 

time to recover between stressors, when you feel 

as though you cannot respond effectively to the 

many demands you face, or when you are part of 

a disaster-affected community and you are also 

having reactions to that experience.

Compassion fatigue includes two elements: 

burnout and secondary traumatic stress. Burnout 

is physical and mental exhaustion leading to 

reduced ability to cope with your environment. 

Burnout involves fatigue, frustration, a sense of 

helplessness, and reduced pleasure in work or 

other responsibilities. Secondary traumatic stress 

is the stress you may experience due to empathy 

with others you see going through trauma, 

including physical trauma such as serious injury, 

illness, or death. People also may experience 

secondary traumatic stress through empathy with 

others who talk with them about their traumas.

Signs and Symptoms of Disaster-related Distress

People affected by disasters such as the COVID-19 pandemic often experience physical changes, 

as well as changes in thinking, emotions, and behavior. In addition to signs and symptoms of 

compassion fatigue, you may notice the following signs and symptoms of disaster distress in 

yourself and those around you.

Physical

 Stomachaches or 

diarrhea

 Changes in appetite 

and eating habits

 Headaches or other 

pains without a clear

physical cause

 Jumpiness or 

exaggerated startle 

response

 Trouble falling 

asleep, staying 

asleep, sleeping too

much, or trouble 

relaxing

Cognitive

 Difficulty 

remembering things

 Difficulty thinking 

clearly or 

concentrating

 Confusion

 Increased worry

 Trouble making 

decisions

Emotional

 Anxiety and fear

 Overwhelming 

sadness

 Anger

 Guilt

 Numbness and 

inability to feel joy 

or sadness

Behavioral

 Increase or 

decrease in activity 

levels and reduced 

stamina

 Frequent crying

 Use of alcohol or 

other drugs in an 

attempt to reduce 

distressing feelings 

or to forget

 Angry outbursts

 Desire to be alone 

most of the time 

and deliberate selfisolation

 Risk-taking 

behaviors
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TIPS FOR HEALTHCARE PROFESSIONALS: COPING WITH STRESS AND COMPASSION FATIGUE

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov

Addressing and Preventing 

Compassion Fatigue

As a healthcare professional, you probably 

already understand the importance of self-care to 

maintain your ability to work effectively. You need 

to take care of yourself first, and allow others to 

care for you, to be able to do your best work in 

caring for others. This section suggests strategies 

for self-care, stress management, and relaxation. 

Based on what has worked for you in the past, 

you may want to come up with a set of strategies 

and schedule them on a regular basis as part of 

a stress management and self-care plan. Such a 

plan can be adjusted if you find it is not realistic 

or helpful. Give yourself credit for all you manage 

to do in the current, challenging environment. 

Self-care and Stress Management

Do your best to attend to your physical health and 

consider the following:

 Try to be physically active, ideally several times

each week, taking part in activities you enjoy.

Try walking or running, if there are places

where you can maintain a safe distance

between yourself and others. (If not, try

exercising early or late in the day, or choosing

less sought-after routes, if you can do so

safely.) You can also do push-ups or sit-ups

at home, dancing, or anything else you enjoy.

Many workouts are available online or on

television—and many do not require payment

or equipment.

 Strive to sleep and eat well. If possible, get

enough sleep or at least rest. Aim for 7 to 9

hours a night. Do your best to eat healthy food.

Drink enough fluids to stay hydrated.

 Try to avoid increasing use of alcohol and other

drugs. Although substances may help feelings

seem more manageable in the short term, they

can also lead to dependence and keep you

from addressing issues over which you have

control.

Signs and Symptoms of 

Compassion Fatigue

In the current highly stressful environment, you 

may notice the following signs and symptoms in 

yourself or your coworkers:

 Increased startle response to activity around

you, a feeling of being “on edge”

 Difficulty making decisions

 Exhaustion

 Difficulty sleeping

 Impaired ability to care for patients and/or

clients

 Intrusive thoughts about patients and/or clients

 Reduced enjoyment or satisfaction with work

 Sense of lack of control or agency in your job

 Feelings of disconnection from colleagues and

work teams

 Feelings of being overwhelmed by the amount

of work to be done

 Anger and irritability

 Reduced ability to feel sympathy or empathy

 Avoidance of reminders of upsetting

experiences with patients

 Increased use of alcohol or other drugs
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TIPS FOR HEALTHCARE PROFESSIONALS: COPING WITH STRESS AND COMPASSION FATIGUE

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov

Also key to health and resilience is maintenance 

of your support networks. Try to remember to do 

the following:

 Stay in contact with loved ones, including family

and friends. Although social distancing orders

mean that many of us cannot be together in

person, several online meeting platforms allow

you to talk remotely with loved ones. Phone

calls are helpful as well. You can also send

letters and postcards to family members and

friends.

 Turn to colleagues for contact and support at

work. Even brief interactions are important.

Take opportunities to recognize colleagues

who have done impressive work in patient care

or team support during the outbreak—informal

recognition in conversation or by email can

have a positive effect too. Remember that you

are part of a team; you do not have to do it

alone.

Following are ideas for activities that may help 

you reduce stress and relax, process your 

experience, and reconnect to your values and 

priorities:

 Visualization. Imagine that you are in a place

that is peaceful and calming to you—a place

you have been, or one where you would like

to be. You may want to write a description of

this place, record yourself reading what you

have written, and then listen to the recording

as a way to relax. Also, many visualization

Progressive Muscle 

Relaxation—Instructions:

1. Get into a comfortable position.

2. Choose a muscle group (e.g., muscles in

your feet or lower legs).

3. Breathe in and tighten the muscles in the

group for 5 to 10 seconds.

4. Breathe out and release the muscles

suddenly. Relax for at least 10 seconds.

5. Repeat the process with another muscle

group. It often helps to progress from head

to toe or vice versa.

and guided imagery scripts and videos for 

relaxation are available online, as are apps 

and podcasts.

 Progressive muscle relaxation. One sign of

stress is tense muscles, which is why stress

can lead to headaches, backaches, and

exhaustion. Progressive muscle relaxation is a

systematic way to relax your muscles. Please

refer to the instructions in the callout box for

steps to follow.

 Mindful movement such as yoga or tai chi. In

addition to offering the health benefits of other

exercise, yoga and tai chi may help with stress

management. Along with the many centers

offering classes online, videos are available

online to use as guidance.

 Meditation. Meditation has many benefits,

including reduced anxiety, depression, and

blood pressure, as well as insomnia relief. A

session can be as short as a few minutes. You

can access classes that many centers and

institutes are offering online, sometimes free of

charge. A host of mobile apps can be used to

start or strengthen a meditation habit.
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TIPS FOR HEALTHCARE PROFESSIONALS: COPING WITH STRESS AND COMPASSION FATIGUE

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov

 Breathing exercises. When experiencing stress

and strong emotions, people often constrain

their breathing, and breathing exercises can

be an effective way to relax. You can try deep

breathing, or breathing into and out of your

abdominal area instead of from your chest.

Imagine your breath going into and out of your

belly as you breathe. Another option is the

4–7–8 technique. Please see the callout box

for instructions.

 Humor. Humor and laughter can help relieve

stress and, if shared, build bonds between

people. Seek out sources of humor that have

made you laugh in the past, such as specific

cartoonists and authors, satirical publications

and news shows, stand-up comedians, and

television and movie comedies.

 Journal writing or drawing. Write or draw in

a journal if you find it helpful. This can be on

paper, on a computer, or in an app. It can

be as minimal as writing down one or two

things you are grateful for a few times each

week, or things you are pleased that you have

accomplished.

 Spiritual and religious practices. Some

congregations and spiritual organizations are

now offering online, live-streamed services

and observances. Some are archiving services

online. Participation in a religious or spiritual

group can be helpful for meaning-making,

reflection, and connection with a community.

Tips for Managers

If you manage other employees and have 

adequate staff, one step you can take to reduce 

staff stress is to schedule employees so that they 

have time to rest and recover between shifts. If 

possible, it can also be helpful to schedule staff 

so that they move into shifts in positions involving 

less stress after completing shifts in high-stress 

positions, so that they have time to recover 

between shifts of more intense work.

In addition, recognizing staff members for the 

work they do may help prevent compassion 

fatigue. You also can offer managerial support to 

The 4–7–8 Breathing 

Technique for Relaxation

1. Sit quietly, relax, and close your eyes.

Place the tip of your tongue against

the ridge on the roof of your mouth just

behind your top front teeth. Your tongue

should remain in this position throughout

the exercise.

2. Exhale completely through your mouth,

making a whooshing sound. It may help

to purse your lips.

3. Close your mouth, and inhale quietly

through your nose for a count of four.

4. Now hold your breath for a count of

seven.

5. Exhale completely through your mouth,

making a whooshing sound, to a count of

eight.

6. Repeat steps 2–5 three times, for a total

of four breaths.

In this technique, exhalation should take

twice as long as inhalation. This ratio

is the important part; the exact amount of

time you spend on each phase is not

important.

SAMHSA offers a video about stress 

management for disaster responders that 

features a demonstration of this breathing 

exercise: https://www.youtube.com/

watch?v=IqpCCnmwNVY&feature=youtu.

be.
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TIPS FOR HEALTHCARE PROFESSIONALS: COPING WITH STRESS AND COMPASSION FATIGUE

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727) | info@samhsa.hhs.gov | https://store.samhsa.gov

employees and, as much as possible, structure 

the work environment to encourage and allow 

time for case discussions.

When To Seek Professional Support

If you or someone you care about is 

overwhelmed by stress and reactions to the 

pandemic, you may want to reach out for 

professional mental health and/or substance use 

services and treatment. Acknowledging the need 

for help is a sign of strength. Even just a few 

visits can be helpful.

One place to seek support is with your 

employer—most have an employee assistance 

program, which offers short-term counseling and 

referrals. Many psychiatrists, psychologists, and 

counselors are now offering services by phone or 

through videoconferencing services. Some offer 

weekend and evening hours to accommodate 

work schedules. You can also check out the 

Helpful Resources section for free, confidential 

help with crises and referrals.

PEP20–01–01–016

Helpful Resources

Substance Abuse and Mental Health Services 

Administration (SAMHSA)

5600 Fishers Lane

Rockville, MD 20857

Toll-free: 1–877–SAMHSA–7 (1–877–726–4727)

TTY: 1–800–487–4889

Email: samhsainfo@samhsa.hhs.gov

SAMHSA Store: https://store.samhsa.gov

SAMHSA Disaster Technical Assistance Center

Toll-free: 1–800–308–3515

Email: dtac@samhsa.hhs.gov

Website: https://www.samhsa.gov/dtac

SAMHSA Disaster Mobile App

Website: https://store.samhsa.gov/product/samhsa-disaster

Helplines

SAMHSA Disaster Distress Helpline

Toll-free (English and español): 1–800–985–5990

TTY: 1–800–846–8517

SMS (English): text “TalkWithUs” to 66746

SMS (español): text “Hablanos” to 66746

Website: https://www.samhsa.gov/find-help/disaster-distresshelpline

Website (espanol): https://www.samhsa.gov/find-help/disasterdistress-helpline/espanol

National Suicide Prevention Lifeline

Toll-free (English): 1–800–273–TALK (1–800–273–8255)

Toll-free (español): 1–888–628–9454

TTY: 1–800–799–4TTY (1–800–799–4889)

Website (English): https://suicidepreventionlifeline.org

Website (español): https://suicidepreventionlifeline.org/helpyourself/en-espanol

Treatment Locator

SAMHSA’s National Helpline

Toll-free: 1–800–662–HELP (1–800–662–4357) (24/7/365 

Treatment Referral Information Service in English and español)

TTY: 1–800–487–4889

Website: https://www.samhsa.gov/find-help/national-helpline

*Note: The views, opinions, and content expressed in this publication 

do not necessarily reflect the views, opinions, or policies of the Center 

for Mental Health Services (CMHS), the Substance Abuse and Mental 

Health Services Administration (SAMHSA), or the U.S. Department of 

Health and Human Services (HHS).