Compassion Fatigue as a Threat to Ethical Practice: Identification, Personal and Workplace Prevention/Management Strategies

C ynthia works in a 350-bed community hospital on a medical-surgical unit, with specialties in orthopedics and nephrology. Her typical assignment is 6-7 patients; some of her patients are transferred from the trauma unit and some are receiving dialysis, awaiting a kidney transplant at an affiliated tertiary hospital. She is working her sixth 12-hour shift because several staff are on medical leave and she needs to supplement her income as she cares for her aging father and raises two grandchildren. She has been a nurse for 7 years and always has loved caring for her patients. However, since two events 3 weeks ago, she finds herself having trouble sleeping, feels exhausted and sad, has flashbacks to the events, and has caught two possible medication errors this week at the last minute. Both events involved patients of whom she was very fond whose condition deteriorated; she believes she should have recognized this and called the rapid-response team. Both patients died. No amount of reassurance from her manager, colleagues, or hospitalist physician has helped relieve her guilt. She finds herself avoiding contact with suffering patients and no longer refers to patients by name, but states the patient’s diagnosis.