Florence was sitting in her car staring blankly at the windshield in front of her, she could hardly remember if she had eaten lunch… or breakfast for that matter. Her bladder was full as she had been preoccupied with her caseload driving from location to location, her lips were dry, her mind wandering off about the calls she had to make. As she began to be aware of the present moment, her shoulders were heavy, her eyelids were fighting to stay open, she felt sluggish and exhausted.
She reached into her bag and begrudgingly slapped on a surgical mask. Taking a deep breath, while her glasses got foggy she muttered “ just four more hours to go” as her train of thought was interrupted by a phone call.
Florence was often self-reliant, competent in her devotion to the welfare of those committed to her care, compassionate and attentive, she would never think of neglecting those entrusted in her hands… however, she was neglecting someone who she truly could not function without…herself.
Most of us are like Florence, devoted to our patients, our careers, our families, our practice.
I cannot stress enough the importance of a simple and genuine expression of gratitude to our colleagues, and those we supervise.
While the rest of the world, as isolating and depressing as it can be, has the option to quarantine and maintain social distance at home; Florence and the rest of the nurses, social workers, doctors, nurses’ aides, physician assistants, nurse practitioners, pharmacy workers, medical transportation workers among countless other health care professionals in our field, are bravely answering the calling.
“I’m becoming that grouchy nurse nobody likes,” Florence thought to herself. Even Florence’s cat didn’t want to be around her. Her heavy workload, excessive demands from patients, and long work hours were beginning to take a toll on her. Florence began to think back on the last several days. She then realized that she was beginning to exhibit symptoms of compassion fatigue: chronic physical and emotional exhaustion, depersonalization, irritability, feelings of inequity, difficulty sleeping, weight-loss, headaches, and poor job satisfaction.
(credit due to Jamanetwork for the original article on compassion fatigue https://jamanetwork.com/journals/jama/fullarticle/2764380)
leadership steps in
Luckily for Florence, the leadership in her organization wrote this article and are empathetic to her plight. They took steps to help her
She was encouraged to ask for help when needed. She felt validated and empowered to defer less important and less time-sensitive activities to the office to lighten her load. Her Clinical Director ensured that Florence did not feel she had to make difficult decisions alone. There was always someone to support her and collaborate with her.
There are five steps an organization and leadership can take to help with compassion fatigue.
Hear me: Listen to and act on health care professionals’ expert perspective and frontline experience and understand and address their concerns to the extent that organizations and leaders are able
Concerns: Uncertainty whether leaders recognize the most pressing concerns of frontline health care professionals and whether local physician expertise regarding infection control, critical care, emergency medicine, and mental health is being appropriately harnessed to develop organization-specific responses
Key Components of Response: Create an array of input and feedback channels (listening groups, email suggestion box, town halls, leaders visiting hospital units) and make certain that the voice of healthcare professionals is part of the decision-making process
Protect me Reduce the risk of health care professionals acquiring the infection and/or being a portal of transmission to family members
Concern about access to appropriate personal protective equipment, taking home infection to family members, and not having rapid access to testing through occupational health if needed
Provide adequate personal protective equipment, rapid access to occupational health with efficient evaluation and testing if symptoms warrant, information and resources to avoid taking the infection home to family members, and accommodation to health care professionals at high risk because of age or health conditions
Prepare me Provide the training and support that allows provision of high-quality care to patients
Concern about not being able to provide competent nursing/medical care if deployed to new area (eg, all nurses will have to be intensive care unit nurses) and about rapidly changing information/communication challenges
Provide rapid training to support a basic, critical knowledge base and appropriate backup and access to experts Clear and unambiguous communication must acknowledge that everyone is experiencing novel challenges and decisions, everyone needs to rely on each other in this time, individuals should ask for help when they need it, no one needs to make difficult decisions alone, and we are all in this together
Support me Provide support that acknowledges human limitations in a time of extreme work hours, uncertainty, and intense exposure to critically ill patients
Need for support for personal and family needs as work hours and demands increase and schools and daycare closures occur
Provide support for physical needs, including access to healthy meals and hydration while working, lodging for individuals on rapid-cycle shifts who do not live in close proximity to the hospital, transportation assistance for sleep-deprived workers, and assistance with other tasks, and provide support for childcare needs
Provide support for emotional and psychological needs
for all, including psychological first aid deployed via webinars and delivered directly to each unit (topics may include dealing with anxiety and insomnia, practicing self-care, supporting each other, and support for moral distress), and provide individual support for those with greater distress
Care for me Provide holistic support for the individual and their family should they need to be quarantined
The uncertainty that the organization will support/take care of personal or family needs if the health care professional develops infection
Provide lodging support for individuals living apart from their families, support for tangible needs (eg, food, childcare), check-ins and emotional support, and paid time off if quarantine is necessary
Next time you see a Florence… please say “Thank you”
This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.