Self-Care for Oncology Nurses When Dealing With Compassion Fatigue

Jeannie Wirth, MSN, RN, CNS, AOCN

As part of our coverage of the Oncology Nursing Society (ONS) 41st Annual Congress held April 28 to May 1 in San Antonio, Texas, today we are speaking with Jeannie Wirth, MSN, RN, CNS, AOCN, an oncology clinical nurse specialist. At this year’s meeting, Ms. Wirth will be participating in a session discussing compassion fatigue and self-care for oncology nurses.

 -Interviewed by Leah Lawrence 

Cancer Network: Thank you for speaking with us today. Ms. Wirth, you are participating in a session discussing self-care for oncology nurses. What are some of the unique challenges faced by oncology nurses with regards to stress or burnout?

Jeannie Wirth: Overall from the literature I reviewed, as well as from my personal experience, empathy and caring are at the foundation of what oncology nursing are all about. It is just our way of being. We will regularly see patients and families that are experiencing a lot of physical, psychosocial, or spiritual distress. We are intimately involved in the care of these patients, and we develop close relationships with patients and families. We have repeated exposure to patients and families and distress. The irony of this is that the compassion and empathy that are at the very core of the ability to do the work that we do is also the compassion and empathy that are at the core of our ability to be wounded by that work.

One of the things that I found in my reading is from Boyle’s book on compassion fatigue. She quoted from Kitchen Table Wisdom: Stories That Heal-“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet and this sort of denial is no small matter.”

Cancer Network: In your presentation you will specifically discuss compassion fatigue. Can you expand on the definition of what that is?

Jeannie Wirth: One of the first things that I want to do is recognize that there is a difference between burnout and compassion fatigue. Burnout really arises from the external environment in which we work. It is related to the question, are we able to be a great oncology nurse because of those external things? On the other hand, compassion fatigue happens whenever we see patients and families that are hurting and we find that we can’t relieve this hurt. It leads to feelings of guilt within ourselves and feelings of not being able to do our job as we see it.

Figley, in 1995, described compassion fatigue as a type of post-traumatic stress disorder in which nurses develop a secondary trauma by becoming affected during repeated care of patients that are experiencing some kind of traumatic event. There is strong evidence that oncology nurses experience compassion fatigue on a regular basis.

Cancer Network: Why is it important for nurses to also be able to provide effective self-care?

Jeannie Wirth: Nurses are able to provide self-care to themselves and that is important because compassion fatigue can really have negative physical, psychosocial, and spiritual effects. Compassion fatigue has been found to have a negative effect on healthcare institutions. Leiter et al in 1998 actually found an inverse correlation between nurses who felt exhausted or frequently felt the desire to quit and patient evaluations of their quality of care. It is really critical for those healthcare systems in which we work to develop some type of strategy to retain and nurture oncology nurses, and this in turn will improve patient satisfaction scores as well as reduce healthcare expenses related to staff turnover.

The final thing that I would want to point out is that our AMA code of ethics actually talks about the fact that nurses owe themselves the same duty for care for self as we do for care of others. We have a professional responsibility to try to really take care of ourselves and decrease compassion fatigue.

Cancer Network: What are some examples of self-care activities or strategies for nurses?

Jeannie Wirth: They can run the gambit. One of the important things for us to remember is that self-care activities to relieve compassion fatigue are much more than taking a warm bath with burning candles. First of all, I think it is important to remember why we became oncology nurses to begin with. Another point is that we have to acknowledge our rate of developing compassion fatigue. A lot of nurses talk about compassion fatigue, but it is everybody else who is experiencing it, not themselves.

I found that you need to identify what would work best for you. Each of us is different. Self-care interventions can be related to the physical body, such as exercise or walking, or taking aerobics or a Zumba class. It can be related to our social being, like going to a party or having coffee with a friend. It could be related to our psychological self or our spiritual self. The thing with self-care interventions that we need to remember is that we need to do them with intention and mindfulness. This means that whenever we are performing whatever our self-care intervention is, we need to think to ourselves, or maybe even say out loud, “I am doing this activity to help relieve my compassion fatigue.” We need to build our own resilience. Most of us say how much we learn from our patients; I think one of the biggest things we learn from our patients is about how to be resilient.

Cancer Network: Outside of self-care, where else can nurses turn for support?

Jeannie Wirth: We need to turn to each other. We need to mentor and support each other. We need to be the most kind to each other that we can possibly be. If we are not kind to each other, how can we be kind and caring toward patients and families? Our support of each other is most important for nurses.

Cancer Network: What is one thing you would recommend as a sort of daily mantra or strategy when it comes to coping with compassion fatigue?

Jeannie Wirth: My own daily mantra is that I must provide oil for my own lamp or soon I will find that I can’t burn very brightly for the patients and families for whom I am caring for. That is my daily mantra.

Cancer Network: Thank you again for taking a few minutes to speak with us about compassion fatigue and self-care for oncology nurses.