Compassion Fatigue, Burnout Leads to High Nursing Turnover

When oncology nurses experience compassion fatigue, the consequences can be dire: from nurses leaving their place of employment, to implications for healthcare institutions, and — most importantly – decreased quality of patient care. A recent study published in the Clinical Journal of Oncology Nursing examined the relationship between compassion fatigue and nurse turnover.

“Compassion fatigue is a growing area of concern for healthcare organizations. Nurses are among the most trusted of professionals among the general population, and it’s crucial that we advocate for nurse well-being so that nurses may continue to deliver optimal care for patients,” Diana Wells-English, DNP, FNP-BC, investigator on the study and nurse at HCA Healthcare, said in an interview with Oncology Nursing News.

From the Data: Compassion Fatigue Associated with Turnover

The researchers used surveys to collect data from 93 nurses at a 90-bed urban cancer center. Using the Professional Quality of Life — Version 5 scale and the Turnover Intention Scale – 6, they measured compassion satisfaction, compassion fatigue, and turnover intention.

Compassion fatigue and burnout were found to be strong indicators of nurse turnover.

“Oncology nurses offer support to families coping with emotionally and physically burdensome illnesses and are consistently exposed to a variety of stressors, often participating in decision making in ethically complex situations. Other contributing factors may be environmental stressors such as high nurse to patient ratios and short staffing. More research is needed to further look at the contributors to compassion fatigue,” Wells-English said.

The majority of participants (n=85) were female; 79 worked full-time, 2 worked part-time, and 12 worked per-diem. When it came to their specialty, 29 worked in hematology, 26 in medical oncology, 19 in gynecology, and 19 in thoracic oncology.

About half (n=47) of survey respondents had average levels of satisfaction, while 45 had high levels of satisfaction, and 1 had a low level of satisfaction. Fifty-six nurses had low levels of secondary traumatic stress, 37 reported average levels, and none had high levels.

For burnout, 38 had low levels, 55 had average, and none had high levels of burnout.

“Nurses with higher burnout were more likely to leave their place of employment, whereas, nurses who had more positive feelings about their helping role were less likely to leave their place of employment,” she said.

Burnout Affects Patient Care

Additionally, high levels of compassion fatigue can end up impacting patient care when the nurses are still at their place of employment, too.

“Nurses who are experiencing high levels of compassion fatigue often struggle to show high levels of empathy- which is important in the field of oncology as these patients are undergoing some of the most difficult moments of their lives. Decreased empathy overall reduces the impact of nursing care. Additionally, compassion fatigue has been associated with medical errors. Nurses experiencing compassion fatigue have also been reported as having low patient safety standards and productivity in the workplace,” Wells-English said.

What Can Be Done

Wells-English said that there are steps that nurses can take to help prevent or mitigate compassion fatigue and increase resiliency. They include:

• Finding a mentor or seeking counseling
• Openly expressing emotions
• Practice a self-care assessment
• Getting enough sleep and exercise
• Talking with coworkers after a difficult encounter
• Practicing mindfulness

Moving forward, more studies need to be done on nursing compassion fatigue, and more practices should be implemented to prevent it.

“Compassion fatigue is a dynamic concept with many facets. Each nurse specialty has unique characteristics that may play a role,” Wells-English said. “Our study only looked at oncology nurses. However, compassion fatigue has been evaluated in many specialties and is increasing being recognized as an issue in healthcare. Future research is needed to determine the many contributors to compassion fatigue and interventions to combat it.”