Anaheim, CA—Compassion fatigue is a unique response to caregiving professions, and is a natural and normal consequence of caring for patients who are suffering or traumatized, according to Susan B. Childress, MN, RN, OCN, Director of Nursing Services, Huntsman Cancer Institute (HCI), Salt Lake City, UT.
Compassion fatigue can lead to deep physical and emotional exhaustion and can cause the inability to feel empathy for patients, loved ones, and colleagues. It often manifests through increased cynicism at work and the loss of enjoyment of one’s career and can result in uncivil communication in the workplace. In addition, compassion fatigue can have a significant impact on an organization’s bottom line, as it affects the financial and quality aspects of care (ie, increased absenteeism/turnover, decreased productivity/quality), as well as patient experience (ie, decreased satisfaction, safety issues, and lower trust), she said.
Ms Childress and her colleagues at HCI identified compassion fatigue as an organizational issue in 2015, and their administration and leadership teams have prioritized creating a compassionate workplace for the past several years. At the Oncology Nursing Society (ONS) 44th Annual Congress, she discussed the experience of building a compassionate workplace at her own institution, and shared tips on how oncology nurses and other providers might do the same.
“I don’t think there’s one thing that is really going to address resiliency and compassion fatigue in your organization,” Ms Childress said. “It’s going to be multifaceted.”
Organizational Strategies for a Compassionate Workplace
As a first step, Ms Childress and her team formed an interdisciplinary committee and distributed surveys to identify their employees’ biggest stressors. High patient acuity, staffing issues, workload, lack of lunch breaks, poor communication, small workspaces, and patient deaths emerged as the major causes of stress. They followed up by asking employees what they thought might alleviate some of those stressors. Proposed self-care activities such as massage, exercise, yoga, meditation, and acupuncture were frequently cited in the survey results.
In 2016, after collecting and analyzing the data, they hired assistant managers and added 53 full-time equivalent positions to distribute the workload. They redesigned the staff lounge, added massage chairs, and increased wellness center offerings, including yoga classes at lunchtime. The following year, they were able to introduce even more building blocks of a compassionate workplace, such as restorative retreats, a wellness coordinator, massage therapists, a website redesign aimed at identifying resources for staff, and even a Starbucks Coffee.
They also partnered with the Schwartz Center to introduce Schwartz Rounds, a forum that helps caregivers process the difficult emotional and social issues they face in caring for patients and their families.
“This takes some effort, but it’s really made a huge difference,” Ms Childress noted.
Between 2015 and 2017, they saw an 8.5% improvement in employee satisfaction (from 42.3% to 50.8%), based on staff agreement with the statement: “My organization helps me deal with stress and burnout.” A resiliency training program has significantly decreased turnover in the residency program at HCI, and they have also noticed a downward trend in registered nurse turnover.
Addressing Lack of Communication
But in March 2017, after their second year of working toward building a compassionate workplace, they received staff feedback identifying an area in need of improvement—civil communication. In response, they developed a communication plan—starting from the top down—by offering communication classes for directors and managers.
They insisted on professional behaviors, set up an incident reporting system that allowed staff to report any behavioral issues, and put a process in place to rapidly address those issues.
“And then we held people accountable, whether they were a physician, a frontline staff member, or even a patient or family member,” Ms Childress said. “We do not ignore [incident reports]. We follow up immediately. We do some training; we do some counseling; we do what we need to do so staff know how important it is to be respectful.”
Maintaining a Compassionate Workplace: 2019 and Beyond
Ms Childress and her colleagues have maintained a compassionate environment by focusing monthly on a different PROMISE (Patient-Centered, Respect, Ownership, Making a Difference, Innovation, Safety, and Excellence) Standard. They have also created a website that offers their managers tools to use for communicating with staff, and they now interview prospective employees for civility. They have hardwired civil communication into employee orientation and continue to integrate it into manager orientation.
They use an incident reporting system to identify incivility among staff providers, patients, and visitors, and through a behavioral emergency response team, they provide strong support to staff when they feel unsafe because of inappropriate behavior from patients or their families. They plan to retain their PROMISE Standard focus, to continue disseminating employee engagement surveys and assessing information from nursing focus groups, and “closing the loop” with staff who submit incident reports.
“And more than anything, we’re going to look at comments,” Ms Childress added. “I’m going to be sitting at home with my highlighter, with pages and pages of comments, trying to identify the themes. What are we doing right and what do we still need to pay attention to when we do our survey next fall?”