I'm not aware of the descriptive data about compassion fatigue occurring to nurses.  How is it different from burnout?  How can compassion fatigue be culled out from other factors contributing to why nurses leave their places of employment?

One of the issues in nursing education and nursing orientation is the volume of information that is required to be taught to student nurses and newly hired nurses.  In order to be added to any curriculum a concept or procedure needs to be well developed and significant to the care of patients and the lives of nurses.

Compassion fatigue may be one of those concepts but it needs to be well established as a significant factor.

I think that nurses need to be taught strategies for stress resiliency and coping, rather than framing it in the negative.  We need to prepare a work force that can take care of itself and create work environments that are structured in such a way that nurses are able to create healthy, engaged and well-rounded lives.  

There is no need to create competencies around compassion fatigue- nurses will discover that for themselves soon enough if they aren't given tools to prevent it! 

I do believe it is important to also let nurses know what they might be at risk for in terms of the ethical impact of their work. The construct of moral distress has been researched and covered extensively in the literature. I absolutely agree that this should be presented in a realistic and positive way as an opportunity for growth and reflection. Compassion fatigue does not have the same research base for nursing.

Maintaining  Professional boundaries has always served me and the students I've taught both medical students and nursing students a like. At SC I teach medical students but also do a considerable amount of nursing education.  The minute a clinician steps over the boundary and becomes excessively emotionally entangled with a patient or family, one enters the dangerous realm of "friend".  This is unacceptable.  Under the concept of professionalism maintaining appropriate boundaries must always be the goal of the nurse.

Theoretically, I can appreciate the authors intentions.

As a nurse of 24 years, and having worked in areas from Pediatric ICU to Public Heath, Parish Nursing to Oncology , Pediatric Recovery Room to Hospice, and currently a Clinical Coordinator of a Hospice Program, I've not only experienced Compassion Fatigue, but taught also a course on how to recognize and address caring for oneself in order to help minimize and cope with the situation.  I agree that it may not be a competency that can or should be created in Nursing Education, but I feel that so many nurses don't realize that not only can they be effected by compassion fatigue, if they don't understand what it is, they cannot be expected to learn how to cope with it.  I believe that educating nurses on the concept and reality that one may experience it, can certainly help them recognize it earlier and then address it before it leads them to leaving thier profession prematurely.  As someone who experienced it early in her nursing career and didn't understand at the time what was happening, without those could recognize or teach me how to cope with it, I may left nursing long ago...

Thanks Marv for raising this very important question. First, I would like to say that, like Koby, I have experienced this in my career, probably more than once. So my personal experience suggests that it is a real issue and a real problem for nurses, as well as other health professionals. 

Looking at the literature, this phenomenon has different names, though I suspect they are either the same or very similar:

• Burnout: emotional exhaustion, demoralization, depression;
• Compassion fatigue: suppressed emotions, dysfunctional coping behaviours like drinking or overspending, fatigue and disengagement;
• Vicarious (or secondary) trauma: posttraumatic stress reactions and disorders resulting from exposure to the suffering of others. 

The work of Figley and Hilfiker is worth exploring to gain an understanding of this phenomenon. There is also an emerging research literature on specific groups, like nurses. There is evidence that student nurses begin to experience some of these features, though the student role itself may provide some protection (Michalec et al 2013). Providing education on compassion fatigue, and resources to prevent it, could help nurses (and other professionals) deal with this before it becomes a problem. 

Before we can doing anything about preventing it, we need to understand the nature of the problem. Health care is stressful. It involves a degree of interpersonal closeness and investment of self that is not present in most other occupational groups. This has been described as 'emotional labour', and it has the capacity to be both rewarding and stressful. 

Compassion satisfaction has been identified as a positive benefit of working with people, and this seems to have a protective effect. There is a very useful assessment tool for professionals to measure their own levels of compassion satisfaction, burnout and secondary trauma, and there is open access to this: 

http://www.proqol.org/ProQol_Test.html

So, we must be aware that the work of health professionals is potentially very stressful but also rewarding. How to achieve the right balance, in favour of satisfaction and reward and away from burnout and trauma, is the challenge that we face. Resilience is a very useful concept to help us to support and develop students. I agree with Donna that educating students about resilience, and developing strategies for resilience, is an important part of professional education. Useful strategies include: building positive nurturing relationships, seeing positive benefits in adversity, developing emotional insight and becoming more reflective (Jackson et al 2007). It is also important to note that trauma does not always result in stress or disorder; it can also result in personal growth (Roberts 2013). 

Jackson, D et al (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. Journal of Advanced Nursing, 60(1), 1-9

Michalec, B et al (2013) The calm before the storm? Burnout and compassion fatigue among undergraduate nursing students. Nurse Education Today, 33, 314–320.

Roberts, D (2013) Psychosocial Nursing Care. A Guide to Nursing the Whole Person. Maidenhead: Open University Press.

There are so many misconceptions about what compassion is and how it is applied in the nurses' work. What we need to do is to teach COMPASSION from an informed and evidenced base rather than to teach 'compassion fatigue' which I believe it to be a misconceived  label which has become fashionable as a dumping ground for all the stresses of nursing. In fact, there is a lot of stress involved when nurses encounter barriers to giving compassion,  which is the essence of nursing and which can be a source for personal growth and job satisfaction rather than fatigue. In the last two years I have been conducting research on various aspects of compassion such as its meaning, the way we learn to give and receive compassion, how much of this is done in nursing education in different countries, how compassion is featured in key textbooks used in nursing education, whether nurses are given compassion in practice and by whom, and whether compassion can /should be measured in nursing practice. I am soon to deliver a free, 3 three week MOOC on culturally competent compassion which starts on the 20th October 2014, so please join me and 300 hundred other people from 28 different countries to discuss and co-create knowledge about compassion. To enrol, please click on the link below and scroll down the webpage until you find the badge of the course. Click on it and follow the instructions to enroll. Please pass this information to your friends and colleagues. Rena Papadopoulos

https://openeducation.blackboard.com/middlesexuniversity

YES!  More managers and and Hospital administration needs to educate themselves and support a program for their staff.  Compassion Fatigue is toxic and must be addressed.

On this subject, read the interesting book "The unconscious at work: individual and organizational stress in human services," A. Obholzer  & V. Roberts (Tavistock Clinic) 1994

I find this interesting. I definitely agree that bedside healthcare professionals esp nurses in a highly stressful environment (ie. ICU) need to take some sort of class to help cope with stress.  As I work in such environment, I find dealing with overly stressed parents who find themselves in end-of-life situations very hard to deal with especially when ethical issues are involved.

Indeed, well being of health care professionals is too often neglected in their academic training. In the literature, tools can be found to enhance affective functioning, stress response and general life satisfaction. Among which, mindfulness meditation practice seems to come out as a training that empowers participants in their attempts to adapt functionally to everyday challenges. Among others, the article from Beddoe & Murphy (2004; Journal of Nursing Education), supports the introduction of such trainings within nursing education by showing that nursing students were better able to regulate their affective state while witnessing another's negative emotion (less personal distress; IRI) after a mindfulness training program (MBSR).

Yes I think nursing education can do more to support nursing students and build emotional resilience prelicensure. To be effective on the job, nurses must be able to manage difficult and challenging workplace situations. However education cannot do it alone and post graduation the workplace must continue to assist and provide ongoing support and psychological help to all healthcare workers.

On our programs of education of  pre registration nurses ( I work in a university that educates 500 pre reg nurses per year)  we have a number of interventions aimed at educating students about stress and coping, the costs of emotional labour ( Pam Smith's work), developing support mechanisms including personal experience of clinical supervision, recognising burnout and then in as they reach their final year developing resilient organisations that support staff, so it is certainly on the agenda of nurse training, however it needs to remain a priority of employers to support practicing nurses in the same way

I recomend you the research of Cicely Saunders her concept of spirituality in caregiving is maybe a way to transmit compassion fatigue awareness. 

Regular clinical supervision can be very helpful in the prevention of compassion fatigue. If nurses are to remain compassionate they need to feel cared for themselves. See Ballett, J and Campling, P (2011) Intelligent Kindness: Reforming the culture of healthcare. London: RCPsych  Publications.

Also termed “vicarious traumatization” or "secondary traumatization" (Figley, 1995).

Yes, compassion fatigue awareness should be taught to all healthcare providers as part of their training.

Very important issue raised by you. Strong recommend that compassion fatigue awareness be taught to all healthcare providers as part of their training.