ACompassion fatigue is a phenomenon that encompasses burnout and secondary traumatic stress. Burnout is the experience of feeling perpetually emotionally exhausted, a loss of personal identity, and decreased sense of accomplishment at work. Secondary, or vicarious, trauma is the stress a person experiences when hearing another person describe their traumatic events. Neuroimaging has demonstrated that our brain’s pain networks are activated when we empathize with another’s experience of pain. “I feel your pain” is more than a platitude, and it can be debilitating for healthcare workers who routinely treat traumatized patients.

What are the signs of compassion fatigue?

Irritability, exhaustion, problems sleeping, ruminating thoughts about the suffering of others, cynicism, avoidance, numbness, apathy, a sense of being detached, and a loss of joy in your work are all signs of compassion fatigue. These symptoms impact the physical and mental health of healthcare workers and also diminish the quality of care they deliver. At the aggregate level, compassion fatigue can lead to poor patient outcomes, absenteeism, and workers leaving the field. This is tragic, as we desperately need this talented and empathic workforce caring for the sick in our communities.

How has COVID-19 affected healthcare workers’ compassion fatigue?

COVID-19 has placed a tremendous strain on a workforce already at risk for burnout. Even prior to COVID-19, I would have said clinician well-being should be our number one healthcare priority, as the rates of burnout, emotional exhaustion, depression, and suicide among healthcare workers were already staggering. Now, these rates are even higher. This is a crisis, as the healthcare system will fall apart without a workforce that is physically, emotionally, and spiritually healthy.

Making matters worse is the fact that the U.S. is also in the midst of a mental health crisis. Prior to the pandemic, life expectancy of Americans had declined due to so-called deaths of despair. Suicide, overdose, and liver failure contributed to the untimely deaths of hundreds of thousands over the past decade. U.S. Surgeon General Vivek Murthy, MD, identified an epidemic of loneliness as the primary driver for most debilitating health conditions in our nation. 

Quarantining and other efforts to reduce the spread of COVID-19 by isolating have exacerbated loneliness, adding fuel to the mental health fire. Rates of severe psychological distress and substance abuse reached 40% nationwide in 2020, and rates of drug overdose increased by 30%. Not a week goes by where I do not hear from multiple patients of the devastating deaths of loved ones. This takes its toll and is difficult to process emotionally, particularly in the context of healthcare worker shortages and the other administrative challenges of healthcare delivery.

So, not only are healthcare workers dealing with hospitals that are overrun with COVID-19 cases and understaffed due to workers who are quarantined or have quit, but they are also facing the unintended psychological consequences of our strategies to mitigate viral transmission.

What can be done to help?

Both individual and system-level strategies need to be prioritized. On an individual level, recognizing the importance of self-care, balance, and boundaries is crucial. In healthcare, we tend to fall prey to the mystique of the healthcare superhero, completely altruistic and ready to serve. But we are mortal and have limits. Rest, a healthy diet, exercise, and spending time doing non-work-related activities are essential. Peer support and mentorship are also extremely valuable. A sense that we are not alone in our battles and acknowledging our distress to another can be very therapeutic.

At a system level, there need to be mechanisms in place to identify workers who are in distress and provisions in place to get them the help they need. In addition, the healthcare workplace and processes need to be creatively reimagined such that team-based practice is the norm, provider autonomy and flexibility are facilitated, and time is provided for self-care.

James H. Berry, DO, is chair of the department of behavioral medicine and psychiatry and director of addiction services at West Virginia University in Morgantown. +Email: [email protected]