My Experience with Compassion Fatigue Occupational Therapy

Compassion Fatigue Featured

Compassion fatigue (CF) is a condition that occupational therapy students or occupational therapists may experience.

“CF is characterized by exhaustion, anger and irritability, negative coping behaviours including alcohol and drug abuse, reduced ability to feel sympathy and empathy, a diminished sense of enjoyment or satisfaction with work, increased absenteeism, and an impaired ability to make decisions and care for patients and/or clients.”

It is related to burnout, which many of you may be aware of. Compassion fatigue can have adverse effects not only on the OT, but also the client/patient. OTs experiencing CF may lack compassion and empathy for their clients, leading to decreased quality of care.

In reflecting on my new grad experiencing working in acute rehab and acute care, I have experienced some CF myself. There were times when I felt like I was “going through the motions” – especially with clients who had a longer length of stay. Would the outcome be different if I did not have CF for these clients? Perhaps.

Although CF is usually experienced by the OT (individual), it can also be a larger group consisting of allied health professionals — physical therapists, speech therapists, nurses, doctors, etc. How can this be? As CF is related to burnout, which is not only an individual’s problem. CF and burnout can be a systematic problem in a unit, office, clinic, hospital, or community.

I believe the cause of CF has multiple contributing factors: environment, experience, work culture, client population, and personal life events/factors.

Environment

The healthcare environment can be very stressful. Despite our best intentions, when we are exposed to stress, we may not be operating at our best. This can lead to decreased compassion and empathy. With COVID-19, the healthcare environment for some OTs has magnified in stress since it’s exposure to the US healthcare system and community. As COVID-19 becomes better managed with research, vaccines, testing, and education we all collectively should hopefully have a less stressful environment.

Experience

OT students and New grad OTs lack clinical experience by nature of their newness to the profession. Many may even feel imposter syndromewhich I believe can be related to CF due to factors such as stress, overachieving, dissatisfaction, and distorted perception of success and achievements. As OTS and OTs gain experience and find ways to cope and manage their imposture syndrome, this may help to reduce CF.

Work Culture

Recent popularity in the controversial topic of “grind” and “hustle” culture has lead to many in the healthcare to become overworked. For example, some nurses may work back to back shift and moonlight different jobs. OTs may take on added stress leading to CF from taking on multiple PRN jobs. The work culture itself may lead to symptoms of CF – high productivity, a mean boss, other allied health professionals being “over it”, and low overall morale in the work setting. As these causes are known, they can be addressed systematically, however execution may not be as easy — upper management, fear of speaking up, high turnover, low budget, lack of understanding of employee rights may be some barriers. As a new grad OT, one way to overcome this is to change jobs…or speak to management and hope for an improvement in these areas.

Client Population

Client population is more static and less easily to be addressed. How can this contribute to CF? For example, a med surg unit in a hospital that regularly admits homeless patients hoping to “get a free ride” can easily lead to CF. This is a community systematic issue and many bigger cities have been unable to solve the “homeless problem”. Don’t get me wrong, many homeless patients need the care, but allied health professionals who frequently see this patient population may mistakenly assume the worse, leading to CF.

While in settings such as hospitals don’t get much a say in who gets admitted, other settings may be able to. In some settings, the client population may have the ability to “change things up” such as in clinics, private practice, even SNFs. However, as we all known, SNFs are likely motivated by profits and this would be counterproductive to their bottom line. If you are suspecting that you are experiencing CF due to a particular client population, unfortunately, the easiest way to address this is to change jobs, in my opinion.

Personal Life Events and Factors

Personally, I would attribute my experience with CF to issues going on in my personal life. Things were not going smoothly in my relationship, I lacked the support of family due to the need to isolate for COVID-19, I stopped going to the gym to “blow off steam” due to COVID-19, my knee pain came back, my bank account was getting low, I was not eating as healthy, and other issues I cannot recall. These personal life factors combined together and likely compounded my CF. I went to work, but instead of focusing on my clients, I was perseverating on my life instead of giving my 100% attention as much as I could have.

Do you think you have experienced this?

I noticed a dramatic improvement in my CF after the most stressful of my personal life factors were addressed. I was happier going to work, engaging my clients more, and “caring more” — speaking up in meetings, advocating, being more proactive, and putting in the extra effort. As we are human, we cannot simply go to work and turn off these thoughts and worries with a “flick of a switch”.

Sometimes, we just need to take a mental health day, take time to ourselves, or have those difficult conversations with our significant others and family about relationships, work-life balance, finances, goals, or whatever is on our minds.

Our clients put their trust in us as healthcare professionals. They need us. The time that they spend in rehabilitation or therapy is time they can never get back. If OTs do not address their CF first, their actions can have long-term consequences on clients — decreased function, plateau, lack of support, and resources that may lead to harm or re-hospitalization.

We talk a lot at work about our clients, small-talk, what we had for lunch, where we went on vacation, but I think we need to have more conversations regarding CF and burnout. We show so much compassion and care for our clients. We should do the same for our colleagues and live by what we have been preaching with “we rise by lifting others.”

Others = co-workers and the OT community.


Sources:

Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review