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Nurses need to put compassion into action for themselves — and here’s how they can do it

A veteran nurse shares her experience dealing with burnout

By Terry Webber
April 25, 2022
Courtesy of Terry Webber
“When practice standards near and dear to nurses meet heavy workloads and patient suffering, it is only natural that caring hearts grow weary. COVID added enormous pressure to this already chronic wound,” Terry Webber says.

Tiny crayfish scoot across the sandy beach after being tossed to shore by the receding tide. Sitting on the edge of the shimmering water, I watch them, hundreds it seems, each knowing exactly what they need to do before they are taken back to sea. I am grateful that they do not need any support from me.

We are three days into our vacation when it feels as if I am entering a tide of my own — unlike the one I had been in for the last two years since COVID-19 arrived. The pandemic has dominated my caregiving, and my husband had to use wild horses to drag me away.

I finally feel able to write this article, where I can share my experience with burnout. I describe it in detail, so that you can identify the symptoms in yourself. And I offer solutions that I hope can help.

Two-year marathon of caring

It has been a two-year marathon of caring for others, with more people preferring end-of-life care at home, their families needing extra support for a road not travelled before. When my own family needed urgent care, I was grateful to be the nurse in the family circle. Others in the community seemed to gravitate toward me and it felt natural to put compassion into action. It was not until torrents of tragedy befell my neighbours, just beyond my reach, that I noticed my own exhaustion. I felt as if I just could not keep up with all the calls to action I had heard.

I suggest that nurses put compassion into action for themselves too.

Some call it compassion fatigue, or burnout. Call it what you will. But for a nurse who has been on call, who has repeatedly answered the call and adapted to continually changing circumstances, it is a dance that is impossible to keep up with. The caring becomes all-consuming and can bring unhealthy consequences, no matter how resilient we think we are.

When caring hearts grow weary

This is not a new phenomenon; I had experienced it before during my 44-year nursing career. When practice standards near and dear to nurses meet heavy workloads and patient suffering, it is only natural that caring hearts grow weary. COVID added enormous pressure to this already chronic wound. This is not just a pan-Canadian issue; nurses around the world felt it too.

Burnout is a condition known to caregiving professionals and family members alike. It is an unwanted side effect from caring for others without stopping to care for oneself. Caring for others uses the physical, the intellectual and the relational bits of ourselves — more so in some fields because of the nature of care required, such as the palliative care field.

The look of dying is not always kind. Seldom linear and often bumpy, the journey can be muddy and messy, mocking the beauty that lies within the process. One repeatedly bears witness to the person gaining vulnerability and losing their appearance, functions and abilities, having to constantly redefine what “quality of living” means to them along the twisty path. Acknowledging and responding to the ebb and flow of the final moments as a midwife for the dying is both rewarding and exhausting.

Checklist of compassion fatigue symptoms

I run down this mental checklist of some of the symptoms of compassion fatigue as part of my self-assessment:

  • Physical changes, such as fatigue, exhaustion, sleeplessness, muscle pain, bouts of illness, weight loss or gain
  • Thoughts such as cynicism or disillusionment with an inadequate system, difficulty concentrating or intellectualizing a situation without acknowledging the human feeling factor
  • Feelings of anxiety, nervousness, irritability, anger, depression, helplessness, guilt and mood swings
  • Changes in behaviours, such as social withdrawal, difficulty with relating to others
  • Loss of faith and/or hope

The years of living and working during the COVID pandemic have had a cumulative effect, making this checklist resonate with me more than I cared to admit. I had seen other symptoms in those I cherished — the coping that involved increased consumption of alcohol or over-the-counter, prescription and illicit drugs.

What to do?

Our inner steward tells us to put the oxygen mask on first before putting it on others. It’s called caring for self and then caring for others. Some suggest developing resiliency to enable the ability to bounce back from adversities. I suggest that nurses put compassion into action for themselves too.

I think about what has helped me stay focused in the past:

  • I take deep breaths and a new awareness emerges, usually signalling what my body needs, be it physical, mental, emotional or spiritual in nature.
  • I acknowledge that I am human too, with loss and grief being a part of the dance that exists in nursing — a dance that I cannot control for my patients and their families or for the situation surrounding them, but one that I can control for myself.
  • I stay centred on the patients and families who are under my care that day, and then I focus on the system in which I work, where it is my responsibility to use my voice to eliminate the barriers that prevent me from remaining centred on the principles of care.
  • I grieve the losses, human and other, as part of my healing. I recognize that I am doing my best, often in an imperfect situation. I reframe events by thinking about the smiles and words of thanks that have come from the smallest and greatest acts of care I have provided. I give gratitude for those whose support enabled nurses to move through difficult situations.
  • I talk with others. Much like grief, a stress expressed to a trusted colleague is a stress diminished. Insights can be gained from others on different ways of coping.
  • I learn from others. Recently, fellow nurse Perry said just the words I needed for my first assignment in caring for a patient having the medical assistance in dying (MAID) procedure that day. Her statement, “It takes a lot of guts to be a nurse,” told me exactly what I needed to do. Today, courage would lead the way. The rest — the compassion, the skills and the knowledge embedded within — would come “PRN” (as needed).
  • I learn from patients who have shared their wisdom, making me a better person and nurse. A man who lives with numerous life-limiting disabilities gave me this mantra for living: “Do the best you can with what you have.”
  • Sometimes I say “no” to “just one more” shift of care, before I become the patient too. Self-care should not wait until a crisis of self happens. Regular practice is key.

Self-healing is an incremental process

The way back is different for each one of us. For me, it happened in small increments this time, not a “bouncing back,” as resiliency suggests. I found rest wherever my eyes needed closing. I found marvel as three herons skimmed the crest of the frothy waves, their wings outstretched in perfect alignment with each other, the red sun exploding behind them as it tipped goodbye to another glorious day. I found peace in the open chapel with a background chorus of blackbirds and ocean waves lulling me. I found hope and joy, my final needs for renewed wellness, amongst the happy children splashing around me.

Another nurse is lounging by the pool today; she has just arrived from Toronto. It feels good to share what brings us here. Her calling came in later years, and she is caring now for the elderly, her roles made daunting by COVID. We end our chat by agreeing that what matters most to the patient is often more about the kindness than the pills that we bring. Although she speaks of love for what she does, I see her doe-like but tired eyes. Just rest here, dear sister. Take care of yourself first.

Tomorrow, we leave for home. Will I be better? I will be better than when I came. But I will require ongoing maintenance.

I will be back better to answer the call to others, but, first, I must post a sign, “To give care, one must learn to take care,” in a place more visible so that I won’t forget again.

Terry Webber, RN, BSPN, is a shift care nurse providing end-of-life care for people in their homes. She is employed by Evergreen Nursing Services, which is affiliated with Vancouver Coastal Health Authority in B.C. She was formerly a registered psychiatric nurse and a CNA-certified nurse in hospice palliative care. Terry is also a 2014 recipient of the College of Registered Nurses of British Columbia’s Nursing Excellence Award in clinical practice.