Two of the most widely accepted consequences in healthcare are compassion fatigue and burnout, with causes just as diverse as their negative effects.
Definitions of each may be complicated and conflicting, best left to qualified psychology professionals, but from a care provider’s point of view, narrowing down the basics can lead to some obvious and positive conclusions.
There are well-known consequences to compassion fatigue and burnout, such as high turnover, a decline in mental health and negative attitudes towards patients. In addition, the risk of poor communication and misjudgement leading to clinical errors, safety issues and professional compromise increases.
Maslach’s theory explains the progression through a series of steps, beginning with the emotional burnout that erodes our resources. In an attempt to alleviate this, we may distance ourselves from patients and colleagues by depersonalising thoughts and interactions. In doing so, we reduce feelings of personal accomplishment, sense of achievement and ultimately, self-esteem. Before we know it, physical, emotional and mental exhaustion can set in.
Compassion fatigue, arising from repetition and increasing contact with patients, compounds to replace any ability to nurture with cynicism and apathy. Negative emotional, cognitive, physical and social consequences will also lead us to experience exhaustion, anger, frustration, depression, sadness and feelings of inadequacy. By the time we add professional implications, reduced empathy, increased judgmental response and less overall joy in life, it becomes clear to see that a negative spiral can occur, gradually or suddenly, with every aspect further impacting on each other. In today’s climate of emergency prehospital care pressures, these are understandable negative reactions to excessive demands.
So why would we want to do this to ourselves?
Paramedics are drawn to the role for various reasons. For some, it may be a desire for excitement, personal challenge or adventure. That desire may be infrequently fulfilled when the reality of repetition kicks in.
Others are highly perceptive to the needs of others and gain satisfaction through helping people and feeling needed or appreciated. An ongoing lack of appreciation or inability to make a positive difference may fail to satisfy at all.
With common natural traits such as flexibility, resilience, strong-mindedness, motivation, detail orientation, decision making skills, action focus and high stress tolerance, paramedics are ideally suited to the role. We also get to develop personal and professional attributes through emotionally demanding work and stressful situations that strengthen us over time, but our downfall may also stem from these characteristics. The ability to keep pain, hurt, frustration, pressure and stress to ourselves is just as common and, culturally, a lack of discussion around feelings or open reflection of life and work challenges looms large.
Add to this an accumulation of high workload, mundane tasks, infrequent use of hard-earned skills and education, long travel and ramping times in confined spaces and the close proximity of the same colleague over weeks, months or years. Patient and bystander behaviours such as hostility, aggression, frequent callers, regular attendance to challenging mental health and social crises. Unavoidable overtime, varied or lack of meal breaks, key performance indicator pressures, organisational frustration, disturbed sleep cycles, work/life imbalance and limited family contact over several days. Not to mention repeat exposure to trauma, neglect and poverty, feelings that the world is not a good place, and shame or guilt at not being able to make things better.
So how can we avoid what may seem like a slippery slope downwards?
A major key may lie in compassion satisfaction. Rarely discussed, less widely revered but just as valid as its counterparts exists a more positive feature of long-term patient contact.
It encourages strengthened self-esteem from feeling useful, increased growth in developing as a person through connecting with others and a notion of bettering society by making a difference. A sense of achievement, success and value can be attained by creating stronger patient rapport and more rewarding interactions. Precepting, mentoring, training and leadership may feel more worthwhile when shaping a culture that seeks out compassion satisfaction into the future.
The benefits derived from helping others and directly contributing in this way are not only useful in the moment, they are cited as a valid way of combating compassion fatigue and burnout.
Rather than trying to avoid what may feel like inevitable adverse effects of paramedicine, there are steps that we can take to focus more on seeking out compassion satisfaction instead.
Steps In The Search For Compassion Satisfaction
- Download and complete the Professional Quality Of Life tool and use this as a benchmark moving forward
- Schedule some time for compassion satisfaction reflective practice in upcoming CPD hours
- Start the conversation with a trusted circle of peers to focus on it together and form a support system
- Find out which positive and proactive resources exist in the workplace and consider offering constructive suggestions if options seem limited
- Build education and training goals that help to create feelings of success and satisfaction more often than focusing on areas rarely used
- Create a satisfaction journal in an app or diary then add “feel good” moments every time they occur, no matter how small
- Ask loved ones to look out for signs of impending burnout or fatigue and explain that satisfaction is the new goal
- Engage psychological support in proactive behaviours rather than having to implement this as a reactive measure later on
As paramedics, we pride ourselves on enhancing skills and knowledge, particularly in less common injuries and ailments so that we feel successful and satisfied. The only way to increase how often we experience that feeling is to seek it out. Priding ourselves on the benefit we can bring and how much difference we can make will only serve to enhance satisfaction overall.
Whichever approach we choose, the balance will always tip one way or the other. High levels of compassion fatigue and burnout will make high levels of satisfaction impossible. In the same way, growing compassion satisfaction will soothe away some burnout and make work a better place to be.
If the personality traits of paramedics trend towards enthusiastic, problem-solving, solution-seeking, resilient people with a desire to help others, let’s put them to good use. Rather than settling for and suffering the cost of caring for others in emotional and physical distress, we can use those motivating characteristics to actively seek out compassion satisfaction.
References:
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Cetrano, G., Tedeschi, F., Rabbi, L…& Amaddeo, F. (2017). How are compassion fatigue, burnout, and compassion satisfaction affected by quality of working life? Findings from a survey of mental health staff in Italy. BMC Health Services Research, 17(755). https://doi.org/10.1186/s12913-017-2726-x
Crampton, D. (2014). Comparison of PTSD and compassion fatigue between urban and rural paramedics. ProQuest Dissertations Publishing, 2014. Retrieved from https://search.proquest.com/openview/cd8aa35ee2baef41f99346e77ac33459/1?pq-origsite=gscholar&cbl=18750&diss=y
Hansen, E., Håkansson Eklund, J…& Stocks, E. (2018). Does feeling empathy lead to compassion fatigue or compassion satisfaction? The role of time perspective. The Journal of Psychology, 152(8), 630-645. https://doi.org/10.1080/00223980.2018.1495170
Martin-Cuellar, A., Atencio, D., Kelly, R. & Lardier, D. (2018). Mindfulness as a moderator of clinician history of trauma on compassion satisfaction. The Family Journal: Counseling and Therapy for Couples and Families, 26(3), 358-368. https://doi.org/10.1177/1066480718795123
Murray, E. (2019). Moral injury and paramedic practice. Journal of Paramedic Practice, 11(1). https://doi.org/10.12968/jpar.2019.11.10.424
Williams, B., Lau, R., Thornton, E. & Olney, L. (2017). The relationship between empathy and burnout – lessons for paramedics: a scoping review. Psychology Research and Behavior Management, 10, 329-337. DOI: 10.2147/PRBM.S145810
Wu, S., Singh-Carlson, S., Odell, A., Reynolds, G. & Su, Y. (2015). Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncology Nursing Forum, 43(4), E161-E169. DOI: 10.1188/16.ONF.E161-E169
Article first published in Tammie Bullard’s regular column “The Good, The Bad & The Ugly Paramedic” in the Australian Emergency Services Magazine, Vol 21, 2020.
