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Feeling The Burn(out): Thoughts On Compassion Fatigue

Bessie Sycip, RN, BSN
MedStar Washington Hospital Center
Washington, DC, USA

"Don't think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life...was obvious in its sacredness. I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another's cross, one must sometimes get crushed by the weight."

- Paul Kalanithi, When Breath Becomes Air

I found myself reading this book, recommended by the Medstar Washington Hospital Center's Emergency Room Book Club. Instead of reading something mindless and relaxing on a recent vacation, I was unable to put this book down, crying freely on a beach when it concluded. Instead of vacationing to distraction, this book was the opposite. It felt like what I needed to read- heavy words in order to guide me. A literary companion to navigate the weight of the work we do as MCS providers. This passage gives me pause as I consider what we undertake every single day, helping patients and families whose lives have been devastated by chronic illness. We are not necessarily halting or reversing death, or even returning them to their previous levels of function. We are helping them exist for a "while longer," however "longer" may be. I have never questioned how important this work is. I have always felt as though the long hours and continuous onslaught of stress was always meaningful.

But what do you do when the weight of your work is not enough to allow you to live your own life? To spend time giving your own life meaning, outside from the dry wall and sterile fluorescent lighting of your institution? What do you do when you are beyond compassion fatigue, and at a totally new destination: compassion failure, or collapse? What do you do when you are struggling with burnout and are unable to give your best to your patients? Unable to provide to your team that deserves you at your best performance level, or-worst of all-to your family and the people you actually choose to spend your time with?

We are a group of intelligent, ambitious providers caught between the proverbial rock and hard place. We yearn to achieve, recognizing the finite amount of time we have to pick at the dream of status for ourselves, our work obligations, and also climbing the ladder of success and life goals in parallel. We live to work over working to live, not only because we are passionate about this field and what we do, but because to us, the call to protect life and mitigate suffering is the best and most moral thing to uphold.

There is emerging research and anecdotal literature calling for attention to compassion fatigue and burnout in clinicians across the field. There are more recognitions of this as a prevalent issue across many areas of healthcare - the emergency response field, critical care and primary care. It is no longer a problem that plagues physicians exclusively, but all providers in every area of the healthcare continuum. There are even less discussions about our culture as healthcare providers. The "suck it up" mentality and the lack of time to grieve or process loss and trauma is omnipresent. There is always another patient waiting to be helped, another patient who is struggling and needs to be seen. We laugh, somewhat derisively, at those who say "work-life balance," because for us, it doesn't exist. Work bleeds into life, especially when your work deals with life and existence itself.

Additionally, there is the moral hazard we incur in medicine, stemming from patients who continue poor behaviors despite their illness. These behaviors are societal and personal and can perhaps be treated, but not ever cured. The quest of those bright-eyed and bushy-tailed, wanting to help, only contribute to the exhaustion and disillusionment. We continually encounter obstacles along the way - administrative, political, financial, and interpersonal.

This is a resilient community that wants and strives for solutions, data and interventions. There is no coddling or effort recognition when the stakes are high and the outcomes concern living and quality of such. Recognizing and identifying a problem is one thing, but how to prevent or manage it? Often times, we read literature identifying complications, and the conclusions all say the same thing: we need more data, more discussions, more analysis. The impact of burnout on healthcare professionals is an insidious leak outward from the individual, affecting retention, field advancement and society as a whole.

Compassion fatigue is not a one-time event, but a process. Values are constantly in flux. Solutions are not formulaic, but highly individualistic. We must identify then revise what is important to us again and again. ■

Disclosure Statement: The author has no conflicts of interest to dicslose.


  1. Kalanithi, Paul. When Breath Becomes Air. 2016. Random House. New York, NY.
  2. Carter, Sherrie Bourg, Psy.D.. "The Tell Tale Signs of Burnout … Do You Have Them?" Psychology Today. November 26, 2013. www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-signs-burnout-do-you-have-them
  3. Carter, Sherrie Bourg, Psy.d.. "Overcoming Burnout." Psychology Today. April 17, 2011. www.psychologytoday.com/blog/high-octane-women/201104/overcoming-burnout
  4. Brunson, Lisa Mae. "The Burnout is Real: Is Diversity and Inclusion in Tech Just a Myth?" Huffington Post. July 11, 2016. www.huffingtonpost.com/lia-mae-brunson/the-burnout-is-real-is-di_b_10906600.html
  5. Bhutani, Jaikrit, Bhutani, Sukriti, Balhara, Yatan Pal Singh, and Kalra, Sanjay. "Compassion Fatigue and Burnout Amongst Clinicians: A Medical Exploratory Study." Indian Journal of Psychological Medicine. October - December 2012. www.ncbi.nlm.nih.gov/pmc/articles/PMC3662129/
  6. Sorenson, C, Block, B, Wright, K, Hamilton, R. "Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature." Journal of Nursing Scholarship. June 29, 2016. www.ncbi.nih.gov/pubmed/27351469
  7. Cocker, Fiona, Joss, Nerida. "Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review." International Journal of Environmental Research and Public Health. June 22, 2016. www.ncbi.nih.gov/pmc/articles/PMC4924075/

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