Compassion Fatigue Part 5: In the Workplace

by Guest Blogger on October 21, 2013

Katherine Dobbs

Katherine Dobbs

When employees say “I am burned out”, they are really recognizing, feeling, and expressing Compassion Fatigue. The problem is that technicians do not know about compassion fatigue…as a result of the general widespread use of the term, burnout.  ~Figley & Roop, 2006

When compassion fatigue affects our employees, our entire practice suffers. Our practice then becomes afflicted with organizational compassion fatigue.  According to Patricia Smith, “when management, workers, volunteers, clients and patients suffer varying levels of Compassion Fatigue, they incorporate their symptoms into the “corporate culture” of the organization. Eventually, the productive mission of the organization is replaced by policies, procedures and goals that reflect high levels of dysfunction…when compassion fatigue among employees hits critical mass, the organization itself suffers.”

We all want our practices to be a place where our clients are treated with compassion, our patients receive the best quality medical care, and our team can pursue personal and professional goals in a supportive environment. This type of positive work environment will result in a team that displays some basic traits, including:

  • The team cares about each other and shows it
  • They genuinely like each other
  • They joke around, and help each other
  • They can pick up on the mood changes of their teammates…
  • And they care and support each other.

 Yet when compassion fatigue is affecting our workplace and our team, then this is when the work environment has become “toxic”:  (~Figley and Roop, 2006)

  • Relationships are strained…
  • Especially with supervisory staff
  • Staff morale tends to be negative
  • The team lacks a sense of trust and optimism
  • The team experiences a lack of mutual support.                                                         

Just as with individual compassion fatigue, there are both personal and professional reasons to minimize compassion fatigue. It is difficult for each individual to reach their potential in this toxic environment, and it is also difficult for the organization as a business to survive and grow. Profitability of the practice is definitely affected. Service organizations must recognize that addressing [compassion fatigue] is part of a reasonable standard of practice for any profession that entails direct service to traumatized “clients”. The cost of not doing so is immeasurable.  ~Saakvitne & Pearlman, 1996

What does organizational compassion fatigue look like, so we can recognize these symptoms in our own practice and make necessary changes?

Symptoms of organizational compassion fatigue:  (~Smith, 2008)                              

  • Excessive amount of worker’s comp claims
  • High absenteeism, turnover…attrition
  • Changes in co-workers’ relationships
  • Inability for teams to work well together
  • Team challenges rules and regulations
  • Aggressive behavior among teammates
    • Team unable to complete assigned tasks
    • Team displays lack of flexibility
    • Unhealthy competition among teammates
    • Rampant rumors and gossip
    • Constant changes in practice policies

When left unaided, stress levels rise. Employees, particularly the line staff and middle management, feel helpless, then hopeless. Resentment, hostility and blame surface…  ~Smith, 2009

In an article by Paul B. Hofmann appearing in the Healthcare Executive in Sep/Oct 2009, there are many factors that lead to compassion fatigue among healthcare workers. These include inadequate professional training, poor mentoring, low staffing, and an organizational culture that does not encourage, value and recognize exemplary displays of compassion. Hofmann goes further in saying that if employees do not believe they are respected and appreciated for their efforts, and if they do not feel cared about by those who have responsibility for them, it will be more difficult for them to establish and maintain a truly caring environment for patients. “Inevitably, compassion fatigue will have an adverse impact on staff recruitment, retention, morale and performance,” says Hofmann.

If we agree with Hofmann as to the factors leading to compassion fatigue among healthcare workers, we recognize that there are plenty of places to help our employees move through and out of the fog of compassion fatigue. We need to provide professional training from their first day, and never stop encouraging them to continue their learning and growing. Mentoring is perhaps the most important task that a manager performs, yet it requires sensitivity to know which employees need mentoring and how they can be best served. It also requires time, to create personal bonds, set professional boundaries, and develop trust so that employees are open and responsive to being mentored by their management team. Low staffing is a reality for many of our practices, as we struggle with each unexpected loss of an employee and try to fill in that space using the “warm body” technique. This is avoidable if our management team continually accepts resumes and applications for all positions even when there is no opening, and conducts ongoing interviews to line up the best candidates for when an opening occurs. If the management has established open communication with each team member, they are also better prepared to know when an employee may be reaching a personal or professional goal that will take them from the practice (i.e. graduating school, completing certification, etc.), or realize when an employee is struggling and thus involuntary termination is unavoidable. Employee loss should never be a surprise, in most cases. If it is, then the management is not projecting employee needs very far into the future.

Organizational culture is so important to minimizing organizational compassion fatigue. As Hofmann stated, our management team (including practice owners and all levels of supervision) must encourage, value and recognize exemplary displays of compassion by the employees. This could be extra time spent with a grieving client, staying late to provide patient care that is necessary, or an employee supporting their teammate through a difficult case. We must be careful not to assume this is unprofitable “down time” or just someone “riding the clock”, when instead it may be the extension of compassion that you really want and need from your team members. Feel free to use the word “compassion” as often as possible when describing activities that you are praising, as this will help them make the connection that it is this display of compassion that is being recognized. As managers in general, it is easy to focus on the problem or trouble employees that constantly need guidance and counseling. However, those employees who probably deserve the support of management the most are those who need to see real examples of how much they are respected and appreciated. This goes beyond tangible rewards and “employee of the month” plagues to words and actions that provide them the feeling that they are cared about. This is where that personal bond is so important.

We can create healthy work places, and here are some guidelines to help us reach that goal:

Eight Laws Governing A Healthy Workplace

1. Provide a respite for the team.

2. Provide continuing education for team.

3. Provide acceptable benefits to aid staff in practicing beneficial self care.

4. Provide management and team with tools to accomplish their tasks.

5. Provide direct management to monitor workloads.

6. Provide positive, team-building activities to promote strong social relationships between colleagues.

7. Encourage “open door” policies to promote good communication between team members.

8. Have grief processes in place when traumatic events occur onsite.

As we conclude the last of our five post series, we would love to hear hear your thoughts regarding compassion fatigue, so if you leave a comment on this blog, your name will be put into a drawing for your own copy of Overcoming Secondary Stress in Medical and Nursing Practice by Robert J. Wicks, which I will mail to you.  All comments must be received by November 9.  Be sure to include your email address so I can let you know on November 10th, if you were the winner! –  Rebecca

 

You can learn more about Katherine Dobbs at http://www.katherinedobbs.com or katherinedobbs@sbcglobal.net 

Other posts written by Katherine are:

Exposing Compassion Fatigue Part 1 ,

 Compassion Fatigue Part 2:Then and Now, and

Compassion Fatigue Part 3: Identifying Stressors and Satisfiers

Compassion Fatigue Part 4: Caring For Ourselves

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{ 7 comments… read them below or add one }

Hilarie Jerauld October 21, 2013 at 8:24 am

I totally agree. It is easy to become complacent about Compassion Fatigue as the owner/manager/veterinarian of a small animal hospital. I most definitely encountered severe compassion fatigue during vet school and in my first 4 associate positions, and much of it was the frustration that came from not having the ability to connect with my patient’s owners or provide them the level of service I felt was needed as a result of the management structure (corporate practice). It is easy for me to forget that the people working for me might have the same struggle, and may not know how to talk about it. This series reminds me to keep this in mind in the future and continue to work toward feeling more comfortable having difficult conversations with our team mates.

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Rebecca October 22, 2013 at 8:16 am

It can happen so quickly in a tough environment and what hospital is never a tough environment! You are absolutely right that a lot of people are experiencing compassion fatigue and either don’t realize it or don’t want to seem weak etc.

Thanks so much for commenting!

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Vet Changes World October 21, 2013 at 9:22 am

When I entered practice, all the vets I spoke with discussed “burnout” as a “when” not an “if”. This series has been fantastic – it was great to revisit ways we can prioritize monitoring for signs of compassion fatigue and getting what we need to heal for the good of not just ourselves but our clients and our team. I am lucky enough to work with a great team that *does* joke around and it make all the difference in the world.

Personally I have found the twitter community of veterinarians really helpful too. Knowing there are other veterinarians out there that do a good job and love their work who feel this way helps too. I’ve seen many vets expressing frustration or heartbreak reassured by their colleagues.

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Rebecca October 22, 2013 at 8:19 am

A good team makes those hard days so much more bearable doesn’t it. Some of the “worst” days have lead to me feeling better about my team though because with the right frame of mind- all on the same team- it can actually be quite a bonding experience. As much as I hate it, I think our teams benefit from seeing us doctors as vulnerable people just like everyone else!

I totally agree with you about twitter- we just have to come up with a way to get more of us like minded vets to engage in the power of social media!!!

Thanks so much for commenting!

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Nicole November 6, 2013 at 12:05 pm

Do you have any recommended resources to help a receptionist who seems to be suffering compassion fatigue with clients regarding finances? She’s been with us for 5 years and came from a not-for-profit, and she really struggles with making the proper patient recommendations because she gets push-back about fees and feels worn down by discussing fees with clients.

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Rebecca November 6, 2013 at 12:33 pm

Well that is a tough situation because that is def. part of her job I would guess. If she needs help personally with finances as a lot of support staff at animal hospitals do then I would strongly encourage you to check out http://www.daveramsey.com. They have a work place program that is outstanding and I know some other hospitals who are taking their staff through the program. I think people who struggle discussing this with others are often people who struggle with this themselves. Hope that helps and I am happy to answer any other questions you might have.

Thanks for commenting!

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Nicole November 11, 2013 at 10:18 am

Thanks Rebecca, I will definitely check that out. I appreciate the info!

PS And thanks for the book – I look forward to reading it 🙂

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