Team-Based Care: Understanding Compassion Fatigue and Burnout in Navigation

September 2020 Vol 11, No 9

Compassion fatigue and burnout were common among oncology navigators even before the COVID-19 pandemic. But now, working from home with new and ever-changing schedules in the face of perpetual uncertainty, many oncology navigators are experiencing heightened anxiety in their personal and professional lives and may be teetering on the brink of compassion fatigue or burnout.

At the AONN+ 2020 Virtual Midyear Conference, Emily Gentry, BSN, RN, HON-ONN-CG, OCN, and Monica Dean, HON-OPN-CG, clarified the important distinctions between these common syndromes and armed navigators with the tools to step back from that brink, while still treating themselves with grace.

“Compassion fatigue is when you co-suffer with others to the point that it is hurting you,” they explained. “Burnout is when you flick off a switch and no longer seem to care at all.” Although burnout can occur in any profession, compassion fatigue is particularly intertwined with the empathetic response characteristic of caregivers.

“We take on the emotional burden of our patients’ agony. We haven’t necessarily been exposed directly to the trauma of being diagnosed with cancer, but we empathize so much with patients in their diagnosis and in their journey that we feel their feelings,” said Ms Gentry. “In time, we lose our spark, our optimism, our humor, and our hope; we tire, and sometimes we’re just not ourselves.”

The onset of compassion fatigue can take months or years and can be set off by one or multiple experiences. Symptoms can include slowness of thought, difficulty prioritizing tasks, irritability and/or anxiety, and emotional or mental exhaustion. “The symptoms that really stand out to me are the physical symptoms,” she added. “You may actually feel nausea or heart palpitations, and you may even feel these symptoms just thinking about your role or going into your work environment.”

Not everyone experiences compassion fatigue, but when its symptoms are recognized—particularly early on—it can be effectively managed.

Compassion Fatigue and COVID-19

Since the pandemic, patient barriers to care have only increased. “A huge role of the navigator is to address barriers to care, but they’ve changed dramatically, and navigators have had to get even more creative in identifying and addressing them, in addition to managing their own anxieties and fear of getting sick on the front lines,” said Ms Dean.

When compassion fatigue is combined with a pandemic, symptoms can be even more heightened. People are fearful about their own health and the health of their loved ones. They may have difficulty sleeping or concentrating, or worsening of chronic health problems or mental health conditions. Many people are also experiencing changes in sleep or eating patterns, including an increased use of alcohol, tobacco, or other drugs.

The pandemic has demanded an increased need for frontline workers and direct response; as a result, healthcare providers have seen drastic and abrupt changes to their personal and professional lives. In addition, increased concern around the availability of regular medical care and community services is only exacerbating the already heightened anxiety. “I think acknowledging that we feel sad or fearful, as well as encouraging each other, is also helpful,” she said.

Ms Gentry emphasized the value of maintaining a routine during this time, as well as the importance of setting boundaries. “As navigators, it can be hard to set those boundaries and step away, but remember that boundaries are also there for our own safety and better health,” she noted.

“In view of COVID-19, the world has been turned upside down, and there was really no opportunity to absorb it,” added Ms Dean. “It’s important to acknowledge the stressors in this current situation.”

And Then, There’s Burnout

Burnout is defined as “cumulative stress from the demands of daily life, and a state of physical, emotional, and mental exhaustion caused by a depletion of the ability to cope with one’s environment, particularly the work environment.” It’s typically characterized by a negative self-concept, a negative job attitude, and a loss of concern for the feelings of patients.

“As oncology navigators, you carry a very heavy weight working with cancer patients every day,” said Ms Dean. “All of our lives changed in March, and this has been exacerbated by having the patients you connected with on a face-to-face level taken away from you. At a time like this, when your priorities have changed, and the environment around you has changed, it’s so important to take care of yourself and make sure you aren’t getting to that burnout stage.”

Resilience and Self-Care

“Resilience refers to the idea of bending, but not breaking,” said Ms Gentry. “For the majority of us, resiliency skills are learnable.”

Resilience is characterized by the skills, abilities, knowledge, and insight that accumulate over time as we learn to overcome adversity and deal effectively with challenges. Factors that contribute to resiliency include an existing social support network, a positive outlook, making realistic plans and sticking to them, being a good communicator, and managing emotions effectively.

According to Ms Gentry, considering one’s locus of control can also lead to resiliency. “Are you focusing on the exterior and blaming others?” she asked. “You’ll have a greater sense of resiliency if you can look inside yourself—at your own strengths and abilities—and turn that into professional growth.”

Particularly during this time of high uncertainty, self-care is paramount, and it starts with acknowledging and expressing one’s own emotions. “Speak kindly to yourself,” she urged. “Acknowledge that it’s hard, and you’re doing your best.” Carve out time for yourself every day, rebalance your workload, establish intentional routines with remote work, and learn to delegate. Create a transition from work life to home life, say no (or yes) more often, and consider joining a supervision/peer support group, she advised.

Find ways to release your stress! Take a walk; sing; yell into a pillow; just do something. “We’ve been operating in survival mode since this pandemic,” she said. “And again, I can’t overemphasize the importance of keeping a daily routine; we think we have a lot of time when we’re at home, but often we’re not managing it well.”

Finally, remember to be sensitive to others on your team, and continue to give each other grace, she added. “As an oncology nurse, sometimes it’s hard to come home and share my experiences with my family, and maybe I’ve somewhat protected them over the years,” she said. “But those working alongside you really understand what it’s like to be on this journey with your patients.”

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Last modified: August 10, 2023

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