This document discusses compassion fatigue and burnout in nursing. It first defines compassion fatigue and burnout as occupational illnesses affecting nurses' health and leading to poorer patient outcomes and higher turnover. Several factors are identified as contributing to compassion fatigue and burnout, including lack of administrative support, ethical dilemmas, poor communication, and high patient ratios. The document then summarizes several research articles on compassion fatigue and burnout in more detail. It finds that personality traits, lack of support, stressful work environments, and constant exposure to patient suffering can increase risks of developing compassion fatigue or burnout. Early identification of risks and interventions are important to prevent nurses from leaving the profession.

1. Running Head: COMPASSION FAGTIUE AND BURNOUT
Compassion Fatigue and Burnout
Christina Dodd
California Baptist University

2. COMPASSION FATIGUE AND BURNOUT 2
Compassion Fatigue and Burnout
Compassion fatigue and burnout has become such a threat to the nursing profession
that they are being identified as “occupational illnesses” (Fuente, 2014, p. 240). The newly
sparked interest in the prevention and identification of these illnesses comes after research
has routinely proved that burnout and compassion fatigue are not only effecting nurses
health, they lead to decline in patient satisfaction, and increasing turnover rates. What
makes these occupational illnesses unique is their ability to affect every nurse in any
specailty. The American Nurses Association (ANA), prefers to use Cordes (1993) definition
of “emotional exhaustion” to define burnout. It is imperative to identify those at risk for
burnout and compassion fatigue because it is the single biggest factor that is causing nurses
to leave the profession (Erikson, 2007). Compassion fatigue is the antecedent to burnout; it
is the beginning stages that begin with the emotional numbing. It usually begins after a
specific event. There are several factors that lead to compassion fatigue and burnout. Many
factors such as administration and managerial support, the amount of ethical dilemmas
faced daily, poor communication, and increased nurse patient ratios are just a few of the
most common risk factors that lead to burnout and fatigue. It is not only nurse’s
responsibility; all areas of the healthcare field must work together to defeat these illnesses
before they consume the profession.
Boyle, D., (Jan 31, 2011) "Countering Compassion Fatigue: A Requisite Nursing
Agenda" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 2.
Boyle’s article takes a deeper examination of burnout and compassion fatigue by
first defining each. Boyle (2011), states that while burnout arises from the repetition of
failed or unmet goals, compassion fatigue arises from the constant exposure to caretaker

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strategies failing which leave the caretaker with feelings of resentment and guilt (p.431).
Compassion fatigue occurs before burnout (p. 432). Compassion fatigue has an acute onset
while the burnout will have a gradual onset (Boyle, 2011, p. 432). She proceeds to describe
the risk factors of compassion fatigue, one being an occupation as a first responder, or
those who see repeated death. The article continues on to discuss the need for increased
support with these nurses. The author encourages a balance between work and life to
combat the feelings of helplessness and guilt. They should be regularly educated on basic
communication skills and personal coping strategies. Boyle found that hospitals who
supported their nurses through support groups for staff, de-briefing sessions, art therapy,
message therapy, bereavement interventions, and closer attention to the spiritual needs of
staff were less likely to have nurses with compassion fatigue.
This article was fundamental to my research because it differentiated compassion
fatigue from burnout in colloquial words. I did not see any other articles that discussed the
gradual onset of burnout versus the acute onset of compassion fatigue. I thought her
research on how institutions that put more effort into the individual needs of their
employees saw lower levels of compassion fatigue. While other articles noted that
managerial support was a key factor in lowering the rates of compassion fatigue the
specificity that she used was beneficial because these simple things such as educating
nurses on basic communication skills was something that every unit could use education
on. I did not find any limitations with this article. I thought her recommendations on
educating nurses on basic communication skills and how to evaluate their coping skills
could be spread to all first responders.

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Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente,
E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing
profession.International Journal Of Nursing Studies, 52(1), 240-249.
doi:10.1016/j.ijnurstu.2014.07.001
Fuentes evaluated 676 Spanish nurses by having nurses from various specialties
and hospitals complete a set of questionnaires. Their aim was to identify possible
modifiable factors causing burnout among nurses. The questionnaire consisted of socio-
demographic information and occupational information. The completed questionnaires
were then evaluated on the Maslach Burnout Inventory scale. The authors found that the
majority of nurses surveyed had moderate to high levels of burnout. The results also found
that nurses who exhibited at least two or more of the following personality traits:
neuroticism, agreeability, extraversion, or conscientiousness were more likely to develop
burnout.
This article brought a unique perspective to my research because it focused on
personality traits. I had not seen any other articles that identified four specific personality
traits as a precipitating factor to burnout. The results lead me to believe that if we could
identify these traits in nurses we might be able to prevent them from developing burnout
syndrome. I appreciated the way the author defined burnout as an “occupational illness”
(Fuente, 2014, p. 240). When stated in those terms I felt that the author was stressing how
important the recognition of burnout is in the workplace.
Hunsaker, S., Chen, H., Maughan, D., & Heaston, S. (2015). Factors That Influence the
Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in

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Emergency Department Nurses. Journal Of Nursing Scholarship, 47(2), 186-194.
doi:10.1111/jnu.12122
This study published by The Journal of Nursing Scholarship looked to identify which
“demographic and work related components” (Hunsaker, 2014, p. 186) lead to higher
levels of compassion fatigue and compassion satisfaction in Emergency Departments. The
research team surveyed 284 Emergency Department Registered Nurses with at least one
year of experience, working at least eight hours with direct patient care. They found that
gender, age, level of education, and length of time as a nurse, directly affected the level of
compassion fatigue and compassion satisfaction. Like several other articles previously
stated, the largest factor leading to increased compassion fatigue was lack of support of
administration. It was also noted that when compassion fatigue was addressed that job
satisfaction increased which resulted in increasing patient satisfaction.
Overall I felt that this article was well thought out and supplemented the consistent
trend of managerial support being a large factor in burnout and compassion fatigue. The
one limitation that the author and I agreed on was the small sample size. I feel that to get a
better idea of the factors associated with compassion fatigue one would need to survey a
larger group. However, even with the small sample size the results were consistent with
several other articles.
Jenkins, B., & Warren, N. A. (2012). Concept analysis: compassion fatigue and effects upon
critical care nurses. Critical Care Nursing Quarterly, 35(4), 388-395.
doi:10.1097/CNQ.0b013e318268fe09
Jenkins article interviewed several Critical Care nurses to identify specific traits of
Critical Care Nurses with compassion fatigue and burnout. Her article identified that

6. COMPASSION FATIGUE AND BURNOUT 6
depersonalization, decreasing levels of performance, loss of empathy, and poor judgment
as the “defining attributes.” Nurses that had these attributes were likely to exhibit weight
gain or loss, be more accident-prone, suffer emotional breakdowns, and were noted to call
off or call in sick more often than the nurses who did not illustrate the defining
characteristics. She found that antecedents to compassion fatigue were intense patient
exposure, high stress environment, and were often exposed to suffering. She then
compared these traits to other case studies and found that these traits were seen in several
of the nurses suffering from compassion fatigue or burnout in the articles.
This article supported my research in a unique way because it was one of the only
articles that were able to identify the “defining attributes.” I would have never thought as
being “accident-prone” to be a signal of compassion fatigue. I thought the attributes were
key in identifying nurses who might be suffering from compassion fatigue; like in all
diseases, early identification is always best. If we can identify these nurses in the early
stages we can get them help before it leads to quitting or endangering a patient. I thought
her antecedents and consequences were consistent with the other articles that I had read
but had much more depth on identification on at risk persons than other articles.
Koppel, J., Virkstis, K., Strumwasser, S., Katz, M., & Boston-Fleischhauer, C. (2015).
Regulating the Flow of Change to Reduce Fontline Nurse Stress and Burnout. The
Journal Of Nursing Administration, 45(11), 534-536.
Koppel’s study consisted of a telephone interview that consisted of questions about how
the institution they work at helps prevent burnout. Less than half of the nurses interviewed felt
they could “strongly agree with the statement: ”My organization strongly helps me deal with
burnout” (Koppel, 2015, p. 534). The participants felt that they could agree on two things, the

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first being that many of the interventions at their institutions occur after burnout has already
set in, or the interventions do not decrease the feelings of being overworked and overwhelmed
(Koppel, 2015, p. 534). The authors felt that disorganized scheduling and poor communication
were the two most prominent factors that lead to compassion fatigue. They felt that
disorganized scheduling and poor communication are often a result of leaders not providing
enough or to information, messages lack action steps, communications are branded with
urgency, or staff does not see a reason behind changes being implemented (Koppel, 2015, p.
536). They suggested limiting information that is given to the whole institution, highlight and
focus on critical elements, and educate on the reasons behind changes prior to implementing
changes.
This study was highly beneficial to my research. Throughout just the small amount of
articles I have read, administration and managerial support are the most common factors
leading to burnout. It was educational to see how a change in how administration
communicates with its employees could vastly improve the health of their staff. This article
connected previous articles I had read that stated better communication is key to lowering
burnout rates. What really made this article a true gem was how it was written from an
administration standpoint. The authors approach of “what can we do for our employees”
allowed the small communication changes to be applicable to all levels of management from
charge nurses to the CFO. I did not feel that this study had any limitations. I felt that it was
diverse enough to not only be applicable in the hospital setting but could be beneficial for any
nursing setting.

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Lee, V. L., & King, A. H. (2014). Exploring Death Anxiety and Burnout Among Staff Members
Who Work In Outpatient Hemodialysis Units. Nephrology Nursing Journal, 41(5),
479-486.
Lee’s study evaluated Hemodialysis nurses for burnout and death anxiety. He felt
that this population would be more at risk for burnout because they are frequently exposed
to chronically ill patients with a high mortality rate. The sample size consisted of 11 nurses.
The nurses were given a pre-intervention survey to complete before taking a class, then a
post-intervention survey. The class consisted of a review of renal pathophysiology,
symptoms of death anxiety and burnout, exploration of the grieving process, effective
coping mechanisms, and end of life care. When comparing the surveys, the nurses showed
less symptoms of burnout, better coping mechanisms, and increased knowledge of burnout
symptoms after the class.
I felt that this study did not add as much information to my research as other
articles had. It is obvious to see how a class could educate nurses on burnout symptoms
and would result in better recognition of symptoms. I felt that this was not as educational
as I could have hoped for. While I was attempting to get a diverse view on what factors lead
to compassion fatigue and burnout in different specialties, the results seemed obvious and
did not really contribute much to my research.
Mason, V. M., Leslie, G., Clark, K., Lyons, P., Walke, E., Butler, C., & Griffin, M. (2014).
Compassion Fatigue, Moral Distress, and Work Engagement in Surgical Intensive
Care Unit Trauma Nurses. Dimensions Of Critical Care Nursing, 33(4), 215-225.
doi:10.1097/DCC.0000000000000056

9. COMPASSION FATIGUE AND BURNOUT 9
Mason’s study evaluated nursing burnout and compassion fatigue among trauma
nurses and Surgical ICU staff. The author found that the nurses that were sampled reported
increased levels of moral distress were linked to nurses showing increased rates of
compassion fatigue. The authors found that it was not the actual dying of the patients that
bothered them, as much as the family members and life altering decisions that needed to be
made that caused them moral distress. These nurses also showed that poor relationships
with management, contributed to the levels of compassion fatigue the nurses were
experiencing.
One limitation noted in the study was that this article was specific to trauma and
Surgical ICU staff. Though it was predictable to see that the amount of death they
experience with their patient population was greater than other specialties, it was
interesting to see how the moral dilemmas these nurses experience effect their job
satisfaction.
Shoorideh, F. A., Ashktorab, T., Yaghmaei, F., & Alavi Majd, H. (2015). Relationship between
ICU nurses’ moral distress with burnout and anticipated turnover. Nursing
Ethics, 22(1), 64-76. doi:10.1177/0969733014534874
This article specifically surveyed 159 Iranian Intensive Care Nurse’s level of moral
distress compared to their level of burnout. The surveys investigated moral distress,
burnout, and anticipated turnover through the Iranian ICU Nurse’s Moral Distress Scale
(IMDS), The Copenhagen Burnout Inventory (CBI), and the Anticipated Turnover Scale
(ATS). The authors found a positive correlation between the nurse-patient ratios, years of
nursing experience, but found there was no correlation between the levels of moral
distress and turnover. One interesting result was the increased levels of moral distress in

10. COMPASSION FATIGUE AND BURNOUT 10
female nurses than male nurses. There was no correlation between gender and turnover or
moral distress and anticipated turnover.
What made this article a stand out was the motivating factor behind the research.
The author felt that this study was imperative to the field because of the high turnover
rates seen among Iranian nurses. They found that turnover negatively affected the quality
of care the patients were receiving (Shoorideh, 2015, p. 66). The largest limitation to this
study was that it was a small and highly specialized sample group. I thought that the article
was beneficial to my research because it opened my eyes to small details that I had not
thought about. It was interesting to see how gender affected burnout. I had not thought of
how gender might change the way handle day-to-day stresses of the ICU, or how different
genders handle moral dilemmas.
The effects of authentic leadership, six areas of worklife, and occupational coping self-
efficacy on new graduate nurses' burnout and mental health: A cross-sectional
study. (2015).International Journal of Nursing Studies, 52(6), 1080-1089 10p.
doi:10.1016/j.ijnurstu.2015.03.002
This study included 1009 new graduate nurses working in an acute care setting for
less than three years. They were asked to complete a survey consisting of questions based
on authentic leadership, areas of worklife (workload, control, reward, sense of community,
values congruence, and fairness), occupational coping and self-efficacy, burnout, and
mental health. Authentic leaders cultivate a work environment that is accepting of others
and promotes work effectiveness. Results illustrated that higher levels of authentic
leadership were directly related to lower levels of burnout and better mental health.

11. COMPASSION FATIGUE AND BURNOUT 11
What made this article stand out was that it was focused on new graduate nurses.
Because it was focused on this population I felt that it could be viewed as a preventative
measure. Once again, it found leadership and management levels were heavily influencing
levels of burnout among the departments. The biggest problem I had with this article was
the need for constant definitions. I felt that they used language that was hard to
understand, and was constantly requiring specific definitions. They created words and
were requiring these words to be defined by what the author thought was the best
definition. I understand that this is a journal publication, but I found the language was
distracting.
Wagner, C. (2015). Moral distress as a contributor to nurse burnout. The American Journal
Of Nursing, 115(4), 11. doi:10.1097/01.NAJ.0000463005.73775.9e
This article evaluated moral distress as a contributor to burnout and fatigue in both
the acute care and critical care environments. The author felt that burnout was important
because every nurse is at risk for developing burnout. The author found that years at the
bedside attributed to increased levels of burnout. She stressed the importance of educating
new nurses on how to properly handle stresses developing from moral dilemmas. She
found burnout to be important because it affects the quality of patient care. The author
encourages actions that facilitate nurse empowerment and increase confidence because
nurses with these two attributes were less likely to suffer from burnout. Actions such as
quality improvement teams, nursing representation on ethics committees, better
physician-nurse communication, and shared governance all lead to empowerment and
communication.

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Wagner’s article was more heartwarming than any other article I read. The article
was developed from the approach that “even the most committed nurse could feel it
acutely” (Wagner, 2015, p. 11). I felt that because her approach seemed protective, and
because she took so much time focusing on how to help the more inexperienced nurse, it
was more caring than previous articles I had read. While moral distress has been a
common theme in my research, Wagner (2015) stated “preventing burnout is more than a
retention strategy- it’s a vital form of patient advocacy” (p. 11). I had never looked at
preventing burnout as a form of patient advocacy. This one point gave the article strength
because it was original. When approaching burnout from an advocacy standpoint, we are
not only bettering our profession, we protecting the right for our patients to have the
highest quality of care. The only limitation I could find would be that if the reader had not
done much research on burnout they might not see the full value behind Wagner’s points.
While she does not cite specific research, her points are valid because it is about moral
dilemma, which she claims cannot be measured.

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References:
Cordes, C. L. & Dougherty, T. W. (1993). A review and an integration of research on job
burnout. Academy of Management Review, 18(4), 621-656.
Erickson, R., Grove, W., (October 29, 2007). "Why Emotions Matter: Age, Agitation,
and Burnout Among Registered Nurses" Online Journal of Issues in Nursing. Vol. 13,
No. 1.