COMPASSION FATIGUE AND BURNOUT IN NURSING VidetteTodaro-Franceschi,RN,PhD,FT, hasbeenanursefor30yearsandhas worked in a variety of acute and long-term care settings in medicine, surgery, and critical care as staff nurse, administrator, clinical specialist, educator, and consultant. She is an associate tenured professor and coordinator of the Clinical Nurse Leader Graduate Program at Hunter-Bellevue School of Nursing, Hunter College, and Doctoral Nursing Faculty at the Graduate Center, both of the City University of New York. A nurse scholar and educator in the areas of end-of- life/palliativecare,bioethics,andleadership,Dr.Todaro-Franceschiistheauthor of the book The Enigma of Energy: Where Science and Religion Converge along with many articles and several chapters. She has performed seminal research on ideas of energy, synchronicity, bereavement healing, end-of-life care, and professional quality of life. A passionate speaker, she has presented nationally andinternationally. Dr. Todaro-Franceschi is an End-of-Life Nursing Education Consortium (ELNEC) trainer and a Fellow in Thanatology (ADEC). She is on the academic advisory board for Annual Editions: Death, Dying and Bereavement, and is a peer reviewerforanumberofprofessionaljournalsincludingtheJournalofHospiceand Palliative Nursing, MedSurg, Nursing Science Quarterly, the Journal of Holistic Nursing,andAlternativeTherapiesinHealthandMedicine. COMPASSION FATIGUE AND BURNOUT IN NURSING Enhancing Professional Quality of Life Vidette Todaro-Franceschi, RN, PhD, FT Copyright#2013SpringerPublishingCompany,LLC Allrightsreserved. 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SpringerPublishingCompany,LLC 11West42ndStreet NewYork,NY10036 www.springerpub.com AcquisitionsEditor:AllanGraubard Composition:TechsetCompositionLtd.,Salisbury,UK ISBN:978-0-8261-0977-4 E-bookISBN:978-0-8261-0978-1 12131415/54321 TheauthorandthepublisherofthisWorkhavemadeeveryefforttousesourcesbelievedtobe reliabletoprovideinformationthatisaccurateandcompatiblewiththestandardsgenerally acceptedatthetimeofpublication.Becausemedicalscienceiscontinuallyadvancing,our knowledgebasecontinuestoexpand.Therefore,asnewinformationbecomesavailable, changesinproceduresbecomenecessary.Werecommendthatthereaderalwaysconsult currentresearch,specificinstitutionalpolicies,andcurrentdrugreferencesbeforeperforming anyclinicalprocedureoradministeringanydrug.Theauthorandpublishershallnotbeliable foranyspecial,consequential,orexemplarydamagesresulting,inwholeorinpart,fromthe readers’useof,orrelianceon,theinformationcontainedinthisbook.Thepublisherhasno responsibilityforthepersistenceoraccuracyofURLsforexternalorthird-partyInternetWeb sitesreferredtointhispublicationanddoesnotguaranteethatanycontentonsuchWebsites is,orwillremain,accurateorappropriate. LibraryofCongressCataloging-in-PublicationData Todaro-Franceschi,Vidette. Compassionfatigueandburnoutinnursing:enhancingprofessionalqualityoflife/Vidette Todaro-Franceschi. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-8261-0977-4--ISBN978-0-8261-0978-1(e-book) I.Title. [DNLM:1. Nurses--psychology.2. Burnout,Professional--psychology.3. Empathy. 4. Philosophy,Nursing.5. QualityofLife. WY87] 610.73--dc23 2012023136 Specialdiscountsonbulkquantitiesofourbooksareavailabletocorporations, professionalassociations,pharmaceuticalcompanies,healthcareorganizations,and otherqualifyinggroups. Ifyouareinterestedinacustombook,includingchaptersfrommorethanoneofour titles,wecanprovidethatserviceaswell. Fordetails,pleasecontact: SpecialSalesDepartment,SpringerPublishingCompany,LLC 11West42ndStreet,15thFloor,NewYork,NY 10036-8002s Phone: 877-687-7476or212-431-4370;Fax: 212-941-7842 Email: [email protected] PrintedintheUnitedStatesofAmericabyBangPrinting Dedicated to my colleagues— nurses everywhere—and especially my students.... May you always work heartfully, assured that those whose lives you touch will be forever changed. CONTENTS Foreword DianaJ.Mason,RN,PhD,FAAN ix Foreword NessaCoyle,RN,ACHPN,PhD,FAAN xiii Preface xv Acknowledgments xix Part1 ProfessionalQualityofLife 1. Introduction:TheGood,theBad,andtheUgly 3 2. TransformingBothHealthandCare 13 Part2 Unity,Purpose,andtheGood:AnEthicofCaring 3. CompassionandContentment:BeingHeartful 29 4. ValuesandExcellencesinNursing 45 5. TheARTofReaffirmingPurpose 57 Part3 TheBadandtheUgly:CompassionFatigueandBurnout 6. AHeavyHeartHurts 75 7. IKnowWhatIOughttoDo! 91 8. BurntOutandSeeminglyHeartless 111 Part4 FacingDeath 9. BeingPreparedtoCarefortheDying 135 10. SharedHorrorsandAching,BreakingHearts 151 vii viii Contents Part5 BeatingtheOdds 11. CultivatingCollectiveMindfulAwareness 165 12. ImagineItandActualizeIt 185 AppendixA: ProQOLVersion5(Stamm,2009–2011) 197 AppendixB: PPACDR-I(Todaro-Franceschi,2010) 201 Resources 203 References 211 Index 225 FOREWORD In her classic work, Ordered to Care, historian Susan Reverby (1987a) wrote about the roots of nursing as a predominantly women’s pro- fession. Women were expected to take care of infirmed close and distant relatives. When caregiving moved outside of the home, it was women whowereexpectedtoprovideit.Indeed,itwasoneofthefewoccupations opentowomen.Caregivingwasviewedas“women’swork”—aviewthat wecontinuetochallengetoday—and,assuch,wasnotvaluedbysociety. Reverby(1987b)arguesthatnurseshavebeen,andcontinuetobe,ordered tocareinasocietythatrefusestovaluecaring.Herworkhelpedmanyin nursing to understand the complexity of the profession and nurses’ own views of self-worth and their conduct. How can we feel good about the workwedoifitisnotvaluedbysociety? When society devalues what we do, it is hard to clutch the thread thatholdstogetherthetapestryofcaring.Nursingisextremelydemanding and challenging work. We are witnesses to tremendous trauma, both physical and psychological. The work takes its toll when we, our col- leagues,andthehealthsystemsinwhichweworkfailtounderstandthat caring for the caregivers is essential if we are to provide high-quality, humanisticcare. We sometimes do our work in uncaring environments. Our health care system is notorious for failing to deliver the right care in the right way at the right time. Hospitals are often more concerned about nurses administering medications than making sure that patients and their family caregivers have the information and support they need to be able to take care of themselves in the immediate post-discharge period. Physicians continue to give “orders,” as if they had the certitude of the Ten Commandments,even though our dutyistothepatient first.Nurses who challenge the status quo or the “orders” of physicians quickly learn that they can be disciplined and even lose their jobs and livelihood.They leave work knowing that they have been unable to support patients in ways their patients needed. Whether it is from unsafe systems of care, insufficient staffing to provide the care patients and families need, or being constrainedfrom advocating for patients as our consciencedictates ix