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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


It's as simple as A, B, C!

Updated: Oct 23, 2023

Vicarious trauma is a relatively new term. Compassion fatigue, moral distress, secondary trauma, and burnout are some of the terms used to describe mental states and feelings from being exposed to patient's trauma day after day. By listening to the stories that patients tell, we are experiencing similar feelings and experiencing similar effects. On MRI the same areas in the brain that light up for patients while talking about trauma lights up for others when listening to the stories. Think about it, you are witnessing and are present in another person's hardest days. You share their suffering; you share their anguish, and you will feel with them. Compassion fatigue can occur anytime in a nurse's career.

And it can occur after one incident or cumulative events over time.

It is similar to PTSD.

Day after day of listening can lead to compassion fatigue, stress and eventually burnout. It can feel like we are drowning in the suffering and misery of others. It is especially significant for student nurses and new nurses who are not used to the daily exposure of these traumatic experiences.

CF has been called the cost of care. It not only includes exposure to patients, but CF can be due to the environment. If a nurse does not feel supported at work or is having to compromise their values and ethical beliefs, then work and service to others becomes compromised. It causes symptoms in many different areas: nervous system with sleep disturbances, emotional issues with mood instability and crying. Cognitive ability decreases, behavior and judgement is impaired and there can be isolation and loss of morale. Further symptoms include fear, anxiety, not wanting to get out of bed to go to work, absenteeism. There can be issues with decision making, forgetfulness, headaches, binge eating or no appetite, loss of sense of humor, depression and suicidal ideation. All of these symptoms can lead to a weakened immune system.

Studies have shown that nurses have positive feelings in addition to the negative ones while caring for patients. Compassion satisfaction is the pleasure and satisfying feeling that comes from helping others. Compassion satisfaction is coming home from work feeling good about the work and service to patients. A satisfying work life has positive benefits for home life.

How do we prevent CF and vicarious trauma and help nurses when compassion fatigue has taken hold. How do we help each other and ourselves?

It’s in the ABC's.

A = Awareness – name the feelings, identify what cases or incidents cause the most stress.

Look at the events or situations that cause the greatest amount of distress.

B = Balance – ensure there is good work-life balance

Build moments of rest into your day, take a lunch and leave the unit.

Remember the reason you became a nurse and find your joy and meaning again.

C = Connections – talk to a co-worker that you trust

Share with a loved one, seek professional help if needed.

Surround yourself with people who are positive and build you up.

Say goodbye to people who are negative and make you feel bad.

Put hope, joy and gratitude in your day.

Every day can be a time to come together with the people that you love, but it can also act as a “reset” button. In order to welcome love into your life (especially self-love), you have to release toxicity. Something as simple as a toxic thought can wreak havoc on your relationship with yourself. Practice releasing beliefs that are holding you back, find affirmations that make you feel powerful, and cut out anything that is not serving you.

What are some things you can do to be compassionate to yourself?

Sleep is very important for recharging our energy. Eating right, exercising often (walking is exercising), finding a new hobby or picking up an old hobby.

Find support – EAP, colleagues that you trust, family (as appropriate).

Religion or spirituality, prayer or meditation.

Practicing mindfulness and being in the present moment

There is nothing wrong with asking for help.

How do you know if you are suffering from compassion fatigue, secondary trauma or burnout?

The Professional Quality of Life Scale is a 30-question scale that has been tested and validated for caring professionals. It can be used as a screening tool for stress-related health problems. Take sometime today to complete the screening as a baseline and use it again when you are feeling overly stressed.

To score the Professional Quality of Life Scale total the specific questions for the Compassion Satisfaction Scale, the Burnout Scale and the Secondary Traumatic Stress Scale Add the scores to see where the total number ranks on the scale: Low, Average, or High.

When you graduate from nursing school and get your first job you will have your patience, your confidence, and your self-worth tested. On those days you will need to remember why you wanted to be a nurse. Why did you give up so much time away from family and friends. Why did you study and study and study? Why did you give up sleep, eat badly, not exercise so you could reach a dream you have for your life? On those days you will need to recite affirmations. Remember to be kind to yourself. "I am enough!" "This is difficult, but I can do this and keep doing it. I have so much to give to others."

A physician who spends her days interviewing abused children wrote about her daily trauma in an essay at called "The Toll of Caring."

I must do my best for my patients by striving to acknowledge their profound emotional impact on me while bringing my utmost skill and compassion to their care. Their collective injuries induce a state of heavy exhaustion. We cannot unsee what we’ve seen or unhear the stories we’ve heard.These memories create emotional and spiritual wounds—wounds that may be invisible to others. My colleagues and I are helpers, trained to put others’ needs first; and asking for help is hard. So, like many patients, we wear a mask of strength and impenetrability—and our injuries, like our patients’ injuries, remain unseen. It is my hope that, together, my colleagues and I can find a way to share our very real trauma with one another more openly, to acknowledge and validate it—and so begin the vital, long-overdue process of our own healing.

By stuffing our emotions, rather than sharing them with a trusted friend or loved one, we are causing damage to ourselves. How can we care for another if we cannot care for ourselves? You cannot show up authentically and be of true service to another if you cannot get out of your own head and be present to another person's pain and suffering. Compassion means suffering with another. Be aware of what these emotions and experiences do to your psyche, have a balanced work-home life and connect with people who can help you be better and who support your mental health.

I say that it is easy and simple as A, B, C., but I do not want to downplay the pain and suffering that you may experience from carrying around the vicarious trauma you are exposed to everyday. Being unable to "cure" our patients and take away their pain will be difficult to watch. It gets easier when you realize that you are there to be a witness and to make sure your patients do not feel alone in their experiences. Stay in the moment, be present to their needs. Share your knowledge to make their lives a little easier. Sometimes all we have to give is our presence.

Practice awareness, name the feelings you are having during tough times.

Balance - leave the struggles at work if you can. Rest and digest and enjoy your family and friends.

Connection - means not only connecting with others who support you, but also connecting to yourself.

As my favorite author, Berne Brown says, keep a strong back to hold you up, a soft front to be compassionate and a wild heart that never stops trying to find creative ways to be of service to others.

If you are not a nurse but take care of others then you, too, can experience compassion fatigue. Watch the wonderful video by Juliette Watts

Watts, J. (2016, November 26). Compassion fatigue: What is it and do you have it? | juliette watt | tedxfargo.

To read more about Compassion Fatigue here is an excellent article for nurses and healthcare professionals.

Paiva-Salisbury, M. L., & Schwanz, K. A. (2022). Building Compassion Fatigue Resilience: Awareness, Prevention, and Intervention for Pre-Professionals and Current Practitioners. Journal of health service psychology, 48(1), 39–46.

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