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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. 


Vicarious Trauma

Updated: Oct 17, 2023

"What can we gain by sailing to the moon if we are not able to cross the abyss that separates us from ourselves? This is the most important of all voyages of discovery, and without it, all the rest are not only useless, but disastrous." ~ Thomas Merton

If I could impart one important and significant lesson I have learned since I walked across the stage and became a nurse, is you must be true to yourself and you must take care of yourself. You must stand up for what you believe in and be an advocate for your patients and yourself.

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. This will take so much out of you. If you are not strong enough to weather their storm because you have your own storms raging inside, then your health will suffer. Emotional, physical, spiritual health will be affected. Studies have shown that vicarious trauma, witnessing the trauma of other people, activates the same fight or flight process in the body and the brain as if you were the one being attacked by the bear on the trail.

A new term has surfaced in the past few years called "Compassion Fatigue". Compassion fatigue can occur anytime in a nurse's career. COVID-19 brought a whole new meaning to compassion and service in hospitals, facilities, and healthcare organizations. During one weekend at the height of the COVID-19 pandemic, 8 of my patients at one skilled nursing facility died. And mine is only one of the millions of stories that nurses all over the world were experiencing with patients and families. These were patients who had spouses, daughters, sons, friends, extended family who were not allowed to be with their loved one as they passed from this world to whatever you believe is next. One of these patients was a woman with end stage heart failure who lived on one side of a SNF while her husband of 68 years lived in another part of the facility. He visited her every day in his wheelchair without fail. But his visits stopped when she got COVID and was put in isolation in another part of the building that only allowed access to essential personnel. He could only visit her through a window. He couldn't hold her hand, kiss her cheek, or say goodbye to her properly. Day after day I watched his grief take days off his life. And she slipped away alone without the love of her life beside her. I watched this happen over and over during the pandemic. Patients who had friends and family died alone in a place that was not their home with strangers, mostly nurses. What does seeing so much death do to a nurse?

Compassion fatigue is defined as being exposed to other's suffering on a daily basis. Absorbing their pain as a consequence of service to others. As a human being with a range of emotions and beliefs, the suffering of others will have an impact on health. But as nurses, our exposure to suffering doubles and triples. The day-to-day absorption of other people's stress will cause a domino effect of the stress response and before we know it, we are flat on our backs and unable to work.

Do you have compassion fatigue?

According to McGrady (2022) symptoms of compassion fatigue can include:

  • Lowered concentration

  • Numbness or feelings of helplessness

  • Irritability

  • Lack of self-satisfaction

  • Withdrawal

  • Aches and pains

  • Exhaustion

  • Anger

  • A reduced ability to feel empathy

All of those symptoms contribute to a weakened immune system which can cause ill health.

For every negative there is a positive. Compassion satisfaction is finding meaning and purpose in our service to others. If I did not see and understand that I was helping people die peacefully despite this awful disease I would not have been able to stay on as a nurse. Every nurse who showed up during one of the most dangerous times to be an essential worker put their life and the lives of their families at risk. Burnout and vicarious trauma will make you ill or help you to become stronger. Whichever one we choose will change us.

How do we find satisfaction in our compassion for others? What can we do to recover from Compassion Fatigue?

The first step is awareness. Numbness and social isolation are two key symptoms of Compassion Fatigue. It is imperative that one treats Compassion Fatigue before it leads to depression and burnout. Awareness comes first, then naming the feelings is second. This can be done alone or with groups like members of a nursing unit, or a group of like-minded nursing students.

Ways to prevent or combat Compassion Fatigue are fostering healthy habits like

  • getting enough sleep

  • eating healthy

  • nutritious meals

  • keeping up with doctor’s appointments

  • practicing grounding or mindfulness techniques

  • work-life balance

  • taking a class in something that interests them (McGrady, 2022).

Ignoring the symptoms of Compassion Fatigue will not make it go away. Feeling, naming and doing those things that foster health and well-being helps to turn Compassion Fatigue into Compassion Satisfaction.

What can you do today to prevent Compassion Fatigue?

What gives you satisfaction at the end of the day?

Susan David (2016) has been doing research and writing about emotional trauma, agility, and resilience for many years. Her bestselling book, Emotional Agility gives valuable information and insight on the effects of emotional trauma on our psyche and how to survive and thrive.

She says, "Every day, we encounter the pain of others. And every day, we face a choice of how to respond: with apathy, sympathy, empathy, or compassion. A colleague is drowning under an impossible ocean of work. A friend is grappling with a messy divorce. A parent is worrying that their savings won’t be enough to carry them through retirement. A family member on the other side of the world is living in a war zone, struggling to survive.

We often use the terms sympathy, empathy, and compassion interchangeably, but they are quite distinct from one another, and these distinctions are key to healthy relationships and wellbeing.

  1. Sympathy is a simple acknowledgment: “I’m sorry you’re in pain.” You recognize what the other person is going through, but from a distance. You express your well wishes and your regrets for their situation. You sit across from them, but not beside them.

  2. While sympathy is separate from the other, empathy is shared: “I can imagine what your pain feels like.” You consider their experience, either cognitively or emotionally, and join them in their psychological space through perspective taking. Empathy doesn’t require you to have had the exact same experiences as another person—we can have empathy for a child who is scared of a monster under the bed even if we believe there is nothing there; we can have empathy for a cat in pain, even though we know full well that we aren’t that cat (though I must say, I’m sometimes envious of my cat’s life of luxury and would be open to trading for a day.) Empathy is powerful. Just feeling that someone else is willing to try to understand often makes our difficulties easier to bear. Compassion takes it one step further.

  3. Compassion asks us to take action in the service of another: “You are suffering, and I will do what I can to help.” You ease their burden in whatever way you're able, even if it’s as small as running an errand or cooking a meal. Compassion isn’t about rushing in to fix. It’s about offering whatever the other needs, whether that’s holding space, active listening, or choosing to see someone for who they truly are.

So how do we protect ourselves—and our ability to be compassionate—in a world that seems to be asking more and more of us each day? It’s crucial to recognize that “empathy fatigue” or “compassion fatigue” does not arise from having “too much” compassion or empathy. In fact, when we reduce empathy or compassion in the face of exhaustion or burnout, we're likely to perpetuate burnout rather than reduce it, because we numb our natural tendencies to connect and commune with others.

So instead of trying to blunt our inclination towards empathy or compassion, it can be helpful to think about how to enhance emotional regulation skills, including self-care, setting boundaries, and recognizing what is within our sphere of influence and what isn’t. Remember that in order to maximize our compassion for others and reduce our risk of burnout, we must also show compassion to ourselves. None of us can do everything for everyone. None of us can eliminate pain from the lives of the people we love. But all of us can do something, and accepting our own limitations is integral to a compassionate life.

The beautiful thing about compassion is that it’s a practice we can all develop. One way to become more compassionate is to notice moments in your daily life when you’re inadvertently withholding compassion. It’s easy to get so stuck inside our own heads that we miss opportunities to care for ourselves and others. We move through the world on autopilot, failing to realize the small ways we can contribute taking on an extra household chore to support an anxious spouse, calling a lonely friend who just moved to a new city. These simple gestures may not feel heroic, but compassion doesn’t require us to be heroes. It just asks us to be aware of what we can do for others while honoring what we must do for ourselves. David, S. (2016). Emotional agility. Penguin Usa.

You can find her book at Amazon or other bookstores. And she has lots of resources at that are free.

David, S. (2016). Emotional agility. Penguin Usa.

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