Compassion Fatigue and Burnout: Prevalence Among Oncology Nurses

Patricia Potter RN, PhD, FAAN

2010-11-03 10:59:16 Stephanie@ons. Welcome to the chat we will begin in a few minutes.
2010-11-03 11:00:41 Stephanie@ons. Today we will be discussing Compassion Fatigue and Burnout: Prevalence Among Oncology Nurses with Patricia Potter RN, PhD, FAAN
2010-11-03 11:03:34 dogsrgr8 Happy to be a part of this discussion
2010-11-03 11:04:09 Stephanie@ons. Dr. Patricia Potter is a nursing research scientist as Siteman Cancer Center at Barnes-Jewish Hospital and Washington University Medical Center. Dr. Poptter conducts and coordinates nursing research activities as well as evidence based practice projects. Her Co-PI on the project was Dr. Teresa Deshields Their research was an initial step inan effort to develop a compassion fatigue prevention program at Siteman.
2010-11-03 11:04:34 Stephanie@ons. Does anyone have any questions for Dr. Potter at this time?
2010-11-03 11:04:59 Bjzh@aol.com Patricia, I would like to hear about the compassion fatigue prevention program, thanks.
2010-11-03 11:05:34 dogsrgr8 We have just cfompleted two separate compassion fatigue prevention sessions.; We will not have a final evaluation until next Mahy
2010-11-03 11:05:58 dogsrgr8 The program involves 4 90 minute sessions (1 a week) and a final 4 hour retreat. Response of staff has been very positive
2010-11-03 11:06:36 Bjzh@aol.com Awesome, you have a good response today with this chat, we're all interested in ways to decrease compassion fatigue/burnout
2010-11-03 11:06:50 cherylvahl What does the content consist of?
2010-11-03 11:06:55 Adena What type of activities do your compassion fatigue prevention sessions entail?
2010-11-03 11:06:57 dogsrgr8 The Compassion fatigue program that we are developing focuses on understanding factors that trigger compassion fatigue and developing self care and self regulation strategies
2010-11-03 11:07:23 cherylvahl Specifically....?
2010-11-03 11:07:29 Adena Has counseling, journaling,or meditation been encouraged in these sessions?
2010-11-03 11:07:39 dogsrgr8 The program involves a great deal of group interaction and discussion. The staff also learn how to perform relaxation exercises to improve self regulation and minimize their responses to stressors
2010-11-03 11:08:08 Bjzh@aol.com Is the program supported financially by the institution or how is it funded?
2010-11-03 11:08:20 dogsrgr8 Counselling, journaling, and meditation are examples of personal self care strategies we encourage. We also discuss professional and spiritual strategies
2010-11-03 11:08:22 Adena Is there any research to support these interventions in oncology nurses?
2010-11-03 11:08:42 Adena Who developed your program?
2010-11-03 11:08:58 dogsrgr8 We received funding internally for this initial pilot project. We hope the results will lead to full funding so we can make it available to all nurses, not just oncology nurses
2010-11-03 11:09:14 cherylvahl Anything administratively/operationally that can be done to prevent, minimize compassion fatigue?
2010-11-03 11:09:58 peggyt Was the program offered to all staff or did you start with the nurses who scored high on burnout and fatifue
2010-11-03 11:10:09 dogsrgr8 We used a consultant to develop the program, Dr. Erick Gentry out of Sarasota Florida. He has done a great deal of work in this area. He developed our team. The three staff who conduct the sessions include a pastoral care staff member, a psych social worker and a PA in psych
2010-11-03 11:10:41 Bjzh@aol.com Patricia, I just did a presentation for my DNP on Burnout in Oncology Nursing, your CJON article on prevalence was helpful
2010-11-03 11:11:00 peggyt Your program appears to be well rounded.
2010-11-03 11:11:01 dogsrgr8 There is limited research on the specific results of any CF intervfention to my knowledge. Most research has simply been descriptive. There is no research on our specifric program. That is what we hope to have by next year
2010-11-03 11:11:46 dogsrgr8 I think the program is well roounded. Staff really gain insight into what affects them in their relationship with patients. We discuss the relationship of burnout and CF - two different phenomena. That helps I think
2010-11-03 11:12:14 dogsrgr8 I would strongly recommend any one interested in CF to survey their staff on the issue
2010-11-03 11:12:48 Bjzh@aol.com I'm a psych NP and my capstone project will involve a weekend retreat to decrease compassion fatigue/burnout correction in oncology nurses. I found research that indicates counseling, support and bereavement groups, retreats, and self care are all effective ways to help. The research said that combined self care programs and organizationally supported programs have the longest lasting effect
2010-11-03 11:12:51 Adena Why did you use the ProQOL tool as oppossed to other measures on CF?
2010-11-03 11:13:10 dogsrgr8 Dr. Beth Stamm has developed the ProQol IV which measures CF, burnout and compassion satisfaction - we used it in the study in CJON
2010-11-03 11:13:23 Bjzh@aol.com Did you also use the MBI?
2010-11-03 11:13:31 dogsrgr8 The ProQolIV has been used in other studies dealing with CF.
2010-11-03 11:13:53 dogsrgr8 In our actual study (which is underway) we added the MBI - yes
2010-11-03 11:14:15 dogsrgr8 We are also using a staff satisfaction instrument in the current study
2010-11-03 11:14:56 dogsrgr8 Other questions? Are any of you involved in trying to develop CF intervention programs?
2010-11-03 11:15:04 Adena Do you feel as though the MBI and the burnout subscale of the ProQOL both measure burnout equally well or was there a need to add the MBI?
2010-11-03 11:15:11 Bjzh@aol.com Compassion fatigue and burnout are closely related as you know, I'm having a hard time focusing on one vs the other. Look forward to seeing your staff satisfaction survey tool, will it be awhile before you publish results?
2010-11-03 11:15:43 dogsrgr8 To be honest we added the MBI because we thought it was a bit more comprehensive, but I have no data on that
2010-11-03 11:16:16 Bjzh@aol.com MBI has been arond longer/gold standard, probably adds to validity of your results, (Maslach Burnout Inventory)
2010-11-03 11:16:18 dogsrgr8 The study will not be completed until May. We just finished the second CF session and we are following staff for 6 months to measure improvement
2010-11-03 11:17:01 Adena Do you have any plans to replicate this study on a larger scale with ONS?
2010-11-03 11:17:44 Bjzh@aol.com Adena-great idea, would be nice to have a compassion fatigue intervention/retreat sponsored by ONS
2010-11-03 11:17:53 dogsrgr8 Good question. Are main goal is to show the need for a program like this. We want to get internal support for a program we could make available to all onc nurses and then all nurses within the organization. We would love to partner down the road with anyone interested
2010-11-03 11:18:01 Adena Will your future study focus solely on nurses or will you continue to include other staff?
2010-11-03 11:18:21 Bjzh@aol.com Sign me up...Bjzh@aol.com :)
2010-11-03 11:18:44 dogsrgr8 OUr first study included other healthcare providers. We focused on nurses because our nurse managers were the ones expressing interest in the problem. We believe it should be open to all healthcare providers
2010-11-03 11:18:56 dogsrgr8 Bjzh where are you located?
2010-11-03 11:19:48 Bjzh@aol.com Cincinnati, my future intervention will be for oncology nurse only b/c I think nurses have our own CF needs, would hope to replicate with nurses from other areas, it will be awhile before I can implement, but your study will help
2010-11-03 11:20:25 Bjzh@aol.com Getting back to your earlier question, wondering if others in the chat room have programs in place
2010-11-03 11:20:36 Bjzh@aol.com participants?
2010-11-03 11:20:41 dogsrgr8 Interestingly, for anyone looking for a research project. Another group that is not even addressed with regards to CF is family caregivers
2010-11-03 11:20:52 Adena I am a doctoral student who has been interested in studying self transcendence as a potential protective factor against compassion fatigue and burnout in the oncology nursing population since 2006. Unfortunately, the road to doctoral study is taking a little longer than I had originally thought and I thank you for sharing all this information!
2010-11-03 11:21:16 dogsrgr8 Glad to help, willing to help any time
2010-11-03 11:21:17 Bjzh@aol.com Adena-I can relate, doing my DNP one class at a time b/c of work:)
2010-11-03 11:21:57 Bjzh@aol.com Adena, where are you getting your doctorate?
2010-11-03 11:22:11 Adena Seton Hall University in New Jersey
2010-11-03 11:22:39 dogsrgr8 Jersey Shore!!
2010-11-03 11:23:28 Bjzh@aol.com your email address to keep in touch? and yours Patricia if your willing? My work email is: Mhap65@ucmail.uc.edu would like to be in touch with anyone here working on similar projects or literature seaches.
2010-11-03 11:23:29 Adena Lol, I have been an oncology nurse for 12 years and definately have seen CF first hand in my staff. This is all very important work everyone is doing as the work we do is not easy!
2010-11-03 11:24:02 Bjzh@aol.com I've seen it more in oncology than in psych or OB, intensity of emotional work is higher, research verfies
2010-11-03 11:24:11 Stephanie@ons. Welcome to the Chat Susan.
2010-11-03 11:24:15 dogsrgr8 No it is not. The beauty of oncology nursing is that we do get to form relationships with patients over time - but that can be exhausting as well follow them in their journey
2010-11-03 11:24:59 dogsrgr8 I agree there are certain areas where CF is more likely. Our study showed differences in inpatient vs outpatient for example
2010-11-03 11:25:14 Bjzh@aol.com Inpatient higher CF than outpt?
2010-11-03 11:25:32 Adena My email is aromeo@princetonhcs.org
2010-11-03 11:25:58 dogsrgr8 An interesting finding we learned in the first study (CJON article) was the risk that nurses with advanced degrees face. This was confirmed in earlier work. I believe these nurses have high expectations that cannot alwaysw be met and it adds to their CF
2010-11-03 11:26:13 dogsrgr8 Inpatient had lower compassion satisfaction than outpatient
2010-11-03 11:26:13 Bjzh@aol.com thanks, hopefully we'll have email addresses for future networking from this transcript
2010-11-03 11:27:00 dogsrgr8 My email is pap1212@bjc.org
2010-11-03 11:27:08 peggyt I I would love to see your final data
2010-11-03 11:27:38 dogsrgr8 We will definitely publish once we are completed.
2010-11-03 11:27:47 Bjzh@aol.com I found in an ANA staffing survey that burnout was higher in younger nurses (under 30) than those over 30, lateral violence is a closely related concept which I think is higher in nurses over 30 don't you?
2010-11-03 11:29:09 rain5393@aol.com Lateral violence?
2010-11-03 11:29:32 dogsrgr8 Our staff with only 6 to 10 years of healthcare experience had the highest risk for burnout
2010-11-03 11:29:50 Bjzh@aol.com nurse to nurse violence, that competitive, blaming, negative behavior..."tormentorship" rather than "mentorship" as Brenda Nevidjon termed it
2010-11-03 11:29:57 dogsrgr8 Lateral violence basically involves the verbal abuse exprfessed between staff members
2010-11-03 11:30:36 Bjzh@aol.com there was a good CJON column on Lateral Violence a few years ago in a profession issues column if you want to take a look
2010-11-03 11:31:18 dogsrgr8 For those of you wondering the differences between CF and burnout - CF is a response to the relational connection, burnout more to the work environment, but they do intertwine. Research shows that Nurses and healthcare providers with high compassion fatigue are less empathic
2010-11-03 11:31:40 dogsrgr8 There are numerous articles on lateral violence out there
2010-11-03 11:31:40 Bjzh@aol.com thanks for that definition Patricia
2010-11-03 11:31:43 rain5393@aol.com I work in a small community hospital with outpt oncology/infusion center. Only 4 nurses, has seen some of that. When I work the other floors, I have been seeing much more of it. Maybe we need to develope a plan of all nursing staff.
2010-11-03 11:32:05 dogsrgr8 Agree
2010-11-03 11:32:50 Bjzh@aol.com interesting, I think LV has to do with individual personality issues as well, sometimes can't be "fixed" but limits can be set/confrontation about need to work harmoniously vs competitively
2010-11-03 11:33:13 Adena I have taken a few online courses on CF through the Figley Institute which I found were very helpful in helping to explain CF and deferentiate it from other related concepts. Just a thought for some who may want to learn more...
2010-11-03 11:33:28 peggyt I I wonder how much of the lateral violence relates to the nurses being burned our or compassion fatigue
2010-11-03 11:33:38 Bjzh@aol.com couldn't find any articles on the relationship of LV to CF or burnout but I'm sure LV is a contributing factor or comes from burnout nurses
2010-11-03 11:33:44 Adena That would be an interesting study!
2010-11-03 11:33:49 dogsrgr8 With all of the emphasis on the use of simulation in nursing education. Nursing students should have the chance to work through some exercises involving lateral violence. We also need more programs to help staff minimize this. Lateral violence can be a symptom of compassion fatigue
2010-11-03 11:34:24 dogsrgr8 If you look at the symptoms of CF - one is relational difficulties. Nurses tend to blame other caregivers. it is clearly an example of lateral violence
2010-11-03 11:34:50 dogsrgr8 there are three groups of symptoms in CF: intrusive, arousal and avoidance. Relational difficulties fall under avoidance
2010-11-03 11:35:33 rain5393@aol.com Have seen a lot of that in the past few months. Thanks for info on Figley Institute, will check it out.
2010-11-03 11:35:45 dogsrgr8 Bjzh - if you are looking for more literature on CF try Erik Gentry as an author
2010-11-03 11:36:01 dogsrgr8 I mispelled Erik earlier
2010-11-03 11:36:07 Bjzh@aol.com thanks, will do, just starting the lit search, will also look at Figley
2010-11-03 11:36:19 dogsrgr8 Absolutely. Gentry uses a lot of his work
2010-11-03 11:36:29 Adena Figley has several books out on CF, too
2010-11-03 11:36:56 Bjzh@aol.com thanks, I have both references from you article Patricia
2010-11-03 11:38:13 Bjzh@aol.com Adena-can u elaborate a bit on self transcendence as an intervention to prevent CF?
2010-11-03 11:40:23 Bjzh@aol.com would also like to hear if anyone else has programs in place like staff support/bereavement groups?
2010-11-03 11:41:55 dogsrgr8 Our pastoral care staff do a lot of support for staff bereavement
2010-11-03 11:41:59 rain5393@aol.com We have a Cancer support group for community, staff can attend. We don't have anything for staff.
2010-11-03 11:42:32 dogsrgr8 the local wellness community has a program for caregivers and patients. I would imagine staff could attend
2010-11-03 11:42:39 cherylvahl Do your chaplains do debriefings or individual counseling for staff?
2010-11-03 11:42:52 dogsrgr8 I believe they do both
2010-11-03 11:43:04 Bjzh@aol.com good question, how many of you have on site counseling available for staff?
2010-11-03 11:43:15 dogsrgr8 We also have a psychologist on staff
2010-11-03 11:43:18 susan.drago@duke.edu Our social workers help us with debriefings when needed
2010-11-03 11:44:44 peggyt We do not have routine groups for staff. Our social worker and pastorial care department belp with debrieifings as needed. In addition staff can take advantage of 3 counseling sessions a year.
2010-11-03 11:45:05 dogsrgr8 One of the challenges we see is as we go forward - being sure to conduct the CF program at the best time for staff to access. Our study involves 4 90 minute sessions (once a week) - we know some staff chose not to participate because it was the end of the day. The class does work best in several sessions, not one large session. Not sure of the right mix yet
2010-11-03 11:45:43 rain5393@aol.com I recently lost my husband to cancer, I have had a great deal of support from my workplace, it has been amazing, but we have no program in place for general support, or dealing with this issue. We do a staff member who will do counceling, not many use it.
2010-11-03 11:45:59 Bjzh@aol.com Patricia-I used to co lead a staff support & bereavement group with a SW on a BMT unit, we rotated between day, eve, and night shift each month...and brought bagels/coffee which helped :)
2010-11-03 11:46:24 Bjzh@aol.com Rain, sorry to hear about your lost but great that your workplace is supportive
2010-11-03 11:46:33 dogsrgr8 Food is always a wonderful incentive :)
2010-11-03 11:47:21 dogsrgr8 Rain - as both a nurse and a family caregiver I am sure you have been exhausted.
2010-11-03 11:47:52 Bjzh@aol.com I've found that work can help with our own grief, I volunteered as a group facilitator at a grieving center here and it helped me with grief for my brother's death, hope you are getting help for the loss of your husband, grief is a process as you know, you have to move at your own pace
2010-11-03 11:48:52 Bjzh@aol.com grief is also related to CF and burnout, we witness alot of death and death of young, those receiving futile care...so difficult, thank goodness for the supports you all have in place, thanks for that info
2010-11-03 11:49:34 Stephanie@ons. We will be posting the transcript of this chat on the ONS Website under the Virtual Journal Club on the Publications tab.
2010-11-03 11:49:47 dogsrgr8 Thanks for everyone's input
2010-11-03 11:50:02 Bjzh@aol.com Great chat Patricia, thanks for your help and expertise!
2010-11-03 11:50:15 dogsrgr8 You are welcome
2010-11-03 11:50:23 rain5393@aol.com It was exhausting. But being at work actually gave me a break, strange as it sounds.
2010-11-03 11:50:23 Stephanie@ons. As our time winds down, does anyone have any last questions for Patricia?
2010-11-03 11:51:00 dogsrgr8 Not strange - a place where you could focus on something else to think about. Same thing happened to me years ago when my mother died
2010-11-03 11:52:02 rain5393@aol.com it is helping now, still hard.
2010-11-03 11:52:31 peggyt Patricia, thank you so much for sharing your work with us. Rain I wish you well.
2010-11-03 11:52:44 dogsrgr8 If there are no more questions about CF and our journal article, may I sugest we log off?? Best of luck to all of you
2010-11-03 11:53:06 rain5393@aol.com thank you
2010-11-03 11:53:38 Stephanie@ons. Thank you all for coming and the great discussion. Thank you Patricia for your article and your time today!! Join us agiain on the 18th at 12pm EST.