Nursing Compassion Fatigue and Burnout vs. Moral Injury

Nurses experience unexpected challenges daily — challenges that would quickly overwhelm most people. Yet despite the mental and physical toll these challenges take, nurses are expected to persevere. Knowing the difference between compassion fatigue, burnout, and moral injury is key to understanding how to address each issue.

As demand on healthcare workers increases, so does the psychological stress on nurses. In fact, many healthcare professionals take pride in their ability to endure long days and high-stress situations. But this attitude often keeps these individuals from engaging in the self-care they need to protect their health.

What is compassion fatigue?

Compassion fatigue occurs when a person is physically, emotionally, and spiritually exhausted from caring for others. To some degree, it hits almost everyone who cares for people who are suffering or who have experienced trauma.

Specific to healthcare, nursing compassion fatigue is a condition in which nurses are no longer able to empathize with patients as a result of burnout and secondary trauma. Nurses experiencing compassion fatigue derive little to no pleasure from their work and often struggle to get through the day. Compassion fatigue is the opposite of compassion satisfaction, in which nurses find meaning and a sense of self-worth in their work. Like nurse burnout and moral injury, compassion fatigue can directly compromise an individual’s job performance.

What are the causes?

Many of the factors that impact an individual’s mental health, including high stress levels, long hours, and secondary trauma, are a normal part of a nurse’s job.

Providing patient care is a demanding role. Many nurses spend their days meeting others’ needs and then go home and focus on meeting the needs of their children, parents, significant others, and friends. All of those demands on their time and attention can lead to compassion fatigue.

Compassion fatigue is often cumulative but can also develop as the result of a single traumatic event. The COVID-19 pandemic is a particularly good example of how a universal experience can be especially damaging for nurses’ mental health.

In addition to the reduced ability to feel empathy, signs of nursing compassion fatigue include:

• Emotional difficulties — anger, irritability, anxiety, increased cynicism, hypersensitivity, or insensitivity
• Mental changes — reduced sense of accomplishment or meaning in work, preoccupation or disengagement in social situations, or social isolation
• Physical troubles — sleep difficulties or frequent headaches or illnesses

Burnout vs. moral injury

Understanding the difference between burnout and moral injury is important, as using different terminology reframes the problem and the solutions. Burnout is characterized by symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment and has been discussed in the healthcare industry for many years.

Burnout, an occupational phenomenon (not a medical condition) resulting from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy. High patient loads, long shifts, complex care protocols, and high-stress, emotionally taxing situations can all contribute to burnout among healthcare professionals, harming their mental well-being.

What had been frequently confused as burnout has only recently been more accurately identified as moral injury — a relatively new term in healthcare. Moral injury has been described as a deep soul wound that occurs when a person feels they must take actions, or witness actions, that violate their deeply held moral beliefs. The term describes the challenges of simultaneously knowing what care patients need, but being unable to provide it due to constraints beyond a caregiver’s control.

Moral injury differs significantly from burnout and became more prevalent in nursing during the COVID-19 pandemic, as nurses were (any often still are) unable to care for patients as they traditionally had. These new pressures have forced nurses to confront morally challenging dilemmas. Moral injury can lead to depressive symptoms and contribute to burnout, interfering with a healthcare professional’s ability to perform their duties effectively.

How to help

Prevention and understanding the differences between compassion fatigue, burnout, and moral injury is key. If you have increased feelings of complacency, disengagement, or hopelessness — take notice of these signs. Establishing a good work-life balance will create boundaries that allows you to leave work stressors at work, a step that can help with reducing nurse burnout.

Nurses understand that following available guidance and resources to support their emotional and mental health is often easier said than done and will also not offer a quick fix. However, some small steps to prioritize self-care, such as getting enough sleep and exercise can go a long way in making sure you feel your best.

In a recent NurseDot podcast episode on “Burnout vs. Moral Injury,” Rola Aarmar, PhD, Partner in Behavioral Health Solutions at Relias, discussed what makes these issues complex and why current approaches may need restructuring.

“Addressing burnout and moral injury is not just about retention — keeping healthcare workers where they are,” said Aamar. “It should effectively do the opposite — offering them the opportunity to grow as professionals, as individuals.”

Throughout the podcast episode, Aarmar details her experience with both burnout and moral injury and offers solutions on how to help address both issues from a nurse and nurse leader perspective.

Compassion fatigue, burnout, and moral injury are drivers of nursing turnover. Understanding the different aspects of each can help you identify what’s bringing you dissatisfaction and help you take steps to find more joy in your career.

To talk about compassion fatigue, burnout, or moral injury with your fellow nurses, download the Nurse.com social networking app.