Compassion Fatigue: What It Is, What It Does and How To Fight It

Compassion fatigue is fairly well-known in human caring industries, but it’s less well-known – and more common – in animal care and welfare. Veterinarians and shelter workers are particularly vulnerable to compassion fatigue due to the emotional fluctuations between extreme highs and lows that may occur several times per day – every day.

According to the study, Prevalence of Risk Factors for Suicide Among Veterinarians – United States 2014, veterinarians have the highest suicide rates in the medical field and suffer from twice the severe psychological distress than the general public. And it’s not just experienced veterinarians who have been exposed to years of trauma; one in six graduates admit to considering suicide.

An earlier study (in 2010) on veterinary surgeons and suicide found that veterinary surgeons are four times more likely to commit suicide than the general public and twice as likely as other healthcare professions.

What is compassion fatigue and why are veterinarians and shelter workers more at risk?

Compassion fatigue has been defined by Dr. Charles R. Figley and Dr. Robert G. Roop as: “… a state experienced by those helping people or animals in distress … an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic experience for the helper.”

Death is the main reason veterinarians are more at risk than other medical workers, according to Jennifer Brandt, PhD, a licensed social worker at The Ohio State University College of Veterinary Medicine. Veterinarians have to cope with death daily, often several times a day. In fact, they have to deal with death five times more often than other healthcare professions. Often death is preceded by severe pain. Sooner or later, all of the death and suffering is going to take a serious toll. And, unfortunately, most universities don’t offer sufficient training on how to cope with death and morbidity.

Because their work environment is so much more stressful and emotionally charged in general, veterinarians at shelters are even more at risk.

What causes compassion fatigue among veterinarians and shelter workers?

It’s no surprise that euthanasia is a major contributing factor to compassion fatigue in veterinarians. But pet parents, especially those who are difficult to deal with or who neglect their pets, top the list of stressors.

There is also the fact that many veterinarians get to know their patients and their families over the years, so when the time comes to make that final difficult decision, not only do they have to try help the grieving parents, but they also have to cope with their own grief. Unfortunately, there usually isn’t time, and they have to move onto the next patient with emotions firmly under control.

Moral stress and ethical dilemmas affect veterinarians in the private and welfare sector, and are major contributors to compassion fatigue. Dr. Elizabeth Strand, a psychotherapist specializing in compassion fatigue, says that veterinarians face ethical dilemmas 3 – 5 times per week. Most often this is when clients want them to perform euthanasia when it’s not necessary (convenience euthanasia) and when clients don’t want them to perform euthanasia when it is necessary. In an ideal world, the animal’s welfare comes first, but in reality that isn’t always possible.

Other factors that lead to compassion fatigue include:

• Personal characteristics and personality traits. The more empathetic and compassionate the veterinarian, the greater the risk for compassion fatigue.
• Professional and social isolation
• Self-medicating (drugs and alcohol)
• Suicide contagion (found by the 2010 study) which is when surgeons are exposed directly or indirectly to suicide among their peers.

Signs of compassion fatigue

• Dreading work when you wake up in the morning
• Constant exhaustion
• Weight loss or gain
• Feeling overwhelmed by grief with no outlet
• Apathy towards colleagues and patients
• Excessive complaining and blaming others
• Trouble falling or staying asleep
• Difficulty concentrating
• Constant headaches or other lingering, niggling aches and pains
• Loss of interest in hobbies and activities
• Intrusive negative thoughts and negative self-talk
• Loss of joy and hope
• Excessive guilt about not doing enough to help
• Questioning your ability to make a difference
• Increased anger and irritability and tendency to snap at family and co-workers
• Hypersensitivity to situations and people
• Recurring nightmares

Note, it’s not only important to pay attention for these signs in yourself, but you should also look for the signs in your co-workers. They might desperately need help or support but be unwilling or unable to ask for it.

Most people involved in animal welfare mask the symptoms because they don’t want to be perceived as weak and unable to cope with a job they should love. And because there is still some stigma attached to mental illness, practitioners may worry that it will affect their professional reputation.

Stages of compassion fatigue

Compassion fatigue usually consists of 5 stages, according to a model by Dr. Eric Gentry and Dr. Anna Baranowsky. The stages are cyclical and not linear.

Stage 1: Zealot Phase

• Enthusiasm and excitement for work that leads to working late, taking on additional work, and devoting large amounts of time to each family.

Stage 2: The Irritability Phase

• Enthusiasm wanes, leading to short-cuts, client avoidance, distraction seeking, and lack of attention, mistakes, and social isolation.

Stage 3: The Withdrawal Phase

Stage 4: Zombie Phase

• Operate on automatic without much thought or consideration, emotional numbness, disconnection from family, friends and co-workers, loss of compassion, and intrusive feelings of helplessness and hopelessness.

Stage 5: Pathology or Renewal

Pathology

• Constantly overwhelmed, even by little things, mental illness (chronic anxiety and depression), and compulsion to leave the profession.

Renewal

• Second wind with renewed hardiness and resilience and transformation (will do things differently – better, more efficiently and effectively).

During the first 3 stages, intervention and support by friends, family and colleagues may be sufficient to overcome compassion fatigue. However, the Zombie stage represents a point of no return and professional help is usually needed to overcome the problem.

Organizational compassion fatigue

Compassion fatigue can be contagious and infect an entire veterinary clinic or practice. Once organizational compassion fatigue sets in, the business will be plagued by inefficiency, loss of clients and cost to reputation.

Signs of organizational compassion fatigue include:

• Absenteeism from all or most staff members
• High staff turnover
• Excessive workers’ compensation claims
• Tasks left unfinished or not even started
• Rigid thinking
• Gossip mongering and snide complaints
• Loss of team cohesion, which affects ability to work together
• Resentment and confrontation
• Competition among staff members
• Short tempers and flare ups between staff members

It’s important for management to recognize that compassion fatigue is behind the problems and that steps are taken as soon as possible to minimise damage and address staff needs. In some cases, this may require a change in business practices, and may even call for professional consultation. Katherine Dobbs, a veterinary management and human resources consultant, suggests the following:

• Monitor workloads – workloads can be discussed at staff meetings or privately.
• Insist staff take their coffee and lunch breaks, and use their vacation time.
• Allow for debriefing sessions following traumatic appointments.
• Provide opportunities for skills training.
• Arrange team-building activities to strengthen the bond between staff members.
• Introduce mentoring programs.
• Allow time off for professional support or counselling.
• Acknowledge good work.
• Encourage, value and praise compassion.
• Allow staff to spend extra time with grieving or emotional clients.
• Respect and appreciate all employees.
• Keep lines of communication open.

The more understood and supported staff feel, the better they can function and the better the service they provide.

Coping with and overcoming compassion fatigue

Once you admit that you have compassion fatigue, you can take steps to minimize its impact and manage stress.

Katherine Dobbs suggests:

• Accept that the situation is stressful and no one is to blame, and then decide on the best reaction.
• Talk about your feelings and experiences. Debriefing sessions at work are important, but you can also talk to friends, family and mentors.
• Improve your communication skills and learn to talk about your feelings and experiences in a healthy way so you can let go and move on. Many counsellors provide communication courses or sessions.
• Take back control of your environment and circumstances and attitude. A positive approach allows you to focus more on the good than the inevitable heartbreak.
• Don’t just complain to management, instead bring solutions to the table for consideration.
• Take good care of yourself. Eat a healthy diet, get exercise, meditate (it really helps), get enough sleep, make time for personal interests, and take a few minutes every day just for you.
• Step away from stress at work. If you start feeling overwhelmed, stop and focus on your breathing for a minute (quick meditation) or sit in the car and listen to some of your favorite happy songs.
• Accept help. It’s difficult to ask for help, but it’s also difficult to accept help offered, so learn to trust others enough to delegate tasks and let them pull their weight too.
• Learn to say no without guilt. You can only do so much and you need to recognize your limits. Your co-workers also need to respect your limits. When your to-do list is manageable you can dedicate energy and attention to those tasks, and you’ll be more efficient and effective and will feel better about the quality of your work.
• Give yourself credit and give credit to others. People like to be recognized and appreciate gratitude, and once you appreciate others, you’re likely to be appreciated in return.
• Be true to yourself. If you have a client with whom you continually butt heads, simply terminate the relationship and recommend another clinic where they might be more comfortable.

The people drawn to caring professions usually feel compassion towards others, but struggle to have compassion for themselves. It’s important to remember that you can’t keep pouring from an empty cup. Take care of yourself and you will be able to take better care of others.

Compassion Fatigue Project

 

Another initiative to help veterinarians manage compassion fatigue is the introduction of the veterinary social work program at the University of Tennessee. Dr. Elizabeth Strand developed the program so that veterinarians, vet techs and nurses, and shelter workers can access professional support designed specifically for their unique needs. Taking UT’s pioneering program as an example, the Universities of Michigan and Missouri have launched their own veterinary social work programs.

In addition to these new initiatives, veterinary schools have also recognised the importance of including compassion fatigue and other mental health stressors in their courses. This way, students are aware of the risks, and can better monitor and manage their emotional and psychological well-being. And, the University of California, Davis, offers on-campus support with one full-time and one part-time counselor specifically for veterinary students. In addition to counselling, students can also join yoga groups, art projects and a surfing club, and visit massage therapists.

The bottom line is that veterinary students need more compassion fatigue training and awareness in courses, so that they can recognize it in themselves and take steps to prevent it from developing further. Education will also help students take awareness with them into their new jobs. Universities also need to make more support options available to veterinary students.

Veterinary clinic managers should also do their utmost to ensure that naturally stressful and challenging work environments have processes in place to help staff cope with trauma.

A small ‘thank you’ can go a long way

It’s true that veterinarians and animal welfare workers need to take care of themselves so that they can take care of others … but it’s also true that we need to take care of the people who keep our furkids healthy. A little bit of gratitude, appreciation and understanding fully expressed will go a long way towards making someone’s day.