How to Beat Compassion Fatigue

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Compassion fatigue is a state experienced by those who help people or animals in distress. In essence, it is the cost of caring when Veterinarians do not balance the work they do for others with the care they provide to themselves.  It can be triggered by a singular traumatic event, such as a cruelty case, or by chronic generalised exposure to the stressors of veterinary life.  It exists on a continuum and can often be exacerbated by the challenges of navigating life as a new graduate; difficult clients, long hours, mental fatigue and reoccurring ‘firsts’ – the first complaint, the first euthanasia, the first performance review or the first disagreement with a colleague.  External factors such as home life, relationships, frequency of exposure to trauma and our overall mental health can impact our susceptibility to compassion fatigue.

What is known is that compassionate people get compassion fatigue. However, the symptoms, intensity and duration of compassion fatigue can vary between veterinarians. Signs and presentations can occur in the mind and the body leading to changes in emotions and behaviour.

Some commonly reported presentations are listed in the above image.

Ultimately, veterinarians can experience an impaired ability to feel empathy towards their patients, co-workers and even family members. The overwhelming sense of responsibility to patients and their owners can feel exaggerated and out of balance.  In the workplace, symptoms can include anger and irritability, poor concentration leading to mistakes, impatience and the dread of working with certain clients/pets.  Compassion fatigue can spark hyper-arousal leading to heightened anxiety, intrusive imagery/flashbacks, sleep disturbances and hyper-vigilance.  When we close our eyes at night we see the faces of those we care for and feel overwhelmed by everything we have to do tomorrow.

Whilst it seems obvious, improved self-care practices are the cornerstone for mitigating compassion fatigue.  Unfortunately, it is our compassionate nature that often sees us putting our own needs last and feeling guilty if we take time for ourselves.  Mindfulness, self-awareness and self-compassion are essential tools to assessing your well-being.

Focusing on self-awareness

  • Take time to identify your susceptibilities and vulnerabilities
  • Now identify your early warning signs in relation to the above
  • Take ten minutes a week to review where you are at, emotionally and physically. Consider what you did in the week before and what you have in the week ahead. Do you need to adjust any commitments, increase your self-care or lay low for the weekend?
  • Take one minute, three times a day to check in with yourself. The 5-4-3-2-1 Mindfulness Activity is helpful here. Whether you are able to step outside or just stand still, quieten your mind by noticing:
    • 5 things you can see
    • 4 things you can hear
    • 3 things you can touch
    • 2 things you can smell
    • 1 thing you can taste …
    • Now take a deep breath and check in with yourself. Learn to listen to your mind and your body and respond accordingly. Sometimes we simply need a few more deep breaths, to stretch tense muscles or eat something. This is also a great activity to do at the beginning and end of shift to signal transition.

Focusing on self-care

Now is the time to develop good self-care practices. They will help protect you against the challenges of the role. Everyone is different and it is important to start with the basics.

  • Sleep hygiene and routines should not be an after-thought when you’re a busy veterinarian. According to Sleep Disorders Australia, ‘sleep hygiene’ describes the healthy habits to ensure a restful night’s sleep. These include:
    • Going to bed and getting up at the same time where possible, with a recommended 7-9 hour sleep period for adults2.
    • If you’re prone to worrying or ruminating over the day’s events, consider setting a ‘worry window’. This means allowing yourself five to ten minutes to review any cases, tasks or interactions before you transition to bed. Write down any actions or questions for the next day rather than trying to keep everything in your head. Recognise what is in your control and out of your control in that present moment. Now ‘close’ your worry window, knowing your list will be there for you in the morning.
    • Transitioning to sleep i.e. sending your brain the signal that it’s time to rest. This can include turning off major lights, cooling the room, taking a shower or drinking a warm drink. It can also be useful to quieten the mind by removing smartphones. Avoid exercise, caffeine and stimulating activities before bed. This should also be the routine if you are on-call or trying to rest between after-hours calls.
    • Don’t force yourself to sleep. If you’re still awake after 30 minutes, get up and do something boring in another room. Keep lights dim. When you feel tired, return to your room. This helps your brain recognise that bedrooms are for sleeping.
  • Look after your body with good nutrition and regular exercise. Studies continue to show a strong relationship between the gut and our emotional state. We now know over ninety per cent of serotonin production occurs in the small intestine3. One Australian study also showed that playing sport three times a week can reduce psychological distress by up to thirty-four per cent4.
  • Plan out, and take, your annual leave. Also consider a conversation with your colleagues to schedule more frequent, short breaks for everyone e.g. four day weekends once a quarter. Many veterinarians report that life is much more manageable when they mentally and physically break the year into four chunks.
  • Find activities or hobbies where you don’t feel the passage of time
  • Limit your trauma inputs. Trauma inputs can include exposure to images, stories and people that traumatise or de-energise you outside of work. Whilst some of this is unavoidable, we do have control over how we access things like the news headlines.
  • Develop varied support networks early on in your career. Networks can range from other veterinarians to friends, family members, online communities, helpful resources such as podcasts and mental health professionals. Ensure your support network includes someone who can formally debrief you after stressful events.
  • Develop your skills and knowledge in areas that assist you to combat the challenges of vet life. Topics can include mindfulness, client communication techniques, resolving conflict, resiliency, goal setting and career planning and emotional intelligence. Developing your skills in mental resiliency will assist you to control what you can and let go of what is outside your circle of control or influence. Your self-worth should not be based on your production. A list of resources is at the bottom of this article.

Compassion fatigue exists on a continuum throughout a career.  It amplifies and diminishes based on current life circumstances, working conditions and the nature of the work we do.   Self-care strategies that have been shown to work are often deceptively simple, but like a muscle, they need to be used daily.  The real test is making a commitment, early in your career, to prioritise your psychological, physically and emotional needs to enjoy a long, healthy veterinary career.

Author
Ms Rosie Overfield
B. Communication, Dip. Counselling, MHROD, CVN
Learning & Development Manager at Crampton Consulting Group

Rosie is the Learning & Development Manager for leading industry firm, Crampton Consulting Group.  She has worked exclusively in the veterinary industry for the last two decades, both ‘on the floor’ as a veterinary nurse, and as a consultant, counsellor and speaker. Through her coaching and education programs, Rosie aims to empower Veterinarians to succeed in their careers without sacrificing physical and mental health.

Rosie has a Bachelor of Communication and a Master of Human Resources and Organisational Development. She is also a qualified counsellor, mindfulness teacher, veterinary nurse and mental health first aid instructor.

Rosie’s special interest in compassion fatigue, vicarious trauma and resiliency lead her to Canada in 2010, where she studied their application to veterinary teams. This has provided a solid foundation for her industry coaching programs.

References

  1. Compassion Fatigue in the Animal-Care Community. Figley C, Roop R. Humane Society Press, Washington, USA, 2006.
  2. Watson NF, Badr MS, Belenky G et al. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of Clinical Sleep Medicine 2015; 11(6): 591-592.
  3. Foster J, Neufeld KA. Gut-brain axis: how the microbiome influences anxiety and depression. Trends in Neurosciences 2013; 35(5): 305-312.
  4. Brumby S, Chandrasekara A, McCoombe S et al. Reducing psychological distress and obesity in Australian farmers by promoting physical activity. BMC Public Health 2011; 11(362). Retrieved from http://www.biomedcentral.com/1471-2458/11/362/prepub

Learning and Development Tools

Books:

  • Emotional Intelligence: Why it can matter more than IQ by Daniel Goleman
  • Mindfulness: An 8 week plan for finding peace in a frantic world’ by Mark Williams and Danny Penman (book)
  • ‘Resilience: The science of mastering life’s greatest challenges’ by Dennis Charney MD
  • ‘The Assertiveness Workbook’ by Randy J. Paterson

Podcasts and Apps:

  • Tara Brach (mindfulness meditations and short Q&A podcast)
  • Headspace
  • Smiling Mind
  • Calm