Recognizing the Signs of Burnout and Compassion Fatigue

Recognizing the signs of burnout and compassion fatigue View PDF

Burnout

Burnout has been referred to as an “unintentional end point” for certain individuals who are exposed to chronic stress within their working environment.1 These job-related stressors can leave people feeling overworked and can occur when there is conflict between coworkers, responsibilities and work demands exceed available resources, and when there are feelings of having no control over the quality of services and work provided, loss of economic security or position, feelings of inequity or lack of respect, or a gap between one’s individual values and the organizational goals.2,3

From the research perspective, burnout is considered one of the elements of Compassion Fatigue.4 From the organizational and social work perspective, it is often distinguished as being different from compassion fatigue in that burnout arises from where one works, whereas compassion fatigue is associated with the work you do.2 Three primary characteristics of burnout according to psychologists and social workers include:2,4

  • Feelings of hopelessness. Burnout is associated with feelings of hopelessness and difficulties in dealing with your work or in doing your job effectively and these negative feelings usually have a gradual onset. They can reflect feeling that your efforts do not make a difference or can be associated with a very high workload or a non-supportive work environment.
  • Exhaustion. You may feel worn out, overwhelmed, drained, tired, and lacking adequate energy. Physical problems include stomach pains and digestion problems.
  • Alienation from job-related activities. You may feel trapped by the work you do. You find your job increasingly negative and frustrating and develop a cynical attitude toward your work and your colleagues. At the same time, you may distance yourself emotionally from your work.
  • Reduced performance. Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout tend to be negative about their activities, find it hard to concentrate, are listless, and lack creativity.

You might be wondering how to assess your personal levels of compassion fatigue, compassion satisfaction, and burnout. A scientifically validated assessment tool called the Professional Quality of Life5 scale is available at proqol.org.

Click on Proqol Measure and Tools and look for Proqol Measure. It was written for caregivers in human medicine like paramedics, psychologists, and social workers; however, it has been used in research studies and clinical work with veterinarians.8,9 Changing the word “person” to client or patient when you complete the scale will help give you better context to accurately answer the questions.

Compassion Fatigue

Compassion fatigue is defined as an overexposure to suffering and pain that can cause personal stress and a reduced ability to be empathetic. 5,6 This stress occurs from a wish to relieve suffering for professional caregivers, like veterinary professionals. However, when work or personal stressors exceed the ability to cope, it can result in psychological and/or physical symptoms that can disrupt a person’s ability to function at work or in one’s personal life. In comparison to burnout, compassion fatigue results from caregivers who frequently must deal with highly distressing situations involving their patients and, in our case as veterinary professionals, animal owners, clients and producers (the people part of the veterinary work). It has been considered the “cost of caring”. 1,5,6

Some experts believe compassion fatigue is a misnomer because it is not fatiguing to extend compassion to others. 7 Empathy fatigue is a term that is popping up to describe the emotional exhaustion which caregivers, including veterinary professionals, experience. One of the reasons for this shift in terminology is recent neurobiological research that shows the cerebral networks activated by acts of empathy are very different than the areas of the brain that are activated by acts of compassion. Compassion lights up the areas of the brain that release positive neurotransmitters such as oxytocin and vasopressin, making one feel revitalized.7 On the other hand, extending empathy activates brain areas that sense and perceive pain and feelings of stress resulting in a depletion of feel-good neurotransmitters. 7

You may begin to see the term empathy fatigue replace compassion fatigue in the literature. Regardless of the term used, as veterinary professionals we experience fatigue when we get too attached to alleviate the suffering of our patients, take on the pain of what others, such as owners, clients, and producers, are feeling, or overtax and exhaust our empathy reserves when we work too deeply in emotionally charged situations.

Watch this presentation by Dr. Brian DiGangi, DVM, MS, DABVP, Senior Director, Shelter Medicine, ASPCA, as he describes different definitions of compassion fatigue, signs, and symptoms, and helpful strategies in an evidence-based way:

Trajectory of the Signs and Symptoms of Compassion Fatigue

Dr. Anna Baranowsky1 has described a trajectory of the signs and symptoms of compassion fatigue. It is not a linear path as a person may have behaviours or thoughts at one time that align to a couple of the phases.

Zealot Phase

  • You have overflowing enthusiasm and go the extra mile without complaining or prompting, willing to stay late or put in extra hours, and you feel we are making a difference.
  • You will make excuses because you think you are super-human. So, you say things like, “I can deal with this stress because I am a veterinary professional.” Or “I’ve been doing this for 10 years, but I am okay, I can handle this.”
  • At times it might feel like you are losing control, so you roll up your sleeves and work harder, becoming a workaholic because you think the work will make your stress or bad feelings go away.
  • Stress starts to affect you and you may experience rapid heartrate, breathing difficulties, aches and pains, shock, sweating, and dizziness.5

Irritability Phase

  • You lose your sense of humour.
  • You begin to cut corners at work.
  • You daydream and get distracted when colleagues or clients are talking with you
  • You make mistakes or oversights.
  • You become cynical and mocking others, talking about them unfairly and with criticism.
  • You feel undervalued and under-resourced, like what you have is not enough to get the job done. You might blame others for not having the resources or putting up protocols or processes that seem like obstacles to getting your work done. You might feel ashamed, thinking that you should be able to handle it, but beating yourself up because you can’t.
  • This is in stark contrast to how you felt in the zealot phase or when you started the job. Maybe you did feel under-appreciated or undervalued at an earlier point, but you said to yourself, “That is okay, the animals need me. I need to care for the animals. I’m not in this for the people. I want to do this.” But then somewhere along the way you say, “That is not okay. I do not have enough or have what I need to succeed.” It is noteworthy that likely there was no change in the circumstances, situation or work tasks, rather there is a change in how you are responding.
  • You become impatient, irritable, moody, angry.5

Withdrawal Phase

  • You are tired all the time. Your sleep patterns are altered; either you sleep all the time or you can’t get to sleep, or you wake up in the middle of the night and you can’t fall back to sleep.
  • You get colds, one cold after another, one cold runs into another. Your cough never clears up.
  • You might fall into the trap of self-entitlement. Self-entitlement is a justification of your negative and maladaptive behaviours because of the positive things you stand for, sort of like a quid pro quo. It’s like wearing an invisible badge of honour on your sleeve. “I stayed up all night with this sick patient, so I am a little cranky today and biting everyone’s head off, but I’m sure you get it. Look at me, I am a hero and so committed to my work.” Or, “I worked overtime every single day this week, so I am getting wasted this weekend.” We begin to justify the negative behaviours because of the things we do and what we believe in.
  • There are complaints about you at work or in your personal life.
  • Patients start to blur in your mind, the cases all run together. You experience difficulty concentrating, confusion, spaciness, whirling thoughts, and blurring thoughts.
  • You see patients and owners/clients/producers as irritants and not as individuals deserving of attention.
  • You may start to neglect, withdraw and detach from patients, clients, family, co-workers and yourself.5
  • The potential for thoughts of self-harm or harming others arises.5
  • The potential for use of negative coping techniques (smoking, alcohol, or other substance abuse and misuse) arises.5

Zombie phase

  • You are on autopilot, just going through the motions.
  • You no longer are good on the job, making mistakes.
  • You feel disconnected.
  • You have nothing left to give. You feel depleted, emptied out, and numb.
  • The potential for thoughts of self-harm or harming others arises.5
  • The potential for use of negative coping techniques (smoking, alcohol, or other substance abuse and misuse) arises.5

Please get help if you are feeling any of these signs. It is possible to disembark from this trajectory with self-awareness and accessing support. If you are in crisis, have thoughts of self-harm, harming others, or thoughts of suicide, go to your local emergency department or call 911 immediately. You can also contact the Canada Suicide Line at 1-833-456-4566 or text 45645 if you have thoughts of suicide. They can connect you to your local crisis centre.

See Appendix A for the “Who ya gonna call list” for other support including a list of Employee Family Assistance Plans (EFAP) and phone numbers offered by your provincial veterinary association. EFAP provide telephone, online, and in person help to address a full range of mental health issues including, but not limited to, family and relationship issues, trauma, depression, anger management, stress management and more.

You may be wondering how to learn strategies to deal with compassion fatigue. Check out this online course: sheltermedicine.vetmed.ufl.edu/education/courses/compassion-fatigue-strategies/

This checklist was written by Dr. Kathy Keil. Dr. Keil studied cognitive and neuropsychology in her undergraduate and graduate psychology degrees prior to attending veterinary school. She is not a licensed psychologist. She has training in Mental Health First Aid, safeTALK suicide awareness, ASIST suicide intervention, and is licensed to teach safeTALK. She regularly teaches suicide awareness and basic intervention skills to veterinary professionals and ways for them to take care of their own mental well-being. She is a member of the ABVMA Member Wellness Committee and a technical services veterinarian with Merck Animal Health. She is the leading force behind the Merck-CVMA “It’s Time to Talk about Mental Health in Vet Med” Awareness Campaign.

References:

  1. Baranowsky, A. B., & Gentry, J. E. (2011b). Workbook/Journal for a Compassion Fatigue Specialist. Toronto, Ontario, Canada: Psych Ink Resources. Available FTP: http://www.psychink.com
  2. Brandt, J. http://veterinarynews.dvm360.com/burnout-compassion-fatigue-depression-what-s-difference
  3. Raab, Kelley. "Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature." Journal of health care chaplaincy 20.3 (2014): 95-108. www.h-partners-for-life.com/wp-content/uploads/2017/04/Mindfulness-Self-Compassion-and-Empathy-Among-Health-Care-Professionals-A-Review-of-the-Literature.pdf
  4. B. Hudnall Stamm, 2009-2012. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL)
  5. Figley, Charles R., and Robert G. Roop. Compassion fatigue in the animal-care community. Humane Society Press, 2006. https://animalstudiesrepository.org/cgi/viewcontent.cgi?article=1004&context=ebooks
  6. Figley, Charles R., ed. Treating compassion fatigue. Routledge, 2002.
  7. Dowling, Trisha. "Compassion does not fatigue!." The Canadian veterinary journal= La revue veterinaire canadienne 59.7 (2018): 749-750. https://europepmc.org/articles/pmc6005077
  8. McArthur, Michelle L., et al. "The Prevalence of Compassion Fatigue among Veterinary Students in Australia and the Associated Psychological Factors." Journal of Veterinary Medical Education 44.1 (2017): 9-21.
  9. Smith, Nicola. "A questionnaire based study to assess compassion fatigue in UK practising veterinary nurses." The Veterinary Nurse 7.7 (2016): 418-425.

Appendix A

Who Ya’ Gonna Call List

This is a list of community resources that can offer mental health help and support including suicide intervention and crisis support. Make this list personal. Add phone numbers for help and support in your own local community.

Please visit your local emergency department or call 911 immediately if you are in crisis.

Call Canada Suicide Support at 1-833-456-4566 or text 45645 if you have thoughts of suicide or you are with someone who does. This is a crisis line for immediate help when in crisis. It connects people to their local crisis centre.

Veterinary Provincial Employee Family Assistance Plan (EFAP) Providers – Check with your association to ensure you have the most up to date information. As of June 25, 2019, the information is as follows:

  • British Columbia, Alberta, and Manitoba EFAP Provider is Homewood Health:
    • 1-800-663-1142. Press (1) for immediate crisis support, offered 24/7.
    • homeweb.ca
  • Saskatchewan Veterinary Medical Association: Professional Psychologists and Counsellors(PPC)
    • 1-306-664-000 or 1-888-425-7721
    • office@peopleproblems.ca
    • peopleproblems.ca
    • Service available to all active general, life practicing, and educational SVMA members (must have been licensed for six months). Four hours of complimentary services annually. Your license number is required.
  • Ontario Veterinary Medical Association EFAP Provider is WorkHealthLife
    • 1-844-880-9137
    • workhealthlife.com
    • Available to OVMA members and their family
    • Professionals Health Program
      • Available to veterinarians registered with College of Veterinarians of Ontario
      • 1-800-851-6606 (Ontario only)
  • Quebec AMVQ Association EFAP Provider is Morneau Shepell
  • New Brunswick Veterinary Medical Association EFAP Provider is Clinic of Applied Psychology
    • 1-506-858-9180
    • cpamoncton.ca/fr (French)
    • cpamoncton.ca/en/ (English)
    • Service available to veterinarians registered with the New-Brunswick Veterinary Medical Association.
    • Three complimentary sessions with a psychologist (confidential). Bilingual appointments available in Moncton or with one of their partners across the province.
  • Nova Scotia Veterinary Medical Association EFAP Provider is the Professional Support Program
    • 1-800-563-3427
    • Service available to veterinarians registered with the Nova Scotia Veterinary Medical Association.
  • Prince Edward Island has no provincial EFAP Provider.
    • Direct suicide support: 1-800-218-2885
  • Newfoundland and Labrador has no provincial EFAP Provider
    • Mental Health Crisis Centre (NL): 1-888-737-4668
  • Northwest Territories/Nunavut/Yukon: Canadian association for suicide prevention NWT

Find the number of your local distress centre and write it down on this list.

  • Tip: Google these search terms, “distress centre” and the “name of your local community”

Write down other resources in your own community like counsellors, psychologists, social workers, chaplains.

The CVMA also has a list of support services categorized per province: canadianveterinarians.net/documents/resources/vet-health-wellness-helplines-support-services

This resource list was written by Dr. Kathy Keil. Dr. Keil studied cognitive and neuropsychology in her undergraduate and graduate psychology degrees prior to attending veterinary school. She is not a licensed psychologist. She has training in Mental Health First Aid, safeTALK suicide awareness, ASIST suicide intervention, and is licensed to teach safeTALK. She regularly teaches suicide awareness and basic intervention skills to veterinary professionals and ways for them to take care of their own mental well-being. She is a member of the ABVMA Member Wellness Committee and a technical services veterinarian with Merck Animal Health. She is the leading force behind the Merck-CVMA “It’s Time to Talk about Mental Health in Vet Med” Awareness Campaign.