Jerome Stone and the Myth of Compassion Fatigue

Jerome Stone, a Registered Nurse and the author of Minding the Bedside: Nursing From the Heart of the Awakened Mind, has written a thought-provoking post for the benefit of the RN.FM Radio community, and we’re honored to publish it here. Please join us in an enlightening discussion with Jerome about the intersection of nursing and mindfulness on Episode #27 of RN.FM Radio on Monday, August 6th!

BOLD STATEMENT: there’s no such thing as compassion fatigue! What?

There’s no such thing as compassion fatigue.

I know that this is going to rock the boat a little and won’t sit well with many in nursing, especially administrators and academics who know full well that there’s a relatively high burnout rate in nursing and that “compassion fatigue” is often cited as a primary reason for this burnout. But, are we really talking about compassion here or is there something else undermining our ability to mindfully attend to the those we care for?

If you do a Google® search for the keywords “compassion fatigue in nurses,” you can come up with hundreds-of-thousands of links on the subject. In fact, when I did a recent search, I came up with 104,000 links, which is up from the 46,700 links that I found just last spring! With these numbers, you’d really think that nurses as a whole are pretty fatigued and that it’s due to being too compassionate.

For me, when I reflect on what I understand to be the deepest meaning of compassion, wishing that others can have happiness and be free from suffering, then I find the notion of compassion causing fatigue to be misleading. Can wanting others to be happy and free from suffering really lead to fatigue?

Perhaps the problem isn’t compassion fatigue, but a matter of nurses not knowing how to care for ourselves and not knowing how to care for our mind when we’re attending compassionately to the needs of others. Perhaps the problem isn’t “compassion fatigue” but a fatigue in doing things that way that we’ve always done them and thinking about things in the way that we’ve always thought about them.

There’s actually plenty of evidence that shows that helping others can actually make us happier. And research into practitioners who use compassion-meditation techniques has shown that we can actually modify the neural (brain) pathways that control our emotions. (Please see Meditation Increases Our Ability to Be Compassionate.)

If the problem isn’t due to compassion “fatigue,” but due instead to our not caring for ourselves and for our minds, then how do we change the way(s) that we care for ourselves?

I tend to learn things more easily when they’re numbered or put into lists. Here’s an easy-to-use list of five reminders that can help you to keep your heart in your work, while keeping your mind in ease.

A Simple List of Things that We Can Do to Maintain a Compassionate Presence at the Bedside:

1. Remember to give yourself the same love (or “care”) that you want to give to your patients. Don’t you deserve that much care? Where have we as nurses gone wrong where we equate a self-centered selfishness for a genuine love or compassion for ourselves? Why do we believe that caring for ourselves is any less important than caring for our patients?
2. Recognize others as wanting the very same things that you want, to be happy and to be free from suffering. This can be essentialized when you can see others as being “another you.” When we think about it, those we care for are like us in their desire to be free from suffering and wanting to be happy. And, given the right (or wrong!) circumstances, we could be in their shoes!
3. We need to remember, repeatedly, that whatever we’re thinking or feeling at the moment will eventually dissipate, and that we’ll be thinking or feeling something different within a matter of minutes or even seconds! Everything that you experience, everything that you think and feel, is impermanent. So, if you can remain present in the moment while you’re attending to another, without letting your thoughts and feelings distract you, then you can attend to others more easily. We can learn a lot about the impermanence of our thoughts and emotions through learning to practice meditation.
4. We need to remember our connection with others. Albert Einstein wrote:

A human being is a part of the whole called by us “Universe,” a part limited in time and space. He experiences himself, his thoughts, his feelings, as something separate from the rest—a kind of optical delusion of his consciousness. The delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. Nobody’s able to achieve this completely, but striving for such achievement is in itself a part of the liberation and a foundation for inner security.[i]

1. Finally, and I stumble on this one constantly, is to forgive yourself each time that you find yourself standing knee-deep in the cesspool of mindlessness. Each time that you realize that you’ve become distracted is in itself an invitation to return to your mind and to your intention to care.

In summary:

1. Caring for yourself as we would care for others,
2. Remembering that others wish to be happy and avoid suffering,
3. Remembering that thoughts and feelings are impermanent
4. Remembering our connection to others,
5. Practicing self-forgiveness.

To support your practice of working with these insights, learning to work with your mind through the practice of meditation is one of the most powerful ways of connecting with your inner resources and discovering an inexhaustible source of inspiration and insight.

It’s through meditative and contemplative practices that we come to realize, on an experiential level, that our thoughts and feelings don’t hold as much sway over us as we’ve come to believe. And when we realize this, we also realize that today’s feelings of being “burned out” can be replaced by tomorrow’s feelings of joy at having attended to those in need in a genuine, mindful manner.

For information on how to learn to meditate and work with your mind, please feel free to visit my blog and download the free ebook, Can Meditation Change the Way that You View Your World? Also, you can download the new ebook, How to Work with the Four Distractions to Meditation, to learn how to work with some of the more common obstacles to meditation.

[i] Letter of 1950, as quoted in the New York Times (29 March 1972) and the New York Post (28 November 1972). However, The New Quotable Einstein by Alice Calaprice (Princeton University Press, 2005: ISBN 0691120749), p. 206, has a different and presumably more accurate version of this letter, which she dates to February 12, 1950, and describes as “a letter to a distraught father who had lost his young son and had asked Einstein for some comforting words.” A human being is a part of the whole, called by us “Universe,” a part limited in time and space. He experiences himself, his thoughts and feelings as something separate from the rest—a kind of optical delusion of his consciousness. The striving to free oneself from this delusion is the one issue of true religion. Not to nourish it but to try to overcome it is the way to reach the attainable measure of piece of mind.