The Cost of Caring
When it’s your job to provide care, how do you cope when helping hurts?
By Alison Brown
IT’S HARD TO BE A HERO. In a time when shiny, larger-than-life superheroes in capes gallantly swoosh across our movie and TV screens, it’s easy to forget that real superheroes wear scrubs.
They’re hurrying down hospital hallways, holding the hand of someone on their death bed, changing bed pans, wiping crumbs, trying to give a combative person a bath.
They’re found in long term care homes and group homes, providing personal care to the most vulnerable.
They daily deal with deep distress, heartbreak, and trauma.
They pour kindness out to others, day in and day out.
But what happens when the well runs dry and the caregiver’s own mental health is compromised, when caring turns into compassion fatigue?
What happens when the hero needs help?
Compassion fatigue is a relatively new term that refers to the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate. It leads to a shift in a caregiver’s worldview due to repeated exposure to trauma and distress.
For years, the term burnout was used to describe the physical exhaustion caregivers experience. But burnout doesn’t mean one’s view of caring has changed or that the cup of compassion has run dry.
Burnout can be resolved by a change of jobs. Compassion fatigue cuts closer to the core.
While people in any profession can experience it, compassion fatigue is especially hazardous for emergency personnel and those in caring professions where compassion is part of the job description.
Healthcare workers are particularly susceptible to developing compassion fatigue. And in a healthcare system as dysfunctional as Ontario’s, where chronic staff shortages leave personal support workers (PSWs) running off their feet, it’s no wonder that those providing care to society’s most vulnerable become vulnerable themselves.
LOCAL 303 MEMBER MARGIE HAMELIN’s journey into compassion fatigue began two years ago following a conflict at the long term care home where she works as a PSW.
“I went through a very dark time,” she recalls. “I had thoughts of driving my car over an overpass. I had to take so many days off work because I always felt ill. I always had a headache.
“I started shutting down and isolating myself and becoming extremely angry with those closest to me. At work, I would disconnect a lot, be really quiet, and distance myself from my coworkers.
“At home, I would spend hours in bed. I just felt so inadequate all the time. I completely changed from who I was at the beginning of my career.”
A PSW for nearly 30 years, Margie has witnessed first hand how much the healthcare industry has changed since she started.
“I have always wanted to work in the nursing field,” she says. “I love helping others and trying to make a difference in someone’s life.”
But due to more government oversight, regulatory paperwork, and diminished hours for hands-on care, the feeling of making a difference has become increasingly elusive. As a result, more and more caregivers are finding themselves in crisis.
“It’s so difficult to see residents who are sad and need a shoulder to lean on or someone to just be there for them,” says Margie. “But there just isn’t any time.”
LACK OF TIME TO CARE is a constant refrain heard among healthcare workers and caregivers, not only in Ontario but across the country. The needs are simply too great for the number of staff available, resulting in less time for them to provide care.
“Some days, I go home and feel like I didn’t give my residents everything they deserve because I don’t have the time,” says Lori Lindsay, a fellow Local 303 member and PSW. “If I have someone who requires palliative care, I want to give them the extra care, but I can’t.
“When I first started this job 25 years ago, it was just that: a job. But I soon got to know the residents, and they became like family to me. So when I lose them, it’s hard to deal with. I grieve for them as I would a member of my own family.”
Lori also feels the strain of trying to provide the best care for residents but not having the resources or support to do so.
“Folks need some kind of care, even if it’s just holding their hand or having a conversation with them,” she says. “They all need something from you. Some days, I’m pulled in 50 different directions—I have five call bells going off, my partner’s on break, and management walks by reminding me to answer the calls. But I’m only one person and I can only do so much.
“Sometimes, I’ve only worked three days and I’m already exhausted. I feel like I can’t make it through another shift.”
FOR MANY CAREGIVERS, STAGE OF LIFE and family responsibilities can contribute to developing compassion fatigue.
“People who work part time, who have no benefits, those who are single parents and often women with two or three jobs are at a greater risk of developing compassion fatigue,” says Dennis Oenema, a CLAC representative in BC who looks after members working in healthcare and social services. “Compassion fatigue is quite debilitating and can take a long time to recover from, and it often directly or indirectly affects personal and family relationships.”
Workers with young children and busy families can attest to how stressful life can be. Add in an occupation that requires them to deal with distress and death, and they become perfect candidates for developing compassion fatigue.
While Lori’s children are older now and have fewer needs and demands, she remembers how difficult it was when they were young.
"When I started working full time, I had two young kids at home,” she says. “It was such a challenging season. I’d have lots of breakdowns and would just snap at the smallest things.
“It was hard being on my feet all day at work caring for others, only to come home and work and care some more. I had to tend to the kids, make their supper, make their lunches, and then put them to bed—and then it was my bedtime! I don’t know how I did it.”
In Margie’s case, it’s not young kids that contribute to her stress but an ailing mother.
“My mom, who is dealing with Parkinson’s disease, is living with us,” she says. “So trying to balance my work life and my home life is nearly impossible. Not only am I a caregiver all day at work, but I’m my mother’s caregiver as well.”
HELPING SHOULDN’T HURT, YET WHEN caregivers are stretched thin both at work and at home, they hurt the one who should be the biggest priority in their lives: themselves. For both Margie and Lori, compassion fatigue was not a term they were familiar with until very recently.
“It’s a new term in our home,” says Lori. “Maybe it was around before, but people would never really talk about it. I think we’re all just so overwhelmed when we go to work, and having stressful situations at home certainly doesn’t help.”
Reps like Dennis and Trish Douma, who is a CLAC regional director in the union’s Chatham Member Centre, deal with the impact of compassion fatigue on their members on a daily basis.
“When members talk to me about it, they don’t usually use the term compassion fatigue to describe what they’re going through,” says Trish. “And they don’t usually mention the impact it has on them; it’s always in terms of the impact to the residents. They care deeply for the residents or patients they care for, so when they describe their struggles, it’s always about how it must be so hard for the residents to not receive the kind of care they deserve. They often don’t readily share how they feel about it beyond ‘I’m exhausted,’ or ‘I’m frustrated.’”
When faced with a member in crisis, Trish tries to stress the importance of self-care. At the 2019 Ontario Stewards Conference, she led a workshop titled “Put Your Own Oxygen Mask on First.” The phrase has become a common metaphor when talking about self-care. It refers to safety protocols when flying an airplane: the flight attendant instructs passengers to put on their own oxygen mask before helping others—even before helping children and seniors.
“In the same way, you can’t pour from an empty cup and help others before you help yourself,” says Trish. "I encourage my members to make sure they’re taking care of their own needs first.
“I know that they’re exhausted, working overtime, and don’t have enough hours in the day. But even if it’s just for 10 minutes, taking care of yourself is so critical to survival.
“I encourage my members to take their breaks and not work through them, to go outside for a breath of fresh air or take a walk. I also tell them to report any issues to management that management is supposed to be dealing with. Many members get fatigued as well from having to tell management again and again what needs to be fixed.”
GOOD MANAGERS RECOGNIZE THE SIGNS and symptoms of compassion fatigue and take the necessary steps to alleviate any pressure they can on their workers.
“We see how caregivers open their hearts and minds to the residents with empathy,” says Mandy Judah, director of care for a long term care home in Ontario. “That makes them vulnerable to being deeply affected or damaged by their work.
“We see compassion fatigue as a moral conflict between their individual values and the work that is required of them. From our perspective, we see the negative effects of caregiver fatigue in pessimistic mindsets, absenteeism, boundary violations, and a general lack of enjoyment for work they used to be passionate about.”
Mandy’s home, in conjunction with the Institute for Healthcare Improvement and the Registered Practical Nurses Association of Ontario, has recently incorporated something called a Joy in Work framework, which focusses on healthcare professional engagement and satisfaction, patient safety, quality care, and patient experience.
“The whole point of this new framework is to offer our workers the potential to recover joy in their work and reduce burnout and compassion fatigue,” says Mandy. “We also have an employee assistance program as part of our benefits package, and we encourage people to use the service.”
MARGIE FOUND A WAY OUT of her dark place by reaching out to her CLAC representative and getting help. She was referred to a psychiatrist and has a good friend at work who can act as a support when times get tough.
“It’s been a journey,” she says. “I still find it hard to cope some days, but I’m getting better by trying to take care of myself. Self-care is something I struggle to fit into my day, but I know the importance of putting it into practice.
“When work gets stressful, I try to step back, breathe, and regroup. I try to make myself aware that I can’t fix everything in the world, nor is it my job to fix everything.”
Lori has built a walk outside into her daily routine and a date night once a week with her husband. Her work also has a social club, where a group of coworkers from different shifts tries to meet for dinner once per month.
"It helps build relationships with my coworkers and see people I normally wouldn’t because we’re all on different shifts,” says Lori. “And we get to see each other wearing something other than scrubs!”
Healing for Lori has come from shifting her perspective and making herself a priority.
“Sometimes, you just have to take a step back and take a couple deep breaths,” she says. “Put yourself in the residents’ shoes. They don’t want to be there either but they need care. And you can’t care for them if you’re not taking care of yourself.”
Do You Have Compassion Fatigue?
Symptoms of compassion fatigue occur on three different levels: behavioural, physical, and emotional. Check these symptoms to see if you may be at risk for compassion fatigue, and then speak to your steward or representative for guidance or support.
8 Behavioural Signs
1. Anger and irritability at home and/or at work
2. Avoiding social events
3. Impaired ability to make decisions
4. Feeling helpless
5. Feeling inadequate/unskilled at your job
6. Problems in personal relationships
7. Compromised care for clients/patients/residents
8. Thinking about quitting your job
10 Physical Signs
3. Not being able to get out of bed
5. Sore back and neck
6. Irritable bowel
7. Gastrointestinal upset
8. Rashes, breakouts
9. Heart palpitations
12 Emotional Signs
1. Emotional exhaustion
3. Increased anxiety
5. Reduced ability to feel sympathy toward clients/patients/residents
6. Cynicism at work
7. Diminished sense of enjoyment
9. Spacing out at work or on the commute home
10. Disruption of worldview
11. Heightened anxiety or irrational fears
12. Suicidal thoughts
Take Care of Yourself
It makes sense that those with deep levels of empathy and compassion for others are most at risk for developing compassion fatigue. The cure? Turn some of that compassion toward yourself.
5 Self-Care Strategies to Help Yourself so You Can Better Help Others
1. Talk, don’t vent. Venting to coworkers who may have symptoms of compassion fatigue themselves can often be toxic rather than productive. Instead, talk with a trusted steward, your representative, or a good counsellor or therapist. If you have a workplace employee and family assistance program, you can receive immediate, free, and confidential help.
2. Take 10. It may seem like taking time for yourself each day is a luxury you can’t afford or time you don’t have, but it’s critical for your survival. Taking 10 minutes per day to do something just for you—a quick walk, stretching, exercising, writing in a journal, practicing deep breathing—works wonders for your mind, body, and spirit.
3. Develop healthy habits. Many helpers and caregivers put their own health and well-being on the back burner despite keeping everyone else healthy and well. Developing healthy habits such as regular exercise, a balanced diet, and refraining from self-medicating with unhealthy things may be hard, but even baby steps in the right direction will benefit you—and everyone else—in the long run.
4. Meditate or pray. Caring for your mind and inner self is just as important as taking care of your physical body—especially in roles where your compassion and kindness are frequently taken for granted. Make time to be in the moment, take deep breaths, and calm your central nervous system.
5. Set emotional boundaries.
Remember that you and the people you care for are different people on different journeys in life. Although it’s challenging, think about walking a mile in someone else’s shoes—the key word being mile. Walk in another’s shoes long enough to understand what they’re going through and then give them back. You cannot wear another person’s burdens.
Even Saints Self-Care
Mother Teresa was known for her tireless charitable efforts and caregiving work. In 1950, she began her own order, the Missionaries of Charity, whose primary task was to love and care for those society had cast aside in the slums of India.
The order eventually spread all over the world, providing help to the poorest of the poor in a number of countries in Asia, Africa, and Latin America as well as relief work in the wake of natural disasters such as floods, epidemics, and famine. The organization also runs houses in North America, Europe, and Australia to take care of shut-ins, alcoholics, the homeless, and AIDS sufferers.
Mother Teresa’s caregiving work around the world earned her many awards and recognitions, such as the Pope John XXIII Peace Prize in 1971, the Nobel Peace Prize in 1979, and canonization by Pope Francis I in 2016. But she was no stranger to self-care. In a plan written to her superiors, she noted that it was absolutely mandatory that the nuns in her care take an entire year off from their duties every four years to allow them to heal from the effects of their caregiving work.
Sources: stress.org, nobelprize.org, britannica.com