Fatigue

There’s a lot to unpack in the world of nursing when it comes to fatigue. I’ve had to do some research myself in order to eloquently and concisely present my thoughts on this topic. And, if you’ve read my other posts, you know I find comfort in the words of others. Per my internet perusing, I’ve found there to be four main types of nurse fatigue: compassion, alarm, mental, and physical. Some more obvious than others. I’m hoping to share my thoughts and experiences on each category as well as provide sources for further explanation.

Compassion

Compassion fatigue sounds a little dark when you first hear it. Out of compassion? Isn’t that kind of your whole job?? To care for people??? And frankly, it can be dark. But as with each type of fatigue, there’s a spectrum. And what I’ve come to learn is regardless of where you are on the spectrum, your fatigue and your feelings are valid. Valid enough, even, that scientific studies have been done to prove it is a universal issue for nurses. The article I kept coming back to was Compassion fatigue in nurses: A metasynthesis by Anna GW Nolte PhD, RM, Charlene Downing PhD, Annie Temane PhD, and Marie Hastings‐Tolsma PhD, CNM, FACNM. They collected and presented a basic compassion fatigue roadmap that served as my high level research guide.

My compassion fatigue experiences stem from when a patient or family member gets under my skin or wears me down by treating me poorly. In response to being verbally abused or not treated with respect I’ve found it’s possible for me to lose compassion for that patient in that moment. It’s a complex juxtaposition of emotions having to provide care for a patient who continually scolds, name calls, and is downright mean. Another instance is caring for a patient who has been on your unit for over 140 days…with no escalation or deescalation of cares, per patient wishes. I’ve sometimes felt my compassion has maxed out with longer term patients, through no fault of their own. It’s our job to honor their wishes. But over 100 days of honoring the same wishes can wear you down.

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Alarm

Alarm fatigue may not be the most severe for most individuals, but after moving from a 25 bed critical access hospital to a 505 bed university hospital, I’ve noticed this to be one of the biggest differences. Sicker patients mean more alarms. More alarms mean more triggering RN responses. Or at least, they should. I know I’m guilty of watching a desatting oxygen alarm ring at 88% and waiting to see if it comes up on it’s own. Also, depending on the patient, asking “is staff in the room?” when a bed alarm goes off, instead of instantly jumping from my chair. My pager vibrates every time my patient’s heart rate goes up or oxygen goes down. Every. Time. For 12 hours. I hear telemetry alarms when I’m home at my apartment. While I do believe my unit does a good job trying to eliminate unnecessary alarms and respond to important ones, the fatigue is real and has potential to harm if not properly addressed.

Mental

In Caring science and nursing presence Carrie A. Roberts explores the necessary balance needed between having a scientific and emotional approach to bedside nursing. And even though this was published in 2018, I find her words applicable to bedside nursing now, amidst the Covid pandemic.

The other week administration was rounding on our unit and asked what some barriers have been lately, knowing that Wisconsin is now the epicenter of the pandemic. My charge nurse mentioned that while other specialties are working remotely, we are still here. And all of their remote work means more in-person work for us, whether it’s coordinating video calls, faxing paperwork, or assessing the patient for them. All of which “[reduces] emphasis on nursing’s primary focus—the patient—[and] compromises the nurse-patient relationship.”

We multitask for 12+ hours. Our brains do not get rest. If we’re lucky, we can decompress on the drive home and leave our day at work. But that isn’t always the case. Mental fatigue stays with us. It’s consumed my off days, leaving my to-do lists incomplete and my Netflix account asking me if I’m still watching. Treating my brain like any other muscle, I have to rest it on my off days so I’m able to come back recharged.

Today’s nurse must be able to lead a code, answer the call light for a turkey sandwich, and monitor a confused elderly patient—all at the same time.

Carrie A. Roberts, MN, RN, a student at Notre Dame of Maryland University School of Nursing, Baltimore, Maryland, USA

Physical

Probably the most obvious of the fatigues, but nonetheless takes conscious effort to combat. Whenever I raise my patient’s bed for a reposition or procedure I make the joke “I do this because I’m told I’m too young to have back problems!” It gets a chuckle a solid 60% of the time. But it does hold truth. For about 2 years now I’ve been getting monthly massages. I don’t spend money on pedicures or hair coloring, but massages are my investment in my own health. I’ve noticed a world of a difference in the tenseness of my shoulders and flexibility of my neck (where I carry all of my stress, I’ve been told).

As with managing all kinds of fatigue, physical fatigue has to be a personal thing and could change daily based on what your body needs. Sometimes it will need stretching and massages and movement. Other times it will need a heating pad and a nap. Listen to it. Take care of it. You only have one body and you need it to do your job.