Patricia Smith

Compassion fatigue and grief are the unrecognized downside to working in the nursing home industry. When sufferers are overburdened by emotions, they want to escape from work, end up feeling isolated from coworkers and unable to participate in the daily give-and-take of the job.

A recently published study in the Archives of Internal Medicine by Leeat Granek found that half the oncology doctors reported feelings of failure, self-doubt, sadness and powerlessness as a result of grief from their jobs. A third talked about guilt, loss of sleep, even crying.

Left untreated, symptoms can lead to emotional outbursts, substance abuse and even clinical depression as well as medical and legal problems.

Although the cost of compassion fatigue and grief to industry is not known, simple job stress costs American industry an estimated $200-300 billion annually. 

For people whose job relies on their ability to be professional while caring for frail and elderly patients, the cost can be even greater. Guilt often delays recognition of the emotional problems and the necessity of dealing with them.  

Caregiving has a downside. If people don’t balance taking care of themselves with taking caring of others, it can lead to stress, burnout and compassion fatigue.

Nursing home employees often have experienced suffering in their own lives and can relate to it in others. This strong identification with those who are in pain or suffering often draws them into a helping profession. Most derive great emotional satisfaction from it.

But many do not. While caregiver fatigue is normal, compassion fatigue is not.

Called secondary trauma, the symptoms of compassion fatigue can surface when caregivers identify with the patient and begin to experience their suffering. This is often the result of unresolved pain and trauma in their own lives.

When employees have issues at work, it results in diminished productivity, absenteeism, accidents and higher turnover, a Regenstrief Institute and Indiana University School of Medicine study of cancer-care providers found.

In the Canadian study by Granek, half the doctors said that their unease affected their ability to communicate about end-of-life issues with the patients and their families.

Nursing home administrators can help by encouraging the issues to be brought into the open. Workshops on compassion fatigue and grief are especially helpful. By offering trainings, management can show employees that they are willing to work through the particular difficulties of working in the long-term care industry. 

Encouraging weekly support groups for compassion fatigue and grief as well as other issues that affect employee health—such as smoking cessation and weight gain—also are helpful. Corporate wellness programs can help elevate employee levels of compassion satisfaction, which is the pleasure we derive from doing the caregiving work we do.

Operators also reap benefits. When employees deal with the emotional side of the job, they find more satisfaction in the workplace and become more caring as a result.  When levels of compassion satisfaction rise, levels of compassion fatigue can drop.

Patricia Smith is the founder of the Compassion Fatigue Awareness Project. An expert in the field of compassion fatigue, Smith is a well-known speaker, who is available for keynote addresses and consulting with organizations nationwide. She also is the author of “To Weep for a Stranger: Compassion Fatigue in Caregiving.” For more information, go to