Compassion Fatigue? Talk About It

Compassion fatigue among infection preventionists (IPs) and other health care professionals is nothing new. Rebecca Leach, MPH, BSN, RN, CIC, an infection prevention and control expert tells Infection Control Today^® (ICT^®) that IPs, doctors, nurses, police officers, firefighters, first responders—these sorts of occupations require that emotions be held in check in order to focus on what needs to be done. But COVID-19? Well, Leach tells ICT^®, that that’s a test like none other. “I think that the problem [with COVID-19] is that there’s just so much coming in. And it’s not only professionally, but also at home. We’re all dealing with the pandemic as much as anybody else at home.” How does an IP not resent the fact that they have to treat patients who could have avoided their health care problems if they had just taken the simple step of getting the COVID-19 vaccine? It’s a question Leach, a member of ICT^®’s Editorial Advisory Board, writes about for ICT^®’s October print edition and which is available on ICT^®’s website now.

Infection Control Today^®: How can health care workers maintain professionalism and treat all patients equally when some patients won’t do a simple thing like get vaccinated?

Rebecca Leach, MPH, BSN, RN, CIC: I think that’s a really good question to ask. And it’s not necessarily a new phenomenon. If you look at other situations where there’s been a lot of social stigma around a disease, such as HIV and those types of things, this conversation was occurring then, as well. I think the biggest thing is that as a health care worker, our job is not to judge our patients, but to treat them. We have to constantly remind ourselves that when you become a health care worker, and you take on this role, that it’s what you’re supposed to do. It can be very difficult, though, because we’re all human. And we’re all tired. And we’ve all been living through this for so long. It can definitely wear on people and make it hard to maintain that professionalism when we see so much preventable illness coming into our facilities.

ICT^®: I found one of the most compelling parts of your article was when you discussed how you felt when you were vaccinated.

Rebecca Leach, MPH, BSN, RN, CIC

Leach: I remember that day very clearly. It was a huge wave of relief, I guess, in a way, because we’ve been hearing about it for so many months, and not sure if you’re going to really get it. And then when the day finally came that I could sit in that line and get my shot through the mass vaccination clinic…. It just felt like maybe there’s an end in sight. Gave me hope. Just that feeling that I had, and I know a lot of other health care workers and colleagues felt the same way. That feeling and then just that overwhelming sense of maybe we can stop this sooner than I thought. But to have it drag on so long and to have people be so adamantly opposed. It just makes you feel like maybe a little letdown. It’s hard to explain, but it definitely … it becomes a very emotional topic for people.

ICT^®: You’ve written for us and spoken to us about vaccine hesitancy among health care workers. Do you see that as a problem still? How’s that being played out? There are reports of health care workers quitting and getting fired over this. Is it really that bad?

Leach: Yes. In my current institution, for example, where they have mandated that staff get the COVID-19 vaccine to work here, they’re trying to determine how many people actually are vaccinated and get a sense of what the issues are, the concerns that people have, and it is definitely a concern. Our own internal data show about 15% or so of staff are not vaccinated and do not want to be vaccinated. It definitely still exists. And it’s hard to determine. I think for some people, it is truly just education or concerns about some of the myths that they hear about vaccines. If you can address that … you’re talking with them and addressing those concerns and sort of debunking the myths. And then for some people it really is kind of that good old American “you’re not going to tell me what to do” attitude. And those are harder to deal with because it really is not related to education. That is really more of a values and beliefs concern. That’s something that’s a little harder to work through.

ICT^®: Is there any compassion fatigue involved when dealing with other health care workers? Or is it basically a non-issue because they don’t usually wind up in the hospital?

Leach: I think that there is. I think probably everybody who is working in pandemic response right now has compassion fatigue because you see that we have a way to help combat this. And the data clearly show that people who are vaccinated … the risk of hospitalization is so much lower. It really is one of the most effective vaccines that we have available to us. I think that anybody working in response right now probably has a little bit—if not a lot—of compassion fatigue because of just the sheer length of time that we’ve been doing this. It’s been for some people almost two years that they’ve been working against COVID-19. It takes over your whole life personally, as well. You get pulled away from family, you get pulled away from having personal time. It’s all that you can focus on at work. It definitely becomes, as I said before, a very emotional issue for us for working in pandemic response to try to work through our own compassion fatigue, and then also to help others who are dealing with it as well.

ICT^®: Do you hear a lot of regret?

Leach: We do hear a lot of stories of patients who are hospitalized and very ill with COVID-19 who then say, “Can I get the vaccine now?” And it’s like, “Well, it won’t help you as much now. It would have been nice if you had gotten it three months ago.” You do hear that quite often from patients once they get here and they realize how sick they are. They regret not taking it sooner.

ICT^®: Where do you think most infection preventionists fit in?

Leach: I think it’s a hard topic for us because we’re not used to talking about this kind of thing in infection prevention. We’re very much focused on evidence-based care and standards. And so, this delves into a little bit of dealing with our emotions, right? And in health care, we don’t talk about that kind of thing. I think the biggest thing is just acknowledging that this even exists and making it normal to talk about it and not shameful. Because I think some health care workers feel shame if they admit that they have compassion fatigue. Because that’s not what we’re supposed to be doing. We’re supposed to be taking care of our patients and caring about them. I think acknowledging that this even exists—that it is a real problem. And that just listening to staff—because we’re not going to be able to maybe solve all the issues—but just to offer an ear, offer some empathy, try to help our staff work through these concerns that they have. Direct them to different resources. A lot of health care facilities have started expanding therapy for staff, acknowledging that this is very much causing a lot of mental health concerns for health care workers. Just finding those resources for people and just being an ear to listen and to help. Maybe give some guidance or just to talk to you. I think it’s really the biggest thing infection preventionists can do for each other, as well as for our staff that we serve.

ICT^®: Some professionals have to build a sort of wall around their emotions or else they won’t be able to do their jobs: police officers, firemen, doctors, nurses, infection professions. I assume that over the years you were able to do that. But I guess COVID-19 changes everything and changes even how strong that wall is, right?

Leach: Yes. I think that that is a very common coping mechanism for a lot of first responders, health care workers, anybody that deals with very traumatic situations and people at their most vulnerable point. You have to build up a little bit of a wall so that you can function. And I think that the problem [with COVID-19] is that there’s just so much coming in. And it’s not only professionally, but also at home. We’re all dealing with the pandemic as much as anybody else at home. Whether you’re homeschooling your kids, or you’re dealing with sick relatives or family who died or whatever it is. It’s just that there’s so much coming in that I think people just build up their walls so high and tight that they can’t even connect with anybody, which is part of compassion fatigue. Where you just don’t connect with anybody, even at your home or personal life. I think that’s one extreme. And then the other extreme is that it just all comes crumbling down and then you have burnout. And so definitely helping develop coping strategies for this type of situation is something that we need to figure out. This generation of people have never experienced something like this and it’s sheer … the time and amount of stressors that are involved—it’s hard to handle,

ICT^®: I guess you can’t underestimate the physical toll. Working 16-hours days isn’t uncommon during the surges, right?

Leach: Right. And just having the patient load be much higher than people are used to. It was very physical. And having to wear the PPE for so long. Especially in the beginning with young staff wearing those N95s. And they were having skin breakdown. It was physically and mentally and emotionally draining for everybody.

ICT^®: Is there anything that I neglected to ask you that you think might be pertinent to this discussion?

Leach: I don’t think so. I’m really glad to talk about it because I think we don’t talk about this kind of thing. I’m glad that we’re acknowledging that it exists and normalizing it and hopefully people, if they’re feeling like this, they can reach out to somebody to talk to and try to work through what they need to get back into their job and be successful.

This interview has been edited for clarity and length.