HEALTH POLICY AND SYSTEMS

HEALTH POLICY AND SYSTEMS

The purpose of this study was twofold: (a) to determine the preva- lence of compassion satisfaction, compassion fatigue, and burnout in emer- gency department nurses throughout the United States and (b) to examine which demographic and work-related components affect the development of compassion satisfaction, compassion fatigue, and burnout in this nursing specialty. Design and Methods: This was a nonexperimental, descriptive, and pre- dictive study using a self-administered survey. Survey packets including a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5) were mailed to 1,000 selected emergency nurses throughout the United States. The ProQOL 5 scale was used to measure the prevalence of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses. Multiple regression using stepwise solution was employed to determine which variables of demographics and work-related characteris- tics predicted the prevalence of compassion satisfaction, compassion fatigue, and burnout. The α level was set at .05 for statistical significance. Findings: The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satis- faction among this group of emergency department nurses. The low level of manager support was a significant predictor of higher levels of burnout and compassion fatigue among emergency department nurses, while a high level of manager support contributed to a higher level of compassion satisfaction. Conclusions: The results may serve to help distinguish elements in emer- gency department nurses’ work and life that are related to compassion satis- faction and may identify factors associated with higher levels of compassion fatigue and burnout. Clinical Relevance: Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses may prevent emotional exhaustion and help identify interventions that will help nurses remain empathetic and compassionate professionals. HEALTH POLICY AND SYSTEMS

The profession of emergency nursing is physically and emotionally demanding. Complex patient loads, long shifts, demanding physicians, a fast-paced environ- ment, and working in an emotionally and physically

challenging area can cause stress for emergency de- partment (ED) nurses (Healy & Tyrrell, 2011; Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010; Von Rueden et al., 2010). Compassion fatigue (CF) and burnout are

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Hunsaker et al. Compassion Fatigue, Satisfaction, and Burnout

conditions that can become overwhelming burdens on nurses and can cause physical, mental, and emotional health difficulties (Potter, 2006). CF is a negative conse- quence of working with traumatized individuals (Figley, 1995). Moreover, CF has been described as emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems and suffering of others (Peery, 2010; Sabo, 2011). Equally as troubling is burnout, which differs from CF in that it is associated with feelings of hopelessness and apathy and creates an inability to perform one’s job duties effectively (Stamm, 2010). Burnout manifests similarly to CF, but is not typically linked to empathy. Instead, it is a gradual worsening of feelings of frustration with career responsibilities (Maslach, Jackson, & Leiter, 1996). Both CF and burnout may cause a nurse to become ineffective, depressed, apathetic, and detached (Boyle, 2011). Long-term results of both CF and burnout include low morale in the workplace, absenteeism, nurse turnover, and apathy (Jones & Gates, 2007; Portnoy, 2011). All of these consequences have a negative impact on patient care. Moreover, high levels of nurse burnout are linked to patient dissatisfaction (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004). Consequently, it is imperative that CF and burnout be recognized and addressed. By studying the impact of CF and burnout on ED nurses, researchers may bring to the attention of managers, healthcare leaders, and nurses themselves the reality of this phenomenon and aid in the comprehension of its negative influence.

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Additionally, the complexity of patient care is climbing, resources are decreasing, and insurance HEALTH POLICY AND SYSTEMS reimbursement is being linked to patient satisfaction (Medicare, 2013). It is more important now, perhaps more than at any other time in health care, to understand the prevalence and predictors of CF and burnout, but also compassion satisfaction (CS), in ED nurses. By understanding factors that influence both positive and negative aspects of nurses’ work, perhaps levels of awareness will be raised and nurses may maintain caring relationships and posi- tive attitudes. Moreover, few studies were conducted to explore factors that influence the prevalence of CF and burnout on ED nurses (Dominguez-Gomez & Rutledge, 2009; Hooper et al., 2010). Thus, the purpose of this study was to determine the prevalence of CS, CF, and burnout in ED nurses throughout the United States and to determine which demographic and work-related components affect the development of CS, CF, and burnout in this nursing specialty.

Based on the purpose of the study, the research ques- tions were: (a) What is the prevalence of CS, CF, and burnout among ED nurses? (b) What demographic char- acteristics such as age and gender are associated with the prevalence of CS, CF, and burnout among ED nurses?

(c) What work-related characteristics such as educational level, years in nursing, shift length, years worked in the ED, hours worked per week, and having adequate man- ager support are significantly associated with the preva- lence of CS, CF, and burnout among ED nurses? And (d) To what extent do the variables of demographics and work-related characteristics predict the prevalence of developing CS, CF, and burnout among ED nurses, respectively? HEALTH POLICY AND SYSTEMS

Literature Review

The term compassion fatigue was first introduced by Joinson in 1992. She described CF as nurses losing their ability to nurture. CF has been defined as the negative consequences of working with a significant number of traumatized individuals in combination with a strong, personal, empathic orientation. Figley (1995), a noted early researcher on CF, commented that those who are in a caring profession have an enormous capacity for feeling and expressing empathy and tend to be more at risk for CF. Humans, by nature, are wired for empathy, and therefore, caregiving can take a toll both emotionally and physically (Flarity, 2011).The stress resulting from helping a traumatized or suffering person may result in CF, which develops as a self-protection measure (Figley, 1995).

While CF is caused by empathy, burnout is associ- ated with environmental factors such as high patient acuity, overcrowding, and problems with administration (Flarity, Gentry, & Mesnikoff, 2013). Burnout is a con- dition often associated with feelings of hopelessness and inability to perform job duties effectively (Stamm, 2010). Burnout and CF are often linked and closely mimic one another. CF is often described as a type of burnout (Portnoy, 2011). A principal difference between burnout and CF is that burnout typically exhibits a gradual onset while CF may occur suddenly. Although measur- ing negative aspects of a nurse’s job is important, it is equally valuable to determine what makes a nurse feel happy. CS is the positive aspect of helping others. It is the satisfaction achieved with one’s work by helping others and being able to do one’s job well (Stamm, 2010). Many nurses chose their profession specifically to help others. HEALTH POLICY AND SYSTEMS

CF and burnout may have severe professional conse- quences in addition to affecting a nurse’s personal well- being. CF and burnout affect nurse retention, patient safety, and patient satisfaction (Burtson & Stichler, 2010; Potter et al., 2010). Hospitals are expected not only to provide positive outcomes for patients, but make them happy while providing quality care. A relatively new per- formance measure for hospitals is patient satisfaction.

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Compassion Fatigue, Satisfaction, and Burnout Hunsaker et al.

Since 2007, the passage of health reform legislation has increased focus on the importance of the patient experi- ence (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). Therefore, Medicare reimbursements to hospitals are now partially based on patient satisfaction measure- ments. Thirty percent of the incentive payments provided by Medicare to hospitals is based on approval scores of satisfaction (Medicare, 2013) HEALTH POLICY AND SYSTEMS

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