Compassion Fatigue in Oncology Nurse Navigation: Identification and Prevention

Abstract

One of the great challenges in caregiving is how to care without giving up your ability to control the deep emotions that always accompany patient care activities. For oncology nurses, caregiving carries with it the near certainty that a portion of the patients being shepherded through the healthcare system will not get well. Lay on top of this an ever-growing patient load and increasingly complex healthcare system, and it is not surprising that these stress points have a cumulative effect, compassion fatigue. Oncology nurse navigators practice in an environment that is sometimes isolated from the traditional support structures available within the hospital and/or oncology setting. Navigators address patient barriers to care that are complex in nature and many times unable to be easily resolved. The nontraditional oncology nursing role combined with the stress of providing patient care increases the likelihood for nurse navigators to experience compassion fatigue. In this chapter, readers will learn more about the roots of compassion fatigue, its symptoms, and strategies to identify it early on so that solutions outlined here can be applied proactively by the individual navigator and their leaders.

Appendix: Best Practice Model

Sarah Cannon Cancer Institute

Medical City Healthcare

The Sarah Cannon Cancer Institute Medical City Healthcare navigation team maintains its perspective on compassion fatigue by implementation of surveys and employee self-assessments, and regularly focuses on the subject during team meetings. The team participates in self-care modules and holds an annual team retreat where the topic is discussed.

16.1.1 Surveys

The team is asked to participate in the Professional Quality of Life (ProQOL) Scale (Exhibit 16.2) survey twice a year (June/December). The scale measures levels of compassion satisfaction, burnout, and secondary traumatic stress. The results are combined with data gleaned from the self-care modules and an annual navigator retreat survey, which identifies the navigation team’s biggest stressors, their preferred frequency of participation in self-care modules, and how they would prefer those events be structured. The larger goal with these surveys is to ensure that a high level of quality of life is maintained within the team and to ensure that the management team is meeting the needs of the navigation team members, where possible.

Exhibit 16.2

The compassion fatigue process

The ProQOL Scale survey was first initiated for the Medical City Healthcare navigation team in the spring of 2016. The team has exhibited a high level for compassion satisfaction and low levels of burnout and secondary trauma. The results would indicate the typical team member represents a person who receives positive reinforcement from their work. The typical team member carries no significant concerns about being “bogged down” or the inability to be efficacious in their work—either as an individual or within their organization. The navigator does not suffer any noteworthy fears resulting from their work. He or she may benefit from engagement, opportunities for continuing education, and other opportunities to grow in their career. He or she is likely a good influence on colleagues and the organization. The individual is probably liked by the patients who seek out assistance.

The following information depicts the manager’s report for the Sarah Cannon oncology navigation team ProQOL survey from the summer of 2017.

ProQOL Scale Results: Summer 2017

Compassion Satisfaction—Compassion satisfaction is characterized by feeling satisfied by one’s job and from helping. It is characterized by people feeling invigorated by work they like to do. They feel they can keep up with new technology and protocols. They experience happy thoughts, feel successful, are happy with the work they do, want to continue to do it, and believe they can make a difference.

• Raw score summer 2017: 43

• Level of compassion satisfaction: HIGH

• Raw score fall 2016: 45

• Level of compassion satisfaction: HIGH

• Raw score spring 2016: 43

• Level of compassion satisfaction: HIGH

Burnout—Burnout is part of compassion fatigue that is characterized by feelings of unhappiness, disconnectedness, and insensitivity to the work environment. Symptoms can include exhaustion, feeling overwhelmed or bogged down, and being “out-of-touch” with the person he or she wants to be, while having no sustaining beliefs.

• Raw score summer 2017: 18

• Level of burnout: LOW

• Raw score fall 2016: 20

• Level of burnout: LOW

• Raw score spring 2016: 19

• Level of burnout: LOW

Secondary Traumatic Stress—Secondary traumatic stress is an element of compassion fatigue that is characterized by being preoccupied with thoughts of people one has helped. Caregivers report feeling trapped, on edge, exhausted, overwhelmed, and infected by others’ trauma. Characteristics include an inability to sleep, sometimes forgetting important things, and an inability to separate one’s private life and his or her life as a helper and experiencing the trauma of someone you have helped, even to the extent of avoiding activities that are reminders of the trauma. It is important to note that developing problems as a result of secondary traumatic stress is rare, but it does happen.

• Raw score summer 2017: 18

• Level of secondary traumatic stress: LOW

• Raw score fall 2016: 18

• Level of secondary traumatic stress: LOW

• Raw score spring 2016: 18

• Level of secondary traumatic stress: LOW

16.1.2 Meetings and Retreats

Giving team members regularly scheduled opportunities to discuss the subject of compassion fatigue and burnout is also considered crucial to creating a healthy workplace environment. The 19-member Sarah Cannon Cancer Institute Medical City Healthcare navigation team, which is responsible for oncology patients in 10 hospitals, engages in monthly meetings that offer opportunities to discuss compassion fatigue and stressors, as well as twice-yearly retreats that include compassion fatigue as part of the agenda.

• Self-Care Modules—Monthly, hour-long sessions that focus on self-care, reflection, and team bonding. Opportunities have included an open discussion/support group, a yoga instructor teaching chair yoga, journaling instruction, and community partners who have shared resources regarding how their services can support the navigation team.

• Navigator Retreats—Twice yearly, in the summer and winter, the team participates in retreats that focus on team bonding. Activities have included a team lunch with a presentation about self-care by a psychologist, an afternoon of bowling and games, holiday parties, and professional education offerings.

Internal surveys of these navigation team members following these gatherings revealed a variety of perspectives related to stressors and compassion fatigue strategies. The surveys help the team supervisor specifically understand the challenges team members face and how they wish to see those challenges addressed, if possible.

Self-Care Module and Navigator Retreat Survey Results: Summer 2017

Navigator Stressors/Challenges

• The largest stressors/challenges in working with patients:

  • Not having enough information to do my job or spending a lot of time finding it.

  • Brevity of life. Although this is an area that I do extremely well with, it is just hard. One day last week I was calling patients, and I discovered that eight had died. That doesn’t happen every week. It is just hard when it does.

  • Getting the referral early enough in the patient’s diagnosis to help them at maximum capacity.

  • Repetitive documentation and spreadsheet work, even though it is getting a little better.

  • Cooperation from doctors and staff.

  • Volume of load is heavy at intervals.

  • Due to the number of patients in the documentation system, I can’t keep up with all my patients in a timely manner.

  • Not feeling like I am able to do enough for my patients, limited resources, limited transportation, etc.

  • The biggest is resources; sometimes you are not able to assist where they really need it; a lot of services are tightening their services.

  • Nothing.

• The largest daily stressor/challenge:

  • Time.

  • Completing survivorship care plans. It takes approximately 1 hour 15 minutes to complete just one.

  • Data.

  • Having many leaders to report to within the hospital setting and leadership not being aware of my role as a navigator.

  • Due to the number of patients I navigate, I can’t keep up with all my patients in a timely manner.

  • Not enough time in the day to get everything I want done.

  • Is trying to stay in contact regularly with my patients. Very high volume.

  • Balancing work and home life.

Self-Care Modules

• Ideal frequency:

  • Monthly, 20%

  • Every other month, 20%

  • Quarterly, 50%

  • Yearly, 10%

• Ideal topics:

  • Delivering a cancer diagnosis, 10%

  • Communication techniques, 20%

  • Compassion fatigue/burnout, 20%

  • Workplace stress, 10%

  • Balancing work/home life, 30%

  • Other, 10%

    • All of the above

• Ideal format of time:

  • Speakers, 90%

  • Support group/group sharing, 40%

  • Handouts, 0%

  • Reflection/growth activities, 50%

  • Quiet/reflection time, 10%

  • Guided meditation, 20%

  • Other, 10%

    • Sometimes I just need more time for me.

Navigator Retreats

• Ideal frequency:

  • Yearly, 30%

  • Every 6 months, 60%

  • Every quarter, 10%

• Ideal format of time:

  • Fun icebreaker activities to get to know each other, 30%

  • Open activities (bowling, pool, etc.), 60%

  • No activities (open time to sit and talk), 20%

  • Social hour, 30%

  • Formal, guided team building, 10%

  • Other, 10%

    • Just some extra time to rest and relax

• Other ideas for a team retreat :

  • Team recreational activities such as golf, painting

16.1.3 Summary

The Self-Care and Navigator Retreat Survey provides further insight into the barriers facing the navigation team. Most of the issues are not easily amended (which is the reason for annual distribution vs twice a year), such as the amount of data entry required, lack of time for tasks, and the inherent nature of physicians/staff (willingness to collaborate, communicate, etc.). The navigators did identify the need for access to new community resources, which the team is are attempting to meet with new online applications. The team seemed comfortable with the frequency of both the self-care modules and the navigator retreats, and offered easy-to-implement suggestions for future team health events.