8 Expert-Approved Steps to Building Compassion Fatigue Resilience for Nurses with Barbara Rubel

As Told by Barbara Rubel, BS, MA, BCETS, DAAETS, Board-Certified Expert in Traumatic Stress: Insights from the ConceiveAbilities Podcast

Compassion fatigue is a growing concern, especially among nurses, who are on the frontlines of healthcare. With nearly 4.7 million registered nurses in the US, nurses are a critical part of patient care. Nurses are also recognized as the most trusted profession, with 78% of people rating their honesty and ethical standards highly. The nursing profession, however, faces a significant challenge with high turnover and burnout, much of which is attributed to compassion fatigue.

Barbara Rubel, leading authority and award-winning author on managing secondary traumatic stress, compassion fatigue, moral injury, and vicarious trauma, recently joined our podcast All Things Conceivable, A Surrogacy Podcast with Nazca Fontes to discuss the impact of compassion fatigue on nurses.

She emphasized the importance of self-care and shared expert strategies for building resilience in the face of adversity, offering valuable insights to help nurses combat compassion fatigue and preserve their well-being. Her FABULOUS framework is an eight-step process designed to empower nurses to combat compassion fatigue in their daily lives.

Listen to the full podcast with compassion fatigue expert Barbara Rubel as she shares the effects of compassion fatigue on nurses and offers 8 steps to combat compassion fatigue and build resilience.

What Is Compassion Fatigue?

NF: For decades, the topic of compassion fatigue among nurses and healthcare professionals has often been overlooked. In the fertility industry, studies show the pain of an infertility diagnosis is on par with the pain of being diagnosed with cancer, heart disease and other serious maladies. Nurses are typically the first and most important resource attending to the emotional needs of these patients. Despite its prevalence, compassion fatigue hasn’t been widely discussed or addressed in the field. Being able to define, name, and express what compassion fatigue is marks an important step toward understanding and combating this issue. What is compassion fatigue and how does it affect nurses?

BR: Compassion fatigue is the exhaustion that comes from constant exposure to the suffering of others, leading to negative feelings and thoughts that can severely impact your health. It involves two key elements: burnout and secondary traumatic stress. We all know what burnout is — chronic workplace stress, exhaustion, cynicism, anxiety, anger, and irritation. It’s something many of us have experienced. But when you combine burnout with secondary traumatic stress, you get compassion fatigue. In this scenario, the person you’re working with is experiencing the primary trauma, such as infertility, but you begin to experience the same stress reactions due to their trauma. This can manifest as anger, fear, sadness, or helplessness — psychological symptoms that mimic their traumatic stress. It’s remarkable how this happens, almost as if through osmosis.

NF: When I first heard the term compassion fatigue, I automatically thought it meant that you just switch off your empathy, like saying, “I don’t have one more reserve to tap into today; I can’t give anything else.” But you’re saying that the definition of compassion fatigue is actually something different. It’s not just about shutting down empathy; it’s the secondary feeling of loss, trauma, or grief that comes from being exposed to someone else’s suffering.

Compassion Fatigue vs. Burnout, Moral Injury and Vicarious Trauma

BR: Compassion fatigue can profoundly impact the way you view your life, as it’s often characterized by acute stress reactions of short duration. When you relive a person’s trauma — such as their struggles with infertility — you take it to heart, and it can shake your beliefs about the world. You might wonder, “Why can’t that person become a mother?” This stress can manifest in nightmares, a pounding heart, feelings of anger, guilt, and vulnerability -and all because of what’s happening to someone else. These are the symptoms of secondary traumatic stress combined with burnout. As compassionate, loving healthcare professionals, it’s almost impossible to switch off your empathy. As a speaker, I often hear at conferences and workshops that we need to lessen our empathy, but you can’t; empathy is a part of your soul, the core of who you are, especially as nurses. The key is figuring out ways to manage what you’re going through. But it’s not just compassion fatigue that healthcare professionals face — there’s also moral injury. Working with people who are suffering, in crisis, traumatized, or grieving can lead to situations where your morals and values are compromised. This could be due to something you did or didn’t do, something done to you or someone else, something you witnessed, or even a leadership failure. For example, you might know the right course of action, but your supervisor says no. As a result, alongside compassion fatigue, you might experience moral injury, leading you to question the meaning of your role as a nurse.

You might also be vicariously traumatized by what your client or patient has shared with you. Vicarious trauma presents a significant professional challenge, stemming from prolonged exposure to clients affected by trauma, grief, and loss. Over time, you may experience adverse effects as you engage with someone who is suffering. This can lead to feelings of no longer being safe in the world, a decrease in self-esteem, strained relationships, and a change in your worldview and sense of self because of the vicarious trauma. We need to recognize that it’s no wonder we feel overwhelmed and distressed — it’s not just the job itself, but what the job has done to our hearts, spirits, souls, and very beings.

How Workplace Stress Can Affect Nurses

NF: With the additional administrative responsibilities placed on healthcare workers, it’s very challenging to just practice in an organic way while you are managing compassion fatigue and additional constraints.

BR: Many healthcare professionals, particularly nurses, feel like their power has been taken away. When we talk about being empathetic and compassionate, losing that power means you can no longer fully engage with those qualities. If you only have 10 minutes with a client or patient, or you can’t do what you know needs to be done, it impacts you in a very deep and profound way.

NF: We need nurses and healthcare workers to be healthy, resilient, and empathetic, especially since they are the single most trusted profession in the United States, with 78% of people rating their honesty and ethical standards as high or very high. The question is, “What can we do to help nurses combat compassion fatigue?” You’ve actually built a framework using the acronym FABULOUS, designed to help build compassion fatigue resilience.

BR: I conducted a deep dive into the last five years of research focused on healthcare, nurses, and mental health professionals, victim service providers, and others in the trenches doing the good work. My goal was to discover what studies, best practices, and evidence-based approaches say about building resilience in these professionals. How do we focus on their well-being? Because it’s not just burnout, compassion fatigue, moral injury, or vicarious trauma — they also experience vicarious grief, sharing similar grief symptoms with their patients. This could be tied to their own personal history of infertility or unresolved losses.

The FABULOUS Framework for Building Compassion Fatigue Resilience

F — Flexibility in the Workplace

BR: To address this, I developed the FABULOUS framework, starting with F for flexibility in the workplace. Collaboration with leadership is essential to create wellness programs, set clear expectations, remove work barriers, and offer flexibility and autonomy in task completion.

Keeping nurses in their jobs requires increasing job flexibility, which boosts satisfaction. Offering mentorship for new employees, hybrid or remote work options where feasible, and team-oriented tasks can strengthen social support. Peer supervisory roles, salary recognition, rewards, and training are also crucial. Improving organizational communication and conducting meaningful stay interviews help ensure employee engagement, making a flexible workplace essential for retaining valuable healthcare professionals.

A — Attitude

The “A” is the second component and it stands for attitude. Attitude is deeply rooted in your beliefs and emotions, shaping how you perceive and respond to people, situations, and your overall work environment. It influences your behavior, relationships with colleagues, supervisors, and patients. A significant aspect of maintaining a positive attitude is ensuring good sleep hygiene, especially for those working shifts. Pay attention to your room temperature, create a calming bedtime routine with activities like reading or meditation, limit screen time and reduce noise. It’s also important to avoid caffeine and limit alcohol intake within three hours before bedtime. Prioritizing sleep is crucial for maintaining a healthy attitude at work.

Workplace interventions are also crucial for maintaining the well-being of employees. This includes scheduling regular rest breaks between and within shifts, possibly adjusting shift sequences, and providing education on sleep, circadian rhythms, and sleep disorders. Implementing nap strategies and giving employees more control over their hours can also make a significant difference. It’s all about work-life synergy — if you’re not getting enough sleep at home, your performance in the workplace will suffer.

Another key aspect under attitude is the practice of gratitude. Throughout your day, try to appreciate a person, place, or thing by looking at it through a positive lens. Take a moment to pause and notice what’s happening around you, finding something to be grateful for. Cultivating gratitude can be as simple as saying thank you or taking time to appreciate what you have, rather than focusing on what you lack. It’s about expressing gratitude without expecting anything in return and incorporating acts of kindness into your day.

For example, when I visit Florida and walk my son Mikey’s dog, a Frenchie, in the heat, I often find myself miserable and with a bad attitude. But when someone comes over and comments on how cute the dog is, my attitude shifts immediately. This shows that we have control over our attitude. Incorporating moments of joy, like those little interactions, is essential. Gratitude can become a deeply enriching and emotional part of your life, enhancing your overall well-being.

B — Boundaries

The next component to focus on is “B” for boundaries. Compassionate and empathetic individuals often give so much of themselves that they may struggle to maintain boundaries. But it’s crucial to ask yourself: What are you allowing? Are you letting a coworker’s bad day affect yours? Are you skipping sick days or mental health days? Take them. Are you working before or after hours? Are you advocating for others but not for yourself? You really need to prioritize how to say no. During my full-day trainings, so many people raise their hands, asking for help with saying no. It’s a common struggle. But there are ways to set boundaries respectfully, such as saying, “I’m not comfortable doing that,” “I can’t fit that into my schedule,” or “I’m in the middle of several things, and there’s just no way.” The key is to figure out what works for you and to say no when necessary.

Boundary development is so important. It makes you more proactive, reduces feelings of being overwhelmed, boosts your self-esteem, lowers stress levels, and sets a positive example for your coworkers.

U — Understanding Job Satisfaction

The fourth component is “U” for understanding job satisfaction — knowing why you love doing what you do. It’s about your team, your positive outlook on your work, and the meaning you derive from your role. For example, I facilitate healing and help people through some of the toughest challenges in life. Understanding why you do what you do, and finding meaning in it, is essential. Maybe it’s the knowledge that you’re making a difference, helping others, and fulfilling a higher purpose. This sense of meaning not only reduces mental distress but also enhances your physical health.

Mitigating compassion fatigue is closely linked to finding meaning in your work. So, as you reflect on this today, consider how you make meaning of your career as a nurse. How are you doing it? Is it strengthening your family bonds? Are you living life to the fullest? Are you building resilience? We know resilience is about adapting, bouncing back, and overcoming difficult challenges. It’s about recovering from adversity, while post-traumatic growth is about moving forward beyond recovery.

You can even experience vicarious resilience when helping someone with their struggles, such as infertility. Watching how they manage, grow, and navigate their journey can inspire you. It’s powerful to witness a couple responding positively to life’s challenges and doing okay. Not everyone falls apart, and those who bounce back or even bounce forward after adversity demonstrate incredible strength. Reflecting on and finding meaning in these experiences can lead to personal strength, a new perspective on life, deeper connections with others, and spiritual growth.

Understanding compassion satisfaction — being fulfilled by the level of compassion you provide to someone struggling with infertility — can be truly transformative.

NF: If you’re trying to find the joy in your day-to-day work, I think that’ll open your eyes and allow you to see it all around you.

BR: You’re absolutely right about seeking it out, but it’s important to acknowledge that while we can name and identify what brings us joy, it takes energy to actually pursue it. Many of us feel drained — we don’t have the energy to manage our sleep, eat well, or even be kind to others. That’s why today’s focus is crucial. That’s why today’s focus is crucial. The acronym FABULOUS reminds us to think flexibly, maintain a positive attitude, set boundaries, and remember why we chose this field. All of these steps contribute to building our resilience, and it takes work.

L — Laughter

It even takes work for the fifth component: “L” for laughter. Some people can’t laugh anymore, they’re done. But laughter is a natural remedy for mental health. It alleviates tension, relieves stress, releases brain chemicals, and improves mood. I love laughing; it’s fun and beneficial. Mentally, it helps you gain new insights; physically, it increases blood flow and releases endorphins.

I was a keynote speaker at the National Association of School Nurses in Washington, D.C., speaking to over 1,300 school nurses. I talked about the importance of going home and decomposing — except I meant to say decompressing. The nurses, being so compassionate, approached me and said, “Barbara, I think you mean decompress.” I laughed at myself because we all make mistakes. It’s okay to laugh at ourselves, and it’s even better to laugh with someone else. Those moments of shared laughter are priceless.

O — Optimism

The sixth component is “O” for optimism. To be optimistic is to embrace a spiritual life that forms the foundation of our well-being and quality of life. Spirituality helps us cope with the stresses of work, affirms our purpose in life, and though it may change with age, it significantly enhances our well-being, especially for those in public service roles like nursing, healthcare or social work.

Spirituality gives us a strong sense of purpose, particularly when working with individuals facing life crises. With a healthy state of mind, we perform better in our roles. It’s important to recognize that we are all connected on a universal scale. As we record this podcast, I’m here in New Jersey, and you’re somewhere else, yet people are listening from all over the world. This spiritual connection transcends physical boundaries, focusing not just on ourselves but extending towards compassion and relationships.

When we focus inward on being FABULOUS — embracing flexibility, a positive attitude, setting boundaries, understanding job satisfaction, and finding joy in laughter — it inevitably impacts our workplace and beyond. We must also seek out awe-inspiring moments. Whether it’s stepping outside during the day to marvel at the clouds, a tree, or even a bug flying by, these moments ground us.

U — Unity and Connection

That brings us to “U,” our seventh component: being united and connected, especially from a management perspective. Managers need to deeply understand what their employees are going through, recognizing the conflict between work pressure and family life. What happens at home affects what’s happening at work, and it’s crucial to build and nurture social connections and interpersonal relationships in the workplace. It’s also important to distance yourself from people who aren’t genuine. As the quote goes, “Some people are real, some people are good, some people are fake, and some people are real good at being fake.” Surround yourself with people you truly like and trust.

S — Self-Compassion

The final component is “S” and that stands for self-compassion. Treat yourself with the same kindness, understanding, and support that you would offer a close friend in times of difficulty or suffering. This idea is supported by the work of experts like Kristen Neff, Davidson, and Warren, who emphasize the importance of self-care during life’s struggles. Acknowledge that you will make mistakes, experience failure, and that you are not perfect. Increase your self-kindness, recognize that you are part of a common humanity, and practice mindfulness. Avoid being overly judgmental, isolating yourself, or over-identifying with what went wrong. I highly recommend exploring Kristen Neff’s work on self-compassion and using your strengths to foster self-compassion.

Building Resilience Beyond Compassion Fatigue

I also want to emphasize the importance of knowing and leveraging your personal strengths to foster self-compassion and, ultimately, to be FABULOUS. Focus on your resilience, creativity, problem-solving skills, self-awareness, spirituality, sense of purpose, and social support. For me, my greatest strength is a love of learning, and everything I’ve shared with you today is grounded in best practices and research. My second greatest strength is wisdom, which I bring into my role as a keynote speaker and trainer. By knowing, defining, and living your strengths, you can effectively manage compassion fatigue and thrive in your professional and personal life.

Supporting Nurses Through the #EmpowerNursesChallenge

ConceiveAbilities understands the impact that continuous exposure to the trauma of others can have on these dedicated individuals, often leading to decreased well-being, strained relationships, and diminished patient care.

That’s why we’ve launched the #EmpowerNursesChallenge, a program designed to raise awareness and promote resilience among the nursing community. Our goal is to empower those who empower others, ensuring that they receive the support they need to continue their vital work with compassion and strength. Learn more about how you can help nurses combat compassion fatigue by joining our #EmpowerNursesChallenge.