The public sector is the part of the economy is made up of organizations owned and operated by the government. These include the military, law enforcement, government healthcare systems, government governing bodies, infrastructure agencies, public education, and public transit, among others. Considering the fact that the decisions made by public sector organizations affect everyone in the community, individuals in the public sector can make a huge impact on nurses affected by compassion fatigue.
Given the complicated public health sector in the United States, it’s hard to determine which agencies may have an impact on nurses. The most obvious agency impacting local nurses is the Board of Nursing in each individual state. In Arizona, the Board of Nursing (BON) functions as a regulatory agency, ensuring that nurses are properly education, fulfilling their scope of practice, and not harming the public. While the Board of Nursing does not specifically put out recommendations regarding the best practices to protect nursing from compassion fatigue, the BON does have a vested interest in approving programs that will educate and retain nurses for the profession.
The Arizona State Legislature is responsible for passing legislation to benefit the people of Arizona, including nurses. This governing body has the most power to pass legislation that directly impacts nurses. Legislators are the people who will vote on bills affecting nurses, whether it is a bill that mandates mental health services for all healthcare workers regardless of the insurance plan, or if it is a bill that creates a workforce group to review nursing education curriculum and establish a plan to address the impending nursing workforce shortage.
The Arizona health insurance agency, known as AHCCCS, is another public sector organization that could potentially impact nurses and nursing staff. Most AHCCCS members receive behavioral health services through their state insurance (AHCCCS, 2020). However, many nurses don’t qualify for AHCCCS benefits because their income level is too high. Consequently, they do not have access to this public sector resource unless they work less hours and make less money to qualify.
While many private sector insurance plans offered by hospitals allow for employee-assistance programs for mental health services, finding a good fit within the confines of the program can be challenging. I can speak to this difficulty through my personal experience trying to find a pre-marital counselor for me and my husband before our wedding. The person we matched with was not a good fit for us. It was so discouraging to go through all that work for everything to not work out. When I decided to seek mental health services for myself later on in life, I chose to find a private sector provider outside of our employee-assistance program because finding the right fit was more important than saving money. However, not everyone has the luxury of being as choosy as I was.
The impact of not having public sector resources for behavioral health can be devastating. Without a lifeline to find help, nurses can become overwhelmed by their compassion fatigue and other stressors in their life. This can lead to depression and emotional trauma, which can ultimately lead to suicide (Kelly, 2020).
This video discuss the impact of one nurse’s suicide on a hospital organization and the prevalence of violent deaths in nurses in the US:
In order to enable nurses to seek the help they need, public sector agencies like the Arizona State Legislature and the Board of Nursing must approve regulation and legislation that benefits nurses and allows them to seek out the help they need. These attempts to help nurses must be complimented by private sector efforts to accomplish the same goal: to help nurses suffering from compassion fatigue and keep them in the profession.
References
AHCCCS. (2020). Behavioral health. Retrieved from https://www.azahcccs.gov/Members/BehavioralHealthServices/
Kelly, L. (2020). Burnout, compassion fatigue, and secondary trauma in nurses: Recognizing the occupational phenomenon and personal consequences of caregiving. Critical Care Nursing Quarterly, 43(1), 73-80. https://doi.org/10.1097/CNQ.0000000000000293
Nurses and Compassion Fatigue 
The World Health Organization reports that globally one person dies from suicide every forty seconds and it is the 10th leading cause of death in the United States (WHO, 2014). There is emerging research demonstrating that physicians are at higher risk for committing suicide and health practitioners are suggested to be alike. An article by Davidson, Stuck, Zisook & Proudfoot (2018) suggested that suicide rates among nurses may be higher than the general population. Due to cause of death reporting accurate reporting it is difficult to definitively conclude. However, the current research determines that it is probable that there are higher rates of suicide among nurses (Davidson et al., 2018).
Pestaner, Tyndall & Powell (2018) discuss the evidence-based interventions school nurses utilize to appropriately screen for children at risk for mental health disorders or suicide. However, there is limited research and time spent providing mental health screening and implementing suicide prevention methods for healthcare workers to spend countless hours selflessly caring for others such as nurses. I know from personal experience working with a new graduate nurse who was experiencing signs and symptoms of severe anxiety. It was pushed off as her just being a new graduate nurse and nervous about her new role. Unfortunately, the day after Christmas in 2019 she took her own life. The amount of grief and guilt the staff that worked with her felt was palpable every day at work. I only wish that there would have been more resources at her fingertips set in place by her employer to reach out to if she was feeling overwhelmed and experiencing thoughts of suicide.
References:
Davidson, J. E., Stuck, A. R., Zisook, S., & Proudfoot, J. (2018). Testing a Strategy to Identify Incidence of Nurse Suicide in the United States. JONA: The Journal of Nursing Administration, 48(5), 259-265.
Pestaner, M., Tyndall, D., & Powell, S. (2019). The Role of the School Nurse in Suicide Interventions: An Integrative Review. The Journal of School Nursing: The Official Publication of the National Association of School Nurses. doi: 10.1177/1059840519889679
World Health Organization (WHO). Preventing suicide: a global imperative. 2014. http://apps.who.int/iris/bitstream/10665/ 131056/1/9789241564779_eng.pdf. Accessed March 2, 2020.
LikeLike
I am so sorry to hear about the nurse you knew. My hope is that there will be increased recognition of the signs of compassion fatigue, anxiety, and burnout, and that there will be policies in place to help nurses and providers get the help they need. Again, I am so sorry to hear about your loss.
LikeLike
Compassion fatigue is something most nurses experience at some point in their career, no matter what specialty. Compassion fatigue and burnout can occur for many reasons in nursing. Staffing ratios, working conditions and work environment, and leadership can have a positive or negative impact on job satisfaction (Ullah et al., 2018). When nurse to patient ratios are high, the prolonged stress of the working conditions increases the likelihood of compassion fatigue and burn out. Both the public and private sectors can impact nursing. For example, public sector is funded with taxpayer’s money and is limited to a strict budget. This creates a perfect recipe for high nurse to patient ratios, limited resources, and staging shortages (Ullah et al., 2018). The public sector also can impact the pay scale for nurses and provide a benchmark for the private sectors. Although the private sector is not funded by the government, many organizations are for profit and rely on payment from patients and procedures. This can impact job satisfaction since organizations place nurses in high stress situations, with poor staffing ratios, and limited resources in hopes of trying to make a profit. Therefore, both sectors can have a positive or negative influence on job satisfaction, compassion fatigue, and burnout for nurses.
In psychiatric nursing, compassion fatigue can be extreme. Behavioral health patients are often in a state of mental and emotional distress upon admit which exposes nurses to prolonged periods of high stress and crisis type situations (Craig & Sprang, 2010). Considering that psychiatric patients present with a myriad of traumatic experiences, it is possible that transference and counter transference can affect these nurses and lead to compassion fatigue and burnout. A study in 2010, found that older nurses report more compassion fatigue in mental health nursing, while the younger nurses report feeling more feelings of burnout (Craig & Sprang, 2010). One must wonder if the years of exposure to mental and emotional stress with patients has different effects on short term and long-term nursing experiences. More studies need to be completed on nursing compassion fatigue and burnout so that solutions and interventions can be developed and utilized in all nurse settings. It is important that nurses take care of themselves just as well as they take care of their patients in order to provide quality care that can improve patient outcomes. Private and public sectors should advocate for mental health care for nurses and ensure staffing ratios are not just profitable but also safe for both nurses and patients.
References
Craig, C., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress & Coping, 23(3), 319-339. doi:10.1080/10615800903085818
Ullah, H., A., S., CH, A., M, & Rana, S. M. (2018). Factors influencing job satisfaction of nurses in public and private sector hospitals: A cross sectional study. Pakistan Journal of Public Health, 8(3), 147-151. doi:10.32413/pjph.v8i3.177
LikeLike
It does not surprise me in the least to see that there are mental health services out there that nurses could benefit from but do not qualify for.
In an article released by the Joint Commission (2019), organizations are told they have a responsibility to support their nursing staff and address the causes of burnout. However, in a 2019 survey, only 5% of nurses reported a high level of support from their organization (The Joint Commission, 2019).
The Joint Commission (2019) uses the term ‘resilience’ to describe the process of personal protection from burnout. Resilience is the ability to successfully adapt in the midst of adversity, developing support systems and promoting a culture of mutual openness and understanding. It is also the ability of a system to have a response to unexpected demands and continue normal operations. The article calls on organizations to learn from their staff: What is important to them? What motivates them? How would they like to be recognized for their hard work? It also calls on leaders to have a presence in the departments, engaging with nurses and allowing for open dialogue to exchange ideas and provide validation (The Joint Commission, 2019).
I hope that the State Board of Nursing, given its devotion to The Joint Commission, considers this article and lobbies for better work conditions and mental health benefits for its members.
Reference
The Joint Commission. (2019). Quick safety issue 50: Developing resilience to combat nurse burnout. Retrieved from https://www.jointcommission.org/en/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-50-developing-resilience-to-combat-nurse-burnout/
LikeLike