Compassion Fatigue: Helping the Helper

Compassion Fatigue: Helping the Helper

By Matt Cascio, RN, CCFP, Compassion Fatigue Coach

I’ve been a Registered Nurse (RN) for 22 years. My practice is more holistic these days, rather than in a hospital setting. At 38 years old, I became a RN after a complete career change. In 2016, I decided to accept a job in an Infusion Center doing something completely different. I didn’t know how attached I would become to my patients and their family members. Cancer had taken my mother in 1999. Knowing what these people were going through made it easier to have compassion and empathy.

After about a year of losing quite a few patients, I noticed I was very unhappy at my job. My hospital was having a lot of issues, so I thought a change would be good for me. I accepted a position at a larger Infusion Center that was caring for a much larger number of patients. During my orientation, my physical health started to decline. My symptoms included horrible GI issues, not sleeping or eating well, and not wanting to go to work because of my stress levels. I also started having nightmares about my patients and their families. I had severe anxiety and profuse sweating. My hands would tremble, which wasn’t good considering what I was doing. It was a struggle to get out of bed and go to work every day. My manager thought maybe the job wasn’t a good fit, so I made the decision to leave. It was a tough decision to make. But it turned out to be the right one in the long run.

Previously, a nurse had given an in-service on Compassion Fatigue. I started researching what the diagnosis meant and how it affected people. My healing journey is a daily practice of resiliency. I’m grateful to have grown so much and to have become much healthier in my mind, body, and spirit. In 2017, I got certified as a Life Coach and have had the opportunity to help people. Now in 2020, I made the decision to become a Certified Compassion Fatigue Professional to be able to use my personal experience to help people learn how to heal.

Compassion Fatigue is a term that is becoming more widely used. But I don’t believe people truly understand the diagnosis. Compassion Fatigue can affect many different people at their jobs, from nurses, doctors, police, firefighters, EMTs, medical residency students, veterinarians, and many more people in “helper” roles. Especially when working in specific fields, the current research shows that it isn’t if you will get Compassion Fatigue, but when you’ll get it.

Here are some statistics on the prevalence of Compassion Fatigue:

  • 86.9% of emergency response personnel report experiencing the symptoms of compassion fatigue after being exposed to highly distressing events.
  • 90% of new doctors under the age of 40 report that their family life has suffered because of their work.
  • 70% of therapists have experienced some form of secondary trauma that is directly related to their profession.
  • 83% of hospice nurses have not had debriefing support after they experienced the death of a patient and 79% of workers within this field report having moderate to high levels of compassion fatigue.1

Some of the terminology used when talking about Compassion Fatigue includes “Compassion Satisfaction”, which involves the pleasure and satisfaction we get from our job. This refers to the positive aspects we derive from what we do as helpers, like providing care or working with a team of people who care for others. It could also involve more personal ideals like altruism and our beliefs about ourselves.

Compassion Fatigue deals with the negative aspects of helping. A diagnosis pinpoints with two separate areas. The first is burnout. Burnout is “the chronic condition of perceived demands outweighing perceived resources”.2  This could be the feelings of burnout on providing care, burnout regarding the system, or burnout about our personal beliefs where our internal well-being is affected.

The second component of Compassion Fatigue deals with work-related trauma, often referred to as Secondary Trauma Syndrome. This condition relates to work-related secondary exposure to extremely or traumatically stressful events involving the people we are helping. Burnout and Secondary Trauma Syndrome are co-travelers when it comes to diagnosing someone with Compassion Fatigue. 2

Research shows that people suffering from Compassion Fatigue are usually in a state of sympathetic nervous system dominance because of the trauma and burnout they experience from their jobs.3 Obviously, the activation of the sympathetic nervous system can be a good thing to provide focus, acuity, anticipation, and fight or flight responses. When someone is constantly in a state of sympathetic nervous system dominance, we start seeing decreased concentration, attention deficit, diminished cognitive and motor functioning, fatigue, avoidance, dis-ease, and self-destructive attempts to soothe the pain with addictive behaviors. 4

Symptoms that are seen with Compassion Fatigue:
  • Anxiety/Fear
  • Frequent complaining
  • Anger– loss of meaning/purpose
  • Dread
  • Relationship Problems
  • Passive aggression
  • Somatic complaints
  • Absenteeism
  • Suicidal ideation
  • Fatigue
  • Reactivity
  • Irritability
  • Racing thoughts
  • Co-worker issues
  • Cynicism
  • Nightmares
  • Hating work
  • Escape fantasies
  • Sleep problems
  • Loss of enjoyment
  • Isolation
  • Sadness/Depression
  • Self RX – alcohol, drugs, food
  • Sarcasm
  • Loss of productivity
  • Violent fantasies
  • Gastrointestinal distress
  • Weight gain/loss
  • Poor concentration 3

As mentioned earlier, dis-ease is a symptom of sympathetic nervous system dominance. Dis-ease relates to the true physical aspects of suffering from Compassion Fatigue and how it can take a serious toll on our health.

Below is a list of symptoms that are common medical conditions, as well as Axis 1 diagnoses seen during a prolonged constant Sympathetic Nervous system dominant state of mind.

  • Shoulder and neck muscle tightness
  • Hormonal imbalances, including estrogen
  • Sensitivity to light
  • Gallbladder problems
  • Sensitivity to sound
  • Uterine fibroids
  • Light sleep and vivid dreams
  • Irritability
  • GI issues like bloating, constipation, or diarrhea
  • Headaches
  • High blood pressure
  • Hair loss
  • Tiredness
  • Thyroid imbalances
  • Feeling cold
  • Polycystic Ovary Syndrome
  • Difficulty losing weight
  • Water retention
  • Sugar or salt cravings
  • Anxiety or depression
  • Increased blood clotting factors
  • Increased risk of DVT and stroke3

How do you know if you could be suffering from Compassion Fatigue? I found an amazing tool known as The Professional Quality of Life Scale (PROQOL). The PROQOL is available to everyone for free. It is the most widely used measure of the positive and negative aspects of helping in the world. It has been around for over 15 years and is available in over 20 different languages. The PROQOL has been shown to be a valid measure of Compassion Satisfaction and Fatigue and was developed with data from over 3,000 people. 2 The test has 30 questions and each question will fall into a specific scale regarding three different constructs: Compassion Satisfaction, Burnout, and Secondary Trauma Syndrome.

There are two ways to score the PROQOL. The first is more detailed and is actually better for research. But the second manner to score is less specific, can be completed quickly, and is easy to comprehend. Once finished, a person is able to measure the levels of Compassion Satisfaction, Burnout, or Secondary Trauma Syndrome they are suffering from. A higher score in the Compassion Satisfaction section shows that you are getting a lot of satisfaction from your job. However, higher scores with Burnout and Secondary Trauma Syndrome are signs you are having issues that could be a concern for your well-being. 2

My scores on Burnout and Secondary Trauma Stress were very high, showing some serious issues that I needed to address. The scores also revealed that I was no longer getting any satisfaction from my job as a nurse in the hospital setting. Using the PROQOL helped me realize that something needed to be done about my situation, especially considering where I was both emotionally and physically.

Someone can retake the PROQOL again over time and see if the scores have changed in a positive direction. If scores aren’t improving, and they are working on healing themselves, it might be good to seek some professional help to assist with your journey.

Perhaps you’ve taken the PROQOL and your scores show you’re suffering Compassion Fatigue. What’s the next step? For me, I remember feeling that I’d given so much of my soul to nursing. The burnout from the system and the trauma of seeing so many patients suffer was too much for me to handle. I wasn’t willing to sacrifice my emotional and phys

ical health any longer. I had some other opportunities, so I took a leap of faith and left hospital nursing.

For others, leaving a job isn’t an option due to their own personal circumstances. The conundrum people face is how to start healing while still working at the same job that’s become an unpleasant and unhealthy environment for them. How do they begin? Healing from Compassion Fatigue is an all-day, everyday process. It begins when you take full responsibility and acceptance of where you are. It will take you on a journey that will become a healthier way of life. You’ll be amazed at how much you can grow and change.

As a Compassion Fatigue Coach, I focus on 5 Resiliency Skills when working with someone. By putting a plan together based on these five skills, we work together to develop a way to not only help them start their healing journey, but to also create more Compassion Satisfaction regarding their jobs.

5 Resiliency Skills
  • Self-Regulation
  • Intentionality
  • Perceptual Maturation
  • Connection and Support
  • Self-Care

Self-Regulation- Becoming resilient is a huge part of the healing process. Resiliency is tied to self-regulation, which is the ability to shift from sympathetic back to parasympathetic nervous system dominance while being fully engaged in the activities of daily living. When you are dealing with “perceived threats” or triggers that start activating your Sympathetic Nervous System, you have to learn to relax. Take a deep breath and be patient with yourself as you keep moving forward through your day.

Intentionality deals with learning to be more committed to changing. This happens with deliberateness and integrity. As Trauma Professionals, we have many demands that are out of our control. But as we work on our resiliency skills and learn to manage our bodies, we learn to suffer less and enjoy work more. By getting to the point where we are more relaxed, we can be more focused on our intentions. Being more focused also ties in with our integrity which can be compromised with some of the symptoms brought on by Compassion Fatigue.

Perceptual maturation is about changing our perception to realize that nothing must change in the workplace in order for the workplace to change. It really isn’t the environment that is causing us stress. It’s what’s going on inside of us. By working on how we perceive ourselves and our workplace, we can make changes and grow. Adapting the perception of our workplace involves our choice to be working there, what we can control, and learning to let go of what is beyond our control. To change the perception of ourselves, we have to look deep inside. That is generally hard for most people. By learning to practice mindfulness, choosing to be happy, and letting go of the negativity, we learn to heal and grow.

Connection and support deal with accepting responsibility for where you are and then reaching out to a few close family members or friends. These are the people that need to know what you are going through. You can let them know you are working on a plan to get healthier. By telling them, you give them permission to not only be there for you, but to hold you accountable when you are struggling. Besides, we always do better with a support system. We’re much more likely to follow through with our intentions if our actions are witnessed by others.

Self-care is about learning to look after yourself again. Most people suffering from Compassion Fatigue aren’t doing much for themselves. This skill involves sleeping and eating better, working out, and connecting with spirituality, personal hobbies, and even professional enrichment. All that brings us joy and passion are exactly what we need for inner peace and happiness.

Compassion Fatigue is a real situation that is on the rise. Trauma professionals, health care workers, and others working in “helper” roles are suffering due to COVID-19. My hope is this article could be the spark that will help pull someone out of their darkness.


Matt Cascio is a registered Nurse of 22 years as well as a Compassion Fatigue Coach. He’s been involved in the Cannabis Industry since 2014. He is a member of the Cannabis Nurses Network and the American Cannabis Nurses Association. Matt has provided Cannabis education at various events in Missouri. He is part of the Cannabis Care Team offering cannabis education to patients and dispensaries in Missouri and Oklahoma. He can be contacted at the Cannabis Care Team.




  1. Gaille, Brandon. (2017). 23 Unusual Compassion Fatigue Statistics. Small Business & Marketing Advice.
  2. Stamm, B. Hudnall. (2005). THE PROFESSIONAL QUALITY OF LIFE SCALE: Compassion Satisfaction, Burnout & Compassion Fatigue/Secondary Trauma Scales. Idaho State University, Institute of Rural Health.
  3. Gentry, Eric. (2012). Tools for Hope. [DVD]
  4. Adams, Joe. (2019). The Hidden Syndrome. Calibration Chiropractic.

Further Reading

  1. Gentry, J. E., & Baranowsky, A. B. (1999). “Treatment manual for accelerated recovery from compassion fatigue”. Psych. Ink.
  2. Gentry, J. E. (2002). “Compassion fatigue: A crucible of transformation”. Journal of Trauma Practice, 1(3-4), 37-61.