During the presentations “Daring to Find Joy and Meaning at Work,” by Kathryn E. Roberts, MSN, RN, CCRN-K, CCNS, FCCM, of Children’s Hospital of Philadelphia, and “Compassion Fatigue, Resilience, and Coping in Pediatric Oncology Nurses,” by Belinda Mandrell, PhD, RN, and Courtney Sullivan, RN, both of St. Jude Children’s Research Hospital in Memphis, TN, for the inaugural ONS Bridge™ virtual conference, speakers addressed these and other related topics.

How to Find Joy

“We all have those moments when it’s easy to find joy and meaning in our work, and then there are those moments when it’s really hard,” Roberts said. “We all experience them, and it’s OK. The more we can learn how to manage those moments, the more resilient we’ll be—as individuals and as a profession.” 

Joy in work, or the lack thereof, affects not only staff engagement and satisfaction but also patient experience, quality of care, patient safety, and organizational performance, Roberts said. Joy is about more than the absence of burnout—it is about connecting to meaning and purpose, and it is an essential resource for the enterprise of healing.

Roberts described finding meaning as sensing or recognizing the importance of an action. The engaged professional—someone who is enthusiastic and passionate about their work, takes positive action to further the organization’s reputation, is motivated to contribute to ongoing organizational success, feels a strong emotional and personal connection to their workplace, and always wants to achieve the best possible results—embodies this.

But sometimes reality doesn’t match up with expectations.

Roberts suggested several strategies for changing this, including making and taking time for relationship building, focusing on what brings you joy and meaning in your role, and changing how you think, such as by connecting your work to service and remembering why you work.

Every nurse should ask themselves three key questions, Roberts said:

• Am I treated with dignity and respect by everyone, and do I treat everyone with dignity and respect?
• Do I have what I need so I can make a contribution that gives meaning to my life, and do I work to make sure my team and colleagues have what they need so that they can make a contribution that gives meaning to their lives?
• Am I recognized and thanked for what I do, and do I recognize and thank others for what they do?

Because of the nature of the profession, oncology nurses should view self-care as an essential component of oncology nursing, Roberts said, and it should be promoted and supported by nursing leadership. 

How to Reduce Compassion Fatigue

Mandrell and Sullivan noted the following risk factors for compassion fatigue, or psychological and physiologic distress stemming from secondhand exposure to the stress and suffering of others: caring for patients with life-threatening illnesses, having a long-term nurse-patient relationship, encountering ethical dilemmas, and witnessing grief and bereavement.

Most at risk are nurses who are younger, have long working hours, work on inpatient units, have a history of personal trauma, and lack adequate communication skills and support systems.

According to Mandrell and Sullivan, compassion fatigue can have a host of effects, ranging from personal (e.g., insomnia, fatigue, hypertension, gastrointestinal distress, irritability, intrusive thoughts of the traumatic event) to professional (e.g., medication errors, tardiness and absenteeism, decreased job satisfaction, increased turnover, decreased patient or family satisfaction).

Continued compassion fatigue and ineffective coping can lead to burnout, which is characterized by emotional exhaustion, depersonalization (cynical, negative attitudes resulting in callous and noncaring conduct), and reduced personal accomplishment.

Physiological or psychological resilience—the ability to overcome negative situations through effective coping and adaptation and the ability to undergo personal change—is thought to protect against compassion fatigue and promote compassion satisfaction, a buffer against the negative aspects of caregiving.

Mandrell and Sullivan also presented findings from a quality improvement project based on the hypothesis that pediatric oncology nurses on a 20-bed inpatient pediatric neuro-oncology unit were experiencing compassion fatigue.

After the six-month pilot program, they observed a decrease in nurses’ compassion fatigue levels, demonstrating the benefit of a structured, ongoing evidence-based compassion fatigue program that includes interventions like an on-unit respite room, education binders with information about signs of compassion fatigue and interventions to address it, organizational wellness resources, healthy eating guidance and recipes, and grief and bereavement coping tools.

Additional programs evolved from the project, including:

• A bimonthly interprofessional forum for participants to discuss difficult emotional and social issues that arise in caring for patients
• A resilience center that functions as a resource for staff to enhance wellness with innovative evidence-based strategies
• RISE (Resilience in Stressful Events), a peer-to-peer support program that allows staff to call for assistance after a stressful event
• A restorative rest project that involved a three-week pilot program introducing a 20-minute restorative rest or nap among bedside night-shift RNs on a solid tumor unit; a policy was developed for hospital-wide implementation, pulling in other healthcare providers and additional disciplines.

Overall, it is important not to neglect the care of those who provide care to others, Mandrell and Sullivan said.