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CAREERS & TRAINING:

Home healthcare YOUR WORLD:

Compassion fatigue


LEADING FROM THE FRONT. w w w . A m e r i c a n S r C o m m u n i t i e s . c o m

OPPORTUNITIES EXIST THROUGHOUT INDIANA.

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QUA R T E R LY

NURSING DEGREES THAT

Cover:

Beth Tharp was recently named Nurse of The Year at the 2012 Salute to Nurses.

MAKE A STATEMENT

Cover photo: Marc Lebryk

Inside

Advertising

IWU Online

4 On the Pulse

Outside sales and events supervisor

5 Clips & Tips Medical technology

Inside sales and events executive

Morris Bradley (317) 444-7437 morris.bradley@indystar.com

Health care specialist

 arah Harmon S (317) 444-7113 sarah.harmon@indystar.com

Education specialist

 andi Keeney M (317) 444-7267 mandi.keeney@indystar.com

Cover Story

8 2012 Salute to Nurses

Careers & Training

Carrie Bernhardt (317) 444-7288 carrie.bernhardt@indystar.com

• Post-licensure (RNBSN) • MSN in Administration and Education • Certificate in Parish Nursing

Education Centers in Indiana, Kentucky, and Ohio* • Post-licensure (RNBSN) • MSN in Primary Care Nursing (Family Nurse Practitioner)

IWU campus in Marion, Indiana • BSN Degree – traditional 4-year program • BSN Degree – Transition to Nursing * Not all programs available at all locations

A degree from Indiana Wesleyan University makes a statement.

16 Home Healthcare Nursing

Your World 20 Compassion fatique 23 Q&A with Beth Tharp

Online/Indiana/Kentucky/Ohio

Online now

INDWES.EDU

Nominate someone for Salute to Nurses. Find a new job in nursing. Subscribe for free email alerts. Do it all at indystar.com/nursing.

866-498-4968

Excited to salute our nursing community Date:

4/17/12

Client:

Indiana Wesleyan University

Contact:

Kristin Higgins

Community Health Network is one of the largest health care providersMarket: in Indiana.

Nothing matters more to us than providing the Job # 2012121 highest quality, most compassionate care possible page (2.25”x4.75”) to our patients. And Size: nothing is more 1/6 critical to our Publication: Salute to Nurses - Indy Star ability to do so than hiring, training, supporting, Insertion Dates: nursing staff. and retaining a highly competent We are proud to support our Community of Nurses, who make possible our ability to sustain our mission to enhance health and well-being for the communities we serve. Visit eCommunity.com/nursing to learn more about our nursing team and our focus on Nursing Excellence. EOE.

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Get your INQ updates! Be sure you’re in the know. Sign up to receive email alerts when the each quarterly issue of INQ goes online: indystar.com/nursing.

On the Pulse

Promotions, workshops, awards

■ Appointments

Marilyn York, RN, has been named cardiac service line leader for Indiana University Health Ball Memorial Hospital. She will lead the cardiology service line, which includes cardiac services, cardiology/neurology, cardiac rehab and respiratory services. York has been with the health care system for 13 years.

Content Indiana Nursing Quarterly is a product of Star Media, 307 N. Pennsylvania St., Indianapolis, Ind. It’s distributed electronically to nurses throughout central Indiana. Submit news items to pubs@indystar.com. Editor

Angela Parker (317) 444-7039 angela.parker@indystar.com

Contributing writers

 rooke Baker, Shari Held, B Ashley Petry, Holly Wheeler Joe Soria Marc Lebryk

■ Recognition

Michele Kuntz Wood, RN, manager of Women’s Health Services for Franciscan St. Francis Health, was recognized as a 2012 IBJ Health Care (DH) AD PROOF: Hero in the non-physician Proof Due Back By: 01/27 2pm category. She has been in Ad #: P21113-f-13680-3x4 management at St. Francis Deadline To Pub: 01/27 5pm First Run: 02/01/12 for 27 of her 38 years in nursing. Publication: Spec Wood helped organize Section: n/a Specs: 2.25 x 4.75 Indianapolis’ first Race Wood as is. for the Cure; helped formApproved the Breast Health Awareness League and with revisions. thenApproved transition it to Central Indiana Affiliate of Susan Revise and resend. G. Komen for the Cure; and spearheaded Initial _________ legislation for the Date breast__________ cancer awareness license plate. Jessie A. Westlund, RN, chief integration officer for Community Health Network and CEO of Community Home Health Services, was a Health Care Hero finalist. Westlund joined Community Health Network in 1998 and has been instrumental in launching several programs including Life’s Journey for people with chronic diseases, Touchpoint Westlund for seniors and Telehealth, which measures the vital signs of at-home patients. — IBJ Photo: PERRY Reichanadter

Graphic designer Photos

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Indiana Nursing Quarterly

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Dr. Ann White has been named dean of the College of Nursing and Health Professions at the University of Southern Indiana. She is only the second dean in the history of the College. Dr. Nadine Coudret served as dean from 1988 to 2012. White joined the University in 1990. She previously served the College of Nursing and Health Professions as White professor of nursing, assistant White dean of nursing, and program director for the Doctor of Nursing Practice program.

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• Spring 2012

pubs@indystar.com.

Indiana University Health named Mona Euler as the first vice president for its nationally ranked neuroscience program, IU Health Neuroscience. Euler will oversee the growth and development of the IU Health Neuroscience Center, a first-of-itskind initiative that will combine the nationally ranked neuroscience programs and resources of IU Health and the IU School of Medicine. Euler comes to IU Health from Kindred Healthcare where she served for 13 years as the market chief executive officer. She holds a nursing degree from Ball State University and a master’s degree from Indiana Wesleyan University. The Cancer Navigator Program at Hendricks Regional Health named Lianna Willhite, RN, as its cancer navigator. She serves as the official liaison between doctors, hospital services, patients and their families, ensuring that patients have the educational, nutritional, emotional and financial resources they need. Willhite has been a nurse at Hendricks Regional Health Willhite for more than two decades. For the past several years, she has worked in the radiology department with patients undergoing diagnostic testing for cancer. In June, Anne Thomas, dean of the University of Indianapolis’ School of Nursing, will be inducted into the Fellows of the American Academy of Nurse Practitioners, which recognizes outstanding contributions to national and global health. She is being recognized for her work in establishing new health clinics and leading the development of national and international educational curriculum. Thomas She currently is helping to develop national standards for nurse practitioner education, among other projects. The Southwest Indiana Area Health Education Center selected Dr. Nadine Coudret for this year’s Indiana AHEC Network Hero Award. For 24 years, Coudret served as dean of the College of Nursing and Health Professions at the University of Southern Indiana. The award is given to an individual or organization who goes beyond the call of duty to ensure the success of the Indiana AHEC Network mission.


Clips & Tips

By Shari Held

Moving forward:

■ While the traditional core values in nursing haven’t changed, the profession continues to evolve. Here’s a look at the trends that are changing the profession some just emerging and some for the better, some not so much.

 vidence E shows that hourly rounding not only reduces call light usage, it decreases falls and increases nurses’ and patients’ satisfaction. —Anne Wolfersberger, RN Wishard Hospital

The rise of evidence-based medicine | Susan McRoberts, RN, MSN and chief nursing officer for Franciscan St. Francis Health, recalled that in the past, considerable time was spent examining and trying to improve processes. “Now we look at McRoberts patient outcomes and try to make them better,” she said. “I think that’s really been a positive for our patients.” Evidence-based medicine has taken the practice in a different direction, and many of the things that have come out of it actually have streamlined processes. One example, based on evidence derived from a pilot program conducted by Wishard Health Services, is hourly rounding. “Evidence shows that hourly rounding not only reduces call light usage, it decreases falls and increases nurses’ and patients’ satisfaction,” said Anne Wolfersberger, RN, and clinical manager for a med/surg and telemetry unit at Wishard Hospital. “While nurses think it is more timeconsuming, it actually winds up saving them time.” Indiana Nursing Quarterly

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Clips & Tips

Research, trends, tips

Technological tricks | Hand-

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held devices, electronic medical records, electronic medication dispensing systems — there’s no escaping technology. Electronic medication dispensing frees nurses to focus on other duties while EMRs place patient information at their fingertips. “Electronic medical records aren’t time-saving for the nurse, but they are safer for the patient,” McRoberts said. “The nurse might be tired, but the computer never gets tired.” EMRs provide more comprehensive patient data — data that can be accessed simultaneously by multiple caregivers. The downside is that interacting with technology means less time for traditional bedside nursing. The challenge

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is in balancing the two for the best outcomes for patients.

Improved collaboration with physicians | Twenty years ago, nurses did what physicians told them to do. Today, they operate as a team. “Physicians seek a lot of feedback from us because we are with the patient most of the time,” Wolfersberger said. The emphasis on obtaining magnet status also has helped drive that collaborative environment. “Today, nurses are in shared governance structures where they help determine clinical policies and procedures and then are accountable for them,” McRoberts said.

A better-informed public | The Internet and Dr. Oz have made medical information readily available

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Clips & Tips

Research, trends, tips

to the public. As a result, patients’ questions are more pointed and sophisticated — but there also is the potential for misinformation. “Traditionally, the one thing that has stood through the years is that the nurse is the most trusted occupation in the U.S.,” McRoberts said. “So nurses have to really stay on top of [health care topics] and be lifelong learners to provide the best information to their patients.”

The role of long-term care facilities | The perception of longterm care also is changing: Nursing homes no longer are repositories where the sick and elderly wait to die. “They come here and get better and they go back to their homes and pick up where they left off,” said Terry Jonas, RN, CDONA and director of nursing for Parkview Care Center in Evansville. “That’s very positive.”

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Jonas said nursing homes also are admitting more acutely ill residents — an up-and-coming trend that stems from the growing senior population and changes in regulations that shorten hospital stays. “Because of that, we, in turn, have to make sure our nurses receive more training and education on dealing with acute residents, versus long-term residents,” she said. Parkview Care Center also hired an in-house physician to be on-site 40 hours per week. Such an addition should improve communication between long-term facilities and hospitals.

Expanded education expectations | A bachelor’s degree or greater is now expected, prompting many nurses to pursue advanced education and even doctorate degrees. Thanks to online coursework, that

education is more accessible. But an advanced degree doesn’t necessarily mandate a job change. Wishard has a career advancement ladder that rewards nurses who continue their education but choose to remain at the bedside. Wolfersberger said it ensures a high level of competency on units and increases usage of evidence-based research. In long-term care facilities, the push is on for nurses to be trained in caring for cardiac patients and those with congestive heart failure. That expertise allows those residents to receive care on-site. Jonas said increased educational expectations and responsibilities have had a positive impact on wages. “Years ago, the pay was pretty embarrassing when you tried to recruit people,” she said. “We’ve come a long way on that, although we still have a way to go.” ●

pubs@indystar.com.

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• Spring 2012

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Cover Story

By Holly Wheeler

Indianapolis Star’s The

10th Anniversary

10th Salute to Nurses was an event to remember


h o s n o r

Cover Story Indianapolis Star’s The

10th Anniversary

Salute to Nurses celebrates and honors those who choose a profession whose core is helping others. This year marked the event’s 10th anniversary and brought together nearly 700 nurses, administrators, friends and families April 25 at the Indiana Roof Ballroom.

Elegance and excitement | Salute to Nurses is about honoring nurses, but the luncheon is about giving these men and women the royal treatment. The elegant setting, delicious food, flowers and prizes set the stage for the awards ceremony. “It’s amazing to be there,” said Beth Tharp, Nurse of the Year. “That ballroom is so gorgeous and elegant. The minute I walked in the door everyone was so attentive and nice.”

The ceremony included an inspirational message from Anne Ryder, a freelance journalist, writer and speaker, who has spent years interviewing some of the world’s most loved caregivers, including Mother Theresa. Several past Nurse of the Year winners also were in attendance, sharing their personal experiences and celebrating with this year’s honorees. “We have a total of 78 nurses who have been award winners and thousands of nominated nurses,” said Carrie Bernhardt, The Star’s advertising sales and events manager. “The 10th annual had a great deal of heart. Something that always amazes me is how humble the nurses are, yet they are so deserving.” Prizes included necklaces from Hofmeister Personal Jewelers, free car washes from Mike’s Express Car Wash, gift cards from Marsh, ZCoil, Natural Concepts, Applebee’s and McDonald’s, and overnight stays at Renaissance Indianapolis North. Indiana Nursing Quarterly

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Cover Story

This year’s Salute to Nurses winners include (from left): Janis Shook, Cheryl Howard, Sandra Evanoff, Beth Tharp (2012 Nurse of the Year), Susan Moore, Sara Horton-Deutsch, Rosemary Hobson, Karen Yehle and Alexis Martin.

2012 Salute to Nurses award winners

■ Nurse of the Year and Advancement in Nursing: Beth Tharp, RN, BSN, MBA, CNO, Community Hospital Anderson ■ Community Outreach: Cheryl Howard, BSN, RN-BC, Franciscan St. Francis Hospital–Mooresville ■ Nurse Educator: Susan Moore, PhD, RN, IU School of Nursing, retired ■ Lifetime of Caring: Janis Shook, LPN, Terre Haute Regional Hospital ■ Inspiration: Sandra Evanoff, ASN, RN, CPAN, IU Health North

Honorable mentions

■ Karen Yehle, PhD, MS, RN, Purdue University ■ Rosemary Hobson, RN, Columbus Regional Hospital ■ Sarah Horton-Deutsch, PhD, PMH, CNS, RN, IU School of Nursing

Student winner As the student winner, Alexis Martin, IU School of Nursing–Kokomo, received an $8,000 scholarship “This year, The Indianapolis Star’s $3,500 scholarship was more than matched by USA Funds,” Bernhardt said. ●

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New twists

A new award — the CARE Award — was introduced for Salute to Nurses’ 10th anniversary. Event sponsors at the silver level and above each chose a nurse from their facility who is Compassionate About Reaching for Excellence. The winners were: ■ Stephanie Isenberg, RN, Community Health Network ■ Linda Kendall, RN, Hancock Regional Hospital ■ Kim McGuire, RN, BSN, CMSRN, IU Health-University Hospital ■ Elaine Shea, RN, MSN, Wishard Health Services ■ Theresa Weisenbach, RN, BSN, MBA, OCN, Franciscan St Francis Health


Cover Story

Indianapolis Star’s The

10th Anniversary

Celebrating a decade of excellence

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Careers & Training

New nursing degree targets newborn care

Amid the growing need to provide intensive care for newborn infants, the University of Indianapolis, the Indiana University School of Medicine and Riley Hospital for Children at IU Health are collaborating on a new UIndy master’s degree program that will be the only one of its kind in the state. The Neonatal Nurse Practitioner program will begin this fall with a mix of classroom instruction, online studies and clinical work in local health care facilities, leading to a specialized master’s degree. The program is designed for working nurses, and the instructors will include active pediatricians and nurse practitioners. Hands-on training and observation will take place at Wishard Hospital, IU Health University Hospital and Riley’s Neonatal Intensive Care Unit. “For the students to have access to those kinds of clinical experiences is unprecedented,” said Anne Thomas, dean of UIndy’s School of Nursing. “These new nurse practitioners will be thoroughly prepared to fill the gap in communities that simply don’t

Master’s moving online

Indiana University-Purdue University Fort Wayne announced that all four areas of specialization of the master of science with a major in nursing program will move to an online format this fall. IPFW offers master’s degrees in adult nurse practitioner, women’s health practitioner, nurse educator and nurse executive. An open house will be held Wednesday, May 16, at the Georgetown Branch of the Allen County Public Library, 6600 E. State Blvd. Those interested in the program will be able to speak with Deb Poling, IPFW director of graduate nursing programs.

have enough neonatal physicians to meet the demand.” Cheri Walkosak, director of neonatal nurse practitioners for the IU School of Medicine, said she needs a continual influx of new talent to maintain her staff of 50 nurse practitioners at Riley Hospital. Nurse practitioners not only provide direct patient care, but also help train nurses, therapists and other health care workers in the preferred practices. The demand for such expertise has increased with the establishment of NICUs in South Bend, Fort Wayne, Evansville, Lafayette, Bloomington and elsewhere around the state as local health care systems provide services close to home. — University of Indianapolis

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Careers & Training Nursing students say technology improves learning Undergraduate nursing students at Indiana State University say technology, including a video software program that records lectures for later review, is helping them master complex curriculum and stay on track in completing a four-year degree. “Many of us are visual learners and taking notes sometimes doesn’t cut it, but if I go back and watch the video along with my notes, it improves my chances of success,” said senior Gayle Goodrick. Indiana State uses McGraw Hill’s Tegrity Campus, an automated system that allows students to view recorded lectures, search and bookmark content, take notes, and collaborate with instructors and fellow classmates. The system is used in traditional, hybrid and online courses. It works on a personal computer, Mac or mobile device. “This technology ... allows content to be explored in a variety of other ways while in the classroom setting, through case studies and other application techniques,” said Marcee Everly, assistant professor and chair of the baccalaureate nursing program. Like many nursing students at Indiana State

and elsewhere, Goodrick is a non-traditional student. As a married mother of four, she has to balance family and her classes, but said Tegrity helps ensure that she doesn’t fall behind in her pursuit of a bachelor’s degree and a license as a registered nurse. “The nursing program is rigorous and things like Tegrity make our success that much more achievable,” Goodrick said. Megan McGuire, a senior nursing major from Hillsboro, used Tegrity during an obstetrics class that Everly teaches. “With Tegrity, you can watch a lecture and pause it whenever you need to take notes,” she said. Everly credited Tegrity will helping to improve the performance of recent ISU graduates on the National Council Licensure Examination for registered nurses. Nearly 93 percent of December bachelor’s degree nursing graduates from Indiana State who took the test for an Indiana nursing license passed, an improvement over previous years and a figure that exceeds the most recent national rate of 87.89 percent.

Indiana Nursing Quarterly

— Indiana State University

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Careers & Training

By Brooke Baker

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Indiana Nursing Quarterly

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• Spring 2012

THINKSTOCK

Home health nurses work flexible hours and set their schedules around patients’ availability and their own needs.


Careers & Training

Home health nursing:

Flexible hours, ever-changing case loads and autonomy ■ Anyone who works in a hospital has seen the trend: Patients are sent home earlier and sicker as insurance companies change the metric for hospitalization. But they probably haven’t seen the other side — the growth of the home health care industry. Opportunities exist for nurses to work in all sorts of home health positions — field nurses, case managers, telehealth, administrators — and jobs are opening up as patient care shifts to the home. Some agencies focus on one sector, such as elder care, while others treat a variety of patients. In both cases, nurses interact with patients in their homes and have the chance to touch and influence all aspects of care. The main difference between hospitalization and home care is that hospital stays are short term and staying at home is a long-term goal. “We have patients who stay [at home] for years,” said Jan Roberts,

CEO and administrator for Alliance Home Health Care, which strives to keep elderly patients at home as long as possible.

A satisfying career | Roberts said turnover in home health care isn’t a problem because nurses tend to be fulfilled in their careers and stay in their jobs until retirement. Most agencies provide job shadowing opportunities and an extensive interview process to Roberts give nurses a chance to see what it’s like before they commit. However, because it’s so different from other sectors, the transition to home health can take some effort. “I find that people either really like it or they really don’t,” said Karin Bridwell, RN, director of St. Vincent Home Health and Hospice. “It’s very unstructured, so nurses have to be very disciplined about starting their day on time and finishing the documentation on time. If someone isn’t really self-disciplined, they are

probably going to fall behind and not be happy with this type of work.” Home health nurses work flexible hours and set their schedules around patients’ availability and their own needs. That’s an attractive benefit to those who don’t want to work rigid 12-hour shifts.

Confidence and well-honed clinical skills | Bridwell said some nurses have the impression that home care is a low-tech environment — taking blood pressures and handholding — but nothing could be further from the truth. “That’s not the case at all,” Bridwell said. “Nurses are doing IV therapy in the home, chemotherapy, extensive wound care — it’s very high tech. And since the nurse is in the home by herself, she has to be really confident in her skills and abilities.” Home-care nurses need to have some acute-care experience, and many come from med/surg backgrounds. They also have to trust their clinical instincts.

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Nicole Offutt Clinical Manager for Visiting Nurse Service is pictured in front of VNS’s fleet of Toyota Prius hybrids which can be seen all over the Indianapolis area.

“One of the things I love best about it is you have probably more autonomy in this type of nursing than you would in almost any other setting,” said Nicole Offutt, RN-BSN, COS-C, clinical manager for Visiting Nurse Service. “You’re the eyes and ears for the doctor out there. In a lot of other settings, the eyes and ears are the doctors themselves. Out here, we’re the ones making recommendations based on what we’re seeing.”

Independence and critical thinking | Val Kappes, RN, manager of St. Vincent Home Health in Indianapolis, said nurses who excel in home health care generally have a talent for critical thinking and the

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self-confidence required to function independently. “You need to be a very independent thinker and you need to be very, very flexible,” she said. “You definitely have to be very autonomous. You have to be comfortable with that, because there’s never another nurse or physician riding with you. It’s not like you can run down the hall and say, ‘Please come help me.’ ’’ RNs in most home health care agencies act as case managers. That means the RN is the point person who organizes the patient’s care. It’s a lot of responsibility but Kappes said it’s incredibly fulfilling because it gives nurses a chance to truly affect their patients’ lives. ●

• Spring 2012

Job opportunities aren’t all field work

Not all home-health nursing careers are in the field. While most of the nurses are out in the community making home visits every day, there also are opportunities for those who prefer an office setting. Many administrative jobs at home health care agencies are filled by nurses, and nurses also are needed to take referrals and admit patients, whether it’s over the phone or in hospitals before patients are released into home care. Telehealth employs nurses to monitor patients long-distance through in-home technology. They educate patients about the telehealth equipment, monitor and chart the input, and help the case manager determine whether intervention is needed. While case managers are RNs, there also are opportunities for LPNs and CNAs, both in the office and in the field.


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E M P O W E R I N G

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Registered Nurses - Critical Care PRN, Pool and Full-Time Night positions available in our Critical Care Unit. Requires current Indiana RN licensure; BSN preferred. Critical Care (or related similar) experience required; minimum 18 months current critical care nursing experience. BLS and ACLS required. Successful completion of dysrhythmia recognition test at initial department orientation.

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A hospital you can believe in. Indiana Nursing Quarterly

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Your World

By Ashley Petry

Compassion fatigue:

THINKSTOCK

Can nurses lose their ability to nurture? ■ The nursing profession offers many rewards including job security, interacting with patients and their families, and knowing that your work is making a difference. But there’s a darker side to nursing that no one mentions: seeing patients suffer and, not infrequently, watching

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Spring 2012

them die. Coming face-to-face daily with suffering and death takes an emotional toll on nurses. Left unchecked, that emotional strain can lead to compassion fatigue, a condition that prevents nurses from connecting emotionally with their patients. Compassion fatigue is getting more attention from nursing leaders these days not only because it can diminish the quality of care patients receive,


Your World

but also because it might push some nurses to leave the profession.

Defining compassion fatigue | Nursing experts still are debating the definition of compassion fatigue. The term was coined in a 1992 research paper about nursing burnout, and it originally was defined as “loss of the ability to nurture.” In “Compassion Fatigue: A Nurse’s Primer,” published last year in the Online Journal of Issues in Nursing, Barbara Lombardo and Caryl Eyre defined it as “a combination of physical, emotional and spiritual depletion associated with caring for patients in significant emotional pain and physical distress.” “Part of the challenge in defining this particular construct is that it’s complicated, and it overlaps with many other ideas,” said Lucia

Wocial, a nurse ethicist with Indiana University Health. Wocial also is an adjunct assistant professor with the IU School of Nursing and a faculty member with the Fairbanks Center for Medical Ethics. “[Compassion fatigue] occurs when your emotional boundaries get blurred,” she said. “The idea is that you may have unconsciously absorbed the emotional impact of the trauma for the person you’re taking care of.” Put another way, compassion fatigue is an imbalance of empathy and objectivity — both of which nurses need to do their jobs well.

Symptoms | Wocial said compassion fatigue often is confused with other occupational hazards, such as burnout. Some research suggests that burnout is the result of conflict within the work setting, rather than the

emotional challenges of caring for patients. Burnout tends to happen gradually, while compassion fatigue can result from a specific traumatic event. It also is reasonable to think of burnout as the end stage of compassion fatigue, said Dr. Caroline Carney Doebbeling, an affiliated scientist with the Regenstrief Institute, who wrote a 2009 paper on the prevalence of compassion fatigue among cancer-care providers. One of the earliest symptoms of compassion fatigue, she said, is avoidance. “One of the things that was described anecdotally was nurses just not wanting to go back in a patient’s room again, or not wanting to spend the time with patients that they had wanted to before,” Doebbeling said. “It’s the beginning of emotional withdrawal from their duties.”

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Your World Symptoms of compassion fatigue vary but also might include the following:

■ Sadness, depression, feelings of hopelessness ■ Moodiness, irritability, a negative attitude ■ Decrease in enjoyment of job ■ Difficulty sleeping ■ Emotional detachment, both at work and in one’s personal life ■ Substance abuse (e.g., drinking excessively after work in an attempt to forget) “Compassion fatigue can look like depression, but it can also make folks look like they’ve become cold or cynical to the work they’re doing,” Doebbeling said. Nurses experiencing compassion fatigue also might complain of physical symptoms, such as stomach upset, exhaustion and frequent colds. In extreme cases, nurses experiencing

compassion fatigue might shift from being apathetic about their patients to being outright judgmental. “They’re tired of caring so much, so they can’t step back and say, ‘That may be an unpleasant person, but they’re unpleasant because they’re in a crisis,’ ” Wocial said. “If the last five patients you worked with seemed unpleasant, ask yourself if maybe it’s you.” As compassion fatigue gets more attention, employers are becoming increasingly aware of how the problem might affect patient care. Nurses with compassion fatigue often spend less time with patients and their families, meaning they might lack valuable insights into how best to care for those patients. “When you’re out of balance, it’s virtually impossible for you to provide excellent care,” Wocial said. “You can do the tasks of nursing, but those are just tasks. That’s not the whole package.”

Tracking the problem | Little research has been done on the prevalence of compassion fatigue among nurses. In 2011, 62 percent of nurses who responded to an American Nurses Association online poll indicated that they had experienced compassion fatigue. But hard data on its prevalence in health care facilities is harder to come by. Doebbeling said nurses would probably be reluctant to admit the problem on surveys conducted by their employers. “I would really love to see some good prevalence studies in different health care settings,” she said. Based on anecdotal evidence, though, experts say they believe compassion fatigue is a bigger problem now than ever before. “I’m pretty confident that compassion fatigue is on the rise,” Wocial said. “Nurses are being asked to do more with less all the time, and nursing as a profession is changing. Nobody does well when everything is changing.” ●

through the situation as if it’s not affecting them personally. There’s no ability for that person to really discuss their feelings or responses to the situation, and it just keeps recurring.” Nursing supervisors can help prevent compassion fatigue in two simple ways:

More advanced interventions for compassion fatigue include discussion groups and individual counseling. Some employers address the problem by offering retreats where nurses can focus on their original reasons for choosing the profession — and hopefully reignite their passion for it. Doebbeling said nurses need a venue in which they can talk about what they’re experiencing and feeling, where they can say, “This is really hard” but not be judged for it. Nurses also can combat compassion fatigue by finding nondestructive ways to let go of their work at the end of the day. Wocial recalled reading about a mortician who did just that. When he arrived home each evening, he placed his hand on the garage door for a moment, a symbol that he was leaving work behind. The next morning, he placed his hand on the door again, symbolically reclaiming the challenges — and the rewards — of caring for others. ●

Healing the healers The first step in combating compassion fatigue is making sure nurses take care of themselves. Wocial points to the fifth provision of the ANA code of ethics, which says “the nurse owes the same duties to self as to others.” She said that, too often, nurses work 12-hour shifts without taking breaks, even to eat or use the restroom. That means they also don’t have time to emotionally process the things they’ve witnessed. “There’s a survivalist mentality in nursing, and that’s not good,” Wocial said. “Recognize that you’re not a robot. You’re human and it’s OK to meet your own needs. In fact, you need to do that.” Nurses also need to strike a balance between having a professional demeanor and dealing with their emotions. “Nurses work in a setting where emotion isn’t necessarily acknowledged or allowed,” Doebbeling said. “Everyone has to have a stiff upper lip, maintain composure and go

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Make sure nurses take real breaks, and help them delegate care for their patients during that time. “One of the most powerful things a supervisor can do is say, ‘Take a break, I’ll watch your patients,’ and not give the nurse a choice,” Wocial said. “The best thing they can do is establish a culture and an expectation that people will take breaks.”

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Create a culture that encourages communication about emotional difficulties. “Don’t wait for them to come to you,” Wocial said. “You need to promote an environment that it’s okay to talk about.”

• Spring 2012


Your World

By Holly Wheeler

with Beth About me Position:

Chief nursing officer at Community Hospital Anderson

Education: ASN, Anderson College; BSN, Indiana Wesleyan University; MBA, Anderson University

B

eth Tharp entered the Salute to Nurses luncheon knowing she would receive the Advancement in Nursing award. What she didn’t know was that she also had been named Nurse of the Year. Tharp, who said she’s “on cloud nine,” is looking forward to a year when she can share the honor with others at Community Hospital Anderson as the hospital celebrates its 50th anniversary.

In her acceptance speech, Beth Tharp gave credit to her colleagues at Community Hospital Anderson.

Did friends or family attend the event with you? “My son [a nurse manager], our other son, my mother, mother-in-law and father-in-law were there. It was very special for my mother-in-law because she is a retired RN.

Tell us about your world

I believe all of the nursing directors from our hospital were there and several others from Community Anderson. Our CEO and president escorted me up on stage. I think there were 70 folks from the Community Health Network there altogether. It was just a wonderful celebration of nursing.”

What happened when your name was announced as Nurse of the Year? “I was totally shocked. I never would have imagined getting the Advancement in Nursing award, let alone the Nurse of the Year. It was probably a good thing that I was so shocked because I was able to give my speech without crying. I was tearing up a little. If I had made eye contact with my family or any of that bunch from the hospital, I probably would not have been able to get through my talk without crying.”

Tharp

accepted that award for all the folks I work with at Community in Anderson — as much for the nurses and the nursing leadership as for the support staff there. “Some things — [establishing] the wound center and the research center — I had a lot to do with, but I certainly could not have done them without everyone being behind them. Then there are things that I had nothing or little to do with. I was just clearing the path and staying out of their way. That group of people really is a force and they’re making a difference in the lives of our patients as well as our profession and our hospital.”

What are your next steps as Nurse of the Year? “I truly believe that because of this, I have a huge responsibility to our profession. Doing what I can, not only working with our staff, but also with schools of nursing in our community, to work on the advancement of practice in nursing. We’re going to be instrumental in however health care reform transpires.” ●

What did you say in your acceptance speech? “When I spoke, I said — and I truly believe this — that I

Send an email to pubs@indystar.com Indiana Nursing Quarterly

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Nursing news and information from across Indiana.

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