Increase Nurse Satisfaction And Decrease Compassion Fatigue: Burnout & Secondary Traumatic Stress

Purpose: The purpose of this quality improvement project was to identify and reduce the level of Compassion Fatigue in Emergency Department nurses by implementing a self-guided intervention. Compassion Fatigue was the largest concern for nurse vacancy rates by administration and confirmed that ED Nurses were in the moderate risk category Compassion Fatigue via Professional Quality of Life (ProQOL-5) survey results.
Design: A Plan Do Study Act method of quality improvement was used for this project.
Setting: A moderately-sized, suburban, Midwestern hospital ED located in a metropolitan area with 42 hospitals serving over three million residents.  This is a general ED, but not a trauma center, caring for approximately 40,000 patients per year.  
Participants/Subjects: A purposeful sample of ED nurses who were scheduled to work 24-hours per week or more was selected. Inclusion criteria were active employment as a registered nurse (RN) in the ED, scheduled to work 24-hours or more per week. All participants were voluntary and results recorded were anonymous.
Methods: The self-guided intervention of Real-Time Transformative Response© (RTR©) was used to greatly reduce or eliminate stressful events that are the root causes of a person's specific stressors. RTR© was distributed to ED Nurses via a three part, self-guided, video educational series. ED Nurses were surveyed pre-RTR© and post.-RTR© intervention to determine the effectiveness of the method.(RTR©) was used to reduce Compassion Fatigue. The ProQOL-5 was used to measure and determine if it was effective in reducing levels of CF in ED Nurses via Qualtrics. Data was analyzed using descriptive statistics and paired-samples t tests using Intellectus Statistics™.
Results/Outcomes: A total of 34 emergency department nurses (N=34) completed RTR© training and ProQOL-5 surveys.  The overall mean score for the pre-RTR© training survey was 107 (sd =1.1385) and the post-RTR© training survey was 106.613 (sd =1.1677) (t =1.6924, df =66, p =0.0476). Mean scores pre-and post-RTR© training were as follows: compassion satisfaction was 3.59 (sd = 0.9521) increased to 3.95 (sd = 0.7766) (t = 1.997, df = 66, p = 0.000), burnout was 2.71 (sd = 1.1501) decreased to 2.36 (sd = 0.9120) (t = 1.997, df = 66, p = 0.000), secondary traumatic stress was 2.45 (sd = 1.0002) decreased to 2.25 (sd = 0.9143) (t = 1.997, df = 66, p = 0.0017).
Implications: In essence, RTR© was proven to be a technique that can reduce compassion fatigue. Increasing compassion satisfaction and reducing turnover can lead to enhanced quality of healthcare, all while reducing stress in a high-stress environment is a significant achievement in emergency clinical practice. Recommendations for future studies include the employment of larger study population sizes, the inclusion of other nursing departments, and long-term evaluation of CF effects and implications in clinical nursing practice.

Author(s): Ashleigh Boyd, Alexandra Myers

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