Reports from the EONS Leadership Summit 2017

Resilient leadership – How to survive as a leader in a changing world

Brenda Nevidjon looks at the many challenges that face us in our working lives and suggests how we can ensure they do not lead to compassion fatigue and burnout.

Brenda Nevidjon

Brenda Nevidjon

Building upon the belief that every cancer nurse is a leader, this session focused on resilience and leadership. In the ever changing cancer care environment and the stresses of life in general, cancer nurses need to develop their resilience to be able to remain engaged in their work whether in clinical, education, research, or administrative positions. Some of the influences that affect cancer nurses daily include:

  • Breakthroughs in cancer treatment, especially the rapidly increasing number of targeted therapies and immunotherapies, which have different mechanisms and side effects than chemotherapy.
  • An aging population which affects both the number of people who will be diagnosed with cancer and survive cancer, coupled with a declining birth rate in some countries.
  • Workforce demand and supply dynamics compounded by an aging nursing workforce in some countries and new roles that move the nurse away from direct patient care.
  • Technology, such as electronic health care records, that challenge all members of the health care team to learn new ways of practice.
  • “Attention economy” – 24/7 emails, texts and social media, which keeps people looking at their phones.

In a cancer care world that can be unpredictable and is not predetermined, the choices an individual makes can contribute to compassion fatigue and burnout, or strengthen resilience. Rosemary Carroll Johnson (2000), wrote in an editorial: “Our ability to thrive as a profession will depend on high levels of professional nurturing, leadership development, taking time to care for ourselves, and recognising our limits and needs.”

Compassion fatigue, burnout, resilience

Burnout is a phenomenon that has been studied for decades. More recently, compassion fatigue has been written about particularly as experienced by nurses in high-risk specialties such as cancer care. The two can have similar signs and symptoms: negativity, changes in sleep habits, eating poorly, being late to work or calling in sick frequently, conflict with colleagues, and dissatisfaction with work. However, as seen in Table 1, the factors that contribute to the phenomenon are different.

Burnout – situation Compassion Fatigue – intrapersonal
  • Work overload
  • Lack of control
  • Lack of reward
  • Lack of community
  • Lack of fairness
  • Values conflict
  • Ongoing exposure to pain & suffering
  • Self-sacrificing vs. self-care behaviors

Table 1: Comparison of Causative Factors in Burnout vs. Compassion Fatigue

With burnout, the factors are structural and cannot necessarily be changed by the individual. An example is shift rotation in hospitals – units must be staffed 24 hours per day and nurses may have limited choice in how their schedule is. In many situations, the solution is to leave the work environment for one that is more supportive. (In the USA, burnout has also become an issue for physicians as demand for greater productivity has increased.)

Compassion fatigue is the exhausted ability to be compassionate and occurs when compassion stress exceeds resilience. (Lombardo, Eyre, 2011) Compassion allows the individual to sustain emotional balance while dealing with others’ distress or despair. One of the reasons cancer nurses often say the specialty is rewarding comes from the close relationship they have with patients and families. When the course of treatment is not effective for a patient, the nurse also experiences loss and grief, which if not dealt with can grow with each loss situation. Coupled with poor self-care habits, a nurse may develop compassion fatigue and find that distancing oneself from patients occurs. The counterpoint of compassion fatigue is resilience.

Resilience literally means ‘to bounce back’. It is the capacity to overcome stress. A seminal study on stress by Kobasa (1979) found that people who 1) have a greater sense of control of what occurs in their life, 2) are committed to themselves and their well-being, and 3) view change as a challenge, were healthier than people who had the opposite perspective. They were hardier, more resilient, than their counterparts.

Strengthening resilience

There are initiatives and activities at work and at home that can strengthen one’s resilience and mitigate compassion fatigue. First and foremost is taking care of oneself. As flight attendants always remind passengers, fit your own mask first and then help others. Too often, cancer nurses may forget the importance of self-care including rest/sleep, exercise, eating healthfully, and engaging in enjoyable activities. Having social support at home and at work is important. Being able to reach out to colleagues when the stress at work intensifies can be informal, such as having lunch together, or formal, such as debrief meetings after critical events. Cancer centers and hospital, which often provide support groups for cancer patients and families, should likewise offer them for nurses.

Being a resilient leader

All cancer nurses are leaders. A resilient leader is someone who

  • does not ignore the negative but reframes the issue
  • faces and manages fear
  • is a realistic optimist
  • welcomes multiple perspectives on a topic
  • uses words carefully, and
  • engages in re-energising activities.

To build resilience, leaders take time to reflect about themselves and their day. They manage choices, not time, focusing on what is important for them to do, what can be delegated, and what can be ignored. Ultimately, resilient leaders create resilient organisations that attract more resilient leaders which, in turn, results in a happier work environment.

Brenda Nevidjon is Chief Executive Officer of the Oncology Nursing Society (USA).