It’s not compassion fatigue, it’s system fatigue: Burnout in the care industry
It's not always one thing, one event, a sudden breakdown, or a moment when you snap. And it doesn't always result in leaving your job, changing cities or having an identity shift after a retreat. Burnout can be drawn-out and insidious, and you may not even recognise it or label it as such.
Data from NHS England Digital shows that the most reported reason for staff sickness by a high margin was anxiety, stress, depression and other psychiatric illnesses (2024).
I've worked in nursing for 14 years. 12 of those years have been working in the Inclusion Health space, in services that support people at the fringes of society, often marginalised, traumatised and up against a system that isn't easy to access or in some cases, doesn’t show them respect. When you're constantly calling out the system to advocate for your patients, and you can see it failing them, there's a feeling of frustration and sense of betrayal. Seeing the system misaligned with its values, you start feeling defeated and disconnected because you can't contribute the way you wish to.
And then there is what comes with nursing – high exposure to traumatic circumstances, in real-time, and when hearing an experience re-told (vicarious trauma). This is the nature of the work – nursing is at the coal face of dysfunction in society and its sometimes-tragic consequences. However, it's the added layer of a system that enforces targets and pathways that our work and patient group can't nicely slot into. You find yourself constantly having to justify your own role or team, frequently having to submit figures of numbers seen, and always fighting for adequate funding. Too much bureaucracy can divorce us from the human side.
Yes, we can argue that bureaucracy is needed for an organised society. Systems become centralised and this can be positive in ways. But too much organisation and bureaucracy can blunt a person's intuition and innovation. The result is people not fitting a system rather than a system that flexes around people and their unique needs.
What does too much bureaucracy look like?
Short term funding and contracts
Referrals only being accepted by certain professionals
Timing of appointments and appointment length
Universal guidelines that don’t apply to everyone
Heavy reliance on Standard Operating Procedures and task-oriented protocols
Criteria checklists used in service applications and diagnoses
Blanket assumptions made about the health needs of groups of people
If left unchecked and unquestioned, the attempts to bend to the requirements of such a commanding system start to show up in work culture and behaviour that can be damaging. Something we underestimate or don’t talk much about is how the mental health of an individual can impact others, particularly the mental health of team managers. Pressure from unmet targets, deadlines and presenting data and information in a way that shows the value of a service, can cause immense stress which then filters to the rest of the team. Being asked point blank "what's the problem?" when the logistics of the project won't allow it to happen how they want it – I think that's called gaslighting. Anyone who knows me knows that I don't throw around terminology like that easily. In my opinion, our language has become overly psychologised but this demonstrates how pressure builds within teams. It can make you question yourself and doesn’t foster openness.
Nurses are known to have thick skin and to just get on with it, but as time has gone on, my capacity is fading and left me not just sensitised, but sensitive to any kind of negative news. I've had periods of my life where I didn't have a TV, but now I avoid all news stories from all sources. Some may see this as being weak and have in fact told me that I’m not facing up to reality. But I’d say that working in nursing places you more in the face of reality than many other professions and it places a high emphasis on reflective practice – both very useful tools to navigate life with and appreciate the bigger picture.
I thought about this from the Ayurvedic perspective – the industry of healthcare is highly-driven with Pitta attributes of ambition, targets and intensity. Yet the reasons many people choose to work in healthcare are because they care, they wish to make a difference and have the stamina and stability to see someone through tough times, all of which are key features of Kapha dosha. When Pitta is left uncontrolled, we see the burning away of the soft, protective and nurturing Kapha qualities causing inflammation.
And I started seeing the effects. Whether it was disturbed digestion, skin flare-ups, a cynical mindset or even disrupted menstrual cycles, it’s clear to see now how the increase in Pitta externally had impacted my biology internally. But I did not see it at the time.
Resilience is a word that gets thrown around a lot and used as a badge of honour but that usually means you get more work piled on you. It’s also not sustainable. Over the years, I’ve seen colleagues go on long-term sick leave, on sabbaticals or even leave the nursing profession altogether due to stress or the inflexibility of the service. But, even when you recognise it as burnout, it's not always the convenient or sensible option to leave work. So, you work through it.
For the last two years now I've changed jobs multiple times, reducing my hours, conscious of what friends would think when I tell them I've changed jobs AGAIN. This wasn't me. I was the steady, sensible, maybe even boring and predictable type who stuck at my work for years. Long-term contracts. Always there early. Always ready. Now my tolerance level for restrictive systems that don’t practice holistically as a baseline is at an all-time low. I think this is why I’ve branched out alone. The health promotion I do through my community workshops and 1:1 consultations give plenty of time for meaningful interactions and I don’t feel rushed or that the person has received a substandard service. Although working for myself brings its own challenges, I am working in harmony with my values and beliefs about preventative health. I haven’t left nursing, but I’m creating a role where I can bring my skills to and use them in a constructive way rather than just “playing the game” as a GP colleague once advised I do.
Today is International Nurses Day and this year’s theme is the wellbeing of nurses. As we continue to see understaffing and high attrition rates of nurses worldwide, I’d like to see the wellbeing of nurses taken seriously by healthcare organisations. But not with tokenistic gestures and self-care gifts. Instead, showing we care through recognising that burnout is the result of structural issues so needs structural changes.
