Jennifer Farrell, a nurse in the hematology/oncology unit at Children's Healthcare of Atlanta, plays a game with patient Beverly Missey, 17. Farrell, who has suffered from compassion fatigue, talks about her experience at the hospital's Care for the Caregiver retreats for employees.

Jennifer Farrell can see the signs in her co-workers' faces and attitudes.

Another 2-year-old with a neuroblastoma brain tumor succumbs to the disease; another child is readmitted to the hospital, no longer in remission. There will be a week when four children die in succession.

In her seven-and-a-half years working as a nurse in the hematology/oncology unit at Children's Healthcare of Atlanta, Farrell has come to recognize the signs of caring too much - and losing perspective on the rest of your life. She was there four years ago - mentally exhausted, emotionally depleted.

"You do so much; give - and give and give," she said.

What she has experienced in the past - and what her peers may be going through - is compassion fatigue, or secondary traumatic stress. The term describes the experiences of nurses and other health care personnel who deal so often with pain and death that they become desensitized, not only in their jobs but in the rest of their lives.

"The third year [working in the hematology/oncology unit] seems to be the hardest," Farrell said. "There are all sorts of things piling up, a lot of deaths, and it starts weighing down on you and you can't seem to filter it out."

Farrell "muddled though" this period in her career, and is now in a "mentally good place," she said.

After the death of a patient, area churches send care packages to nurses at Children's Healthcare of Atlanta. The gifts acknowledge the love and care given by nurses.

These days, her peers have an outlet to talk about what they're experiencing.

Johnnathan Ward, a chaplain for the unit, asked Farrell to speak to other nurses at the hospital's Care for the Caregiver retreat. She was asked to give an experienced perspective on handling the stresses associated with their jobs.

Held at Simpsonwood Conference Center in Norcross, the retreats are for Children's nurses experiencing what many think is professional burnout, but often is more a reflection of the constant stress of dealing with death and dying. The retreats are open to any nurse in the hospital, or anyone who may be experiencing signs of compassion fatigue. There have been six retreats, with a total of 60 attendees.

Compassion fatigue is not limited to health care workers who deal with sick patients. Many adults who care for their elderly parents and their own children often suffer from compassion fatigue.

Burning out
"When a care provider starts to lose a sense of caring, and becomes emotionally tired, this affects their ability to care, and depletes their emotional and mental health resources," Ward said.

When compassion fatigue takes hold, a person's productivity and enthusiasm decrease and he or she may feel burned out, he said.

"The retreats provide education about compassion fatigue and its impact on the health care worker; encourage development of a self-care plan that addresses their needs; and help identify available resources that will enhance a self-care plan," Ward said.

Compassion fatigue isn't directly addressed in nursing school, Farrell said. "They do talk about establishing professional boundaries, but that is a gray area and different with every nurse," she said. "I know in the beginning I was giving my phone number to every family and visiting the children in the hospital on my days off."

Dr. Ann Haight, Dr. Alcuin Johnson, Jennifer Farrell, Tammie Brickhouse, Jessica Pina and Johnnathan Ward, from left, discuss the recent death of a patient during a support group meeting at Children's Healthcare of Atlanta. The group helps staff members cope with death.

Such involvement can be handled by some nurses, but may backfire for others when a child dies.

Feelings of guilt
"There seems to be a personal guilt when kids pass away," Farrell said. "We do good things, but because of how we're trained, or by guiltreasoning, we remember the ones that don't make it, and don't remember the ones who do. It's important to find a balance, and be conscious of the fact that there are so many miracles. . . . We forget that sometimes."

The retreats help put jobs and feelings in perspective, she said.

"We tend to think that the only person who can even comprehend what we feel are those who work in the field. So you can't talk to your husband or best friend; can't explain how tough the job is, or how rewarding," Farrell said.

"So the only person that helps us is us. And [the retreat] helps us learn how to take what we experience and put something tangible on it and learn to deal with it."

The retreats grew out of staff support groups that began two years ago, Ward said. Although the staff support meetings are for all Children's employees, Ward said the group is especially helpful for nurses who care for seriously ill children and have dealt with a series of deaths.

The hospital's Scottish Rite campus also sponsors regular sessions called "Good Grief."

The support groups, which meet twice a month to accomodate various shifts, are there to help workers deal with the overwhelming emotion that often occurs during the work week, Ward said.

"There are ground rules that everything is confidential, and people can share, talk and relax," he said. "This is a nontherapeutic session, to talk about the stresses you may feel, and talk about taking better care of themselves. It's a time to learn that other people will be feeling the same thing."

For Farrell, that means learning perspective.

"What's important is to know how to put it on a shelf, so I know I can go on to the next day and the next year."