Part I

This is the first of a two-part series on ‘compassion fatigue’ and burnout in an area of nursing that, over the years, has seen a significant increase in cases. It is called Neonatal Abstinence Syndrome (NAS). The original article was submitted to Neonatal Network in 2017 by Nurse Erin Sweigart, MSN, RN, RNC-NIC.

‘Compassion fatigue’ dates back to 1992 and is associated with people working in ‘caring’ professions. It is unique in that it is the result of interaction with people in need of help rather than involving the work environment.

The primary purpose of this article is to recognize the potential for ‘compassion fatigue’ and burnout occurring among NICU nurses who are caring for infants during withdrawal. Nurse Sweigart stated that in addition to analyzing NAS, assessments are recommended to also improve the care of the infants and mothers.

The second part of this article describes a typical interaction between the nurse, hospital administration, the baby, the mother, and the family.

 A Short List With A Long Message

Recognizing these risk factors is a major preventative measure. Some of the factors causing burnout are:

• Staffing constraints
• Support services that are inadequate
• Educating nurses regarding addiction
• Equating nurses’ expectations with the actual care that is required for the infants

Infant Patients with NAS

The majority of NAS cases occur when women take opioids while pregnant. The baby is exposed to the drugs before birth while in the womb and then goes through a cycle of full withdrawal after birth.

Caring for a difficult patient can be exhausting but caring for an infant with NAS is mentally, emotionally, and physically draining on NICU nurses. Economic factors are also putting downward pressure on much-needed resources.

Three Studies and Their Themes

To begin the discussion, we can rely on three studies that have followed the daily routine of nurses caring for NAS infants. Their reports cited frustration, burnout, distress, and complete exhaustion.

Fraser and colleagues described various nursing experiences including nurse/infant relationship, which the nurses described as difficult, nurse interaction with the infant’s family, tensions over the care of the infant, and lastly, nurses’ needs.

The Fraser report indicated that NICU nurses felt families were demanding and had various emotional and other needs. There is no doubt that trying to cope with some of the families was extremely stressful as they could be verbally abusive, threatening, and aggressive. Occasionally a mother would blame the nurses for the infant’s distress, or on the contrary, the mother showed little interest in the care of her baby.

The nurses voiced concern that the infants were being sent back to an unsafe environment. They often questioned whether it would be advantageous to send the infants to a special care facility rather than back with their families. They touched on the need for educational support to assist in their work with such high-risk groups.

Murphy-Oikonen and their associates reported several primary issues when studying nurses in charge of NAS infants. The first issue dealt with a commitment to the infants. There appeared to be a disagreement between the families’ expectations and those of the nurses.

The second involved the technical competence of the NICU nurse in relation to the maternal care that is required for NAS infants. And a third issue was the increased focus on drugs that had an impact on the nurses’ life both at home and at work.

The Murphy-Oikonen team recommended that the nurses become familiar with the families’ lifestyles through improved education. On behalf of the nurses, the team recommended recognition of the tremendous strain nurses are experiencing in their effort to care for NAS infants.

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