Compassion fatigue in the Emergency Department
This blog focuses on compassion fatigue in the Emergency department (ED) in the setting of Trinidad and Tobago. Working in the ED often means existing in a constant high intensity state. The pace is relentless, the emotional demands are high, and there is rarely enough time to process one case before moving onto the next.
The ED often becomes a meeting point for the realities of everyday life. The patients reflect the wellbeing of the wider community. Assault, road traffic accidents, chronic disease complications, mental health crises, and social hardship all often intersect within the same shift. During Carnival season in the country, this contrast is particularly striking. The photo attached captures this duality. Outside the hospital, there was music, celebration, colour and joy, while inside there were critically ill patients, trauma calls and families waiting anxiously for updates. It served as a reminder that the ED continues to function regardless of what is happening outside their walls.
Understanding compassion fatigue
Compassion fatigue is often described as the emotional and physical exhaustion that develops from prolonged exposure to suffering and trauma. Unlike burnout, which is closely linked organisation workload and systemic stressors; compassion fatigue stems from the emotional burden of continuously caring for people during moments of crises and vulnerability.
In the ED, healthcare workings are repeated exposed to grief, trauma, death, violence, frustration, and emotional strain often all occurring in a single shift. There is little emotional separation between one patient encounter and the next. A healthcare worker can often find themselves moving directly from informing relatives of a death to treating to next patient that requires immediate attention, with no pause in between. The emotional transitions are often abrupt and continuously flow throughout the shift.
As part of my SLICC project, I explored the literature surrounding compassion fatigue among ED healthcare workers and found that the evidence closely mirrored my own experiences. Studies consistently identified factors such as high patient acuity, staff shortages, repeated exposure to trauma, irregular shift work and limited recovery time as major contributors to compassion fatigue. All of which reflected my personal experience.
The culture of survival in healthcare
One theme that particularly stood out during my literature review was the normalisation of emotional endurance within healthcare. In many emergency settings, exhaustion is expected. Long shifts, inadequate breaks, sleep deprivation, and emotional suppression are often viewed as unavoidable parts of the profession. There is an unspoken understanding that healthcare workers continue functional regardless of how overwhelmed they feel. Over time this mindset can make compassion fatigue difficult to recognise because it becomes embedded within daily practice.
Reflecting on my own experiences within the ED, I started to recognise how easily fatigue becomes normalised among healthcare workers. Conversations surrounding exhaustion are often met with phrases such as “that’s just how the job is” or reminders that previous generations worked under the same or worse conditions. While this perspective may come from resilience and experience, they can unintentionally reinforce the belief that emotional distress should be tolerated rather than properly acknowledged.
As a result, vulnerability can begin to feel like weakness, and workers may suppress their own emotional needs to continue functioning within demanding environments. Over time, this creates a culture where compassion fatigue becomes not just common but expected.
Theory U and survival mode
Through Otto Scharmar’s Theory U, I started to recognise how much of emergency medicine feels like function in ‘download’ mode, responding automatically, moving from task to task, surviving. Quick decisions and efficiency can directly impact patient outcomes. However constantly operating this way leaves little room to emotionally process experiences or acknowledge the cumulative effects of repeat exposure to suffering.
After busy shifts, I noticed there were moments where being compassionate felt very task orientated and emotionally it felt like functioning on autopilot simply to cope with the workload. The literature suggests that this emotional distancing is another manifestation of compassion fatigue.
Organisation culture and the cultural web
The cultural web framework also helped me understand how workplace culture influences compassion fatigue. Stories of resilience and sacrifice are deeply embedded within healthcare environments. Senior staff often speak about the difficult conditions they endured during training, reinforcing the idea that hardship is something to tolerate rather than question. Informal expectations surrounding endurance reliability and ‘pushing though’ shape how healthcare workers behave and what they feel comfortable expressing. They discourage openness about stress, emotional exhaustion and mental wellbeing and leads to compassion fatigue being normalised.
Within the ED, there is also the pressure to maintain efficiency despite increasing patient volumes and resource limitation. Staff shortages, overcrowding, and unpredictable patient presentations create environments where emotional wellbeing is not prioritised. As a result, healthcare workers may begin viewing fatigue as an individual weakness rather than a predictable response to sustained stress and trauma exposure.
Compassion fatigue in the context of Trinidad and Tobago
From the literature, compassion fatigue can be seen to manifest differently depending on the local healthcare context. Much of the research originated from high-income countries where healthcare roles and responsibilities differ from those in TT. In my local setting, physicians take on multiple roles and responsibilities beyond medical decision making due to staffing and resource limitations. Tasks such as performing electrocardiograms, venepuncture, transporting patients, screening and triaging patients are done by the physician. Doctors often find themselves taking on these roles due to lack of personnel and prioritising their patient’s care in a timely manner. These cumulative demands can alter how emotional, physical and compassion fatigue are experienced locally. Currently there is limited local discussion emotional the emotional impact of emergency medicine despite the intense realities that healthcare workers face daily.
In conclusion, my work done on this SLICC has made me reflect not only on compassion fatigue academically, but personally. It has encouraged me to think more critically about how healthcare systems, workplace culture and expectation shape the emotional wellbeing of healthcare workers. Maintaining compassion within high-pressure environments require more than individual resilience. It requires supportive cultures, reflective spaces and organizational recognition that healthcare workers themselves are human beings navigating significant emotional demand.
The wellbeing of those providing care directly influences the quality, empathy and sustainability of the care patients ultimately receive.
Find out more about studying for a Master of Public Health at the University of Edinburgh, whether you want to join us online or on our campus:
