Healthcare Worker Burnout and Compassion Fatigue: A Guide for Organisations

Healthcare worker burnout affects patient safety and team continuity. Read about compassion fatigue, violence risk and the measures organisations can take.

Long shifts, busy emergency departments, rising tension in waiting rooms, severe cases, losses, and in between it all, the expectation of always being cheerful and attentive... Doctors, nurses, midwives, health technicians, paramedics and hospital support staff work with this load every day. Healthcare worker burnout is a problem not only for the individual but also for patient safety, quality of service and the continuity of the organisation. A burned-out healthcare worker can become more prone to making mistakes, may think of leaving, or may develop a deep distance from a profession they love. In this article, for hospital managers, chief physicians, healthcare organisation owners, HR and OHS specialists, I look at what burnout and compassion fatigue are, why they are so intense in the healthcare sector and the concrete steps organisations can take.

What Are Healthcare Worker Burnout and Compassion Fatigue?

The World Health Organization defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It has three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one's job or work-related negativism and cynicism, and reduced professional efficacy. The WHO classifies burnout not as a medical condition but as an occupational phenomenon that should be used only in the work context (WHO, 2019).

Compassion fatigue, on the other hand, is the emotional and physical exhaustion created by constantly witnessing the suffering of others and trying to help them. While burnout is more closely linked to workload, organisational problems and lack of control, compassion fatigue is a fatigue specific to helping professions that come into contact with pain, trauma and loss. In healthcare workers the two often overlap.

Some signs of compassion fatigue are as follows:

• Becoming numb to patients' suffering or, conversely, taking every case home
• Severe cases replaying again and again in the mind
• Sleep problems, startling, being constantly on guard
• Intense reluctance before going to work, thoughts of leaving the profession
• Withdrawing from family and friends, being unable to enjoy things that once brought pleasure

These signs alone do not mean a diagnosis of a mental disorder; however, if they continue for a long time and affect functioning, a professional assessment is needed.

Causes of Healthcare Worker Burnout

The factors that feed burnout in the healthcare sector are both individual and organisational. However, research and field experience show that most of the decisive factors stem from work organisation:

• Excessive workload and staff shortages: A nurse being responsible for many patients, a doctor having to examine within minutes.
• Long shifts and shift patterns: Sleep deprivation, night work and inadequate rest periods.
• Violence from patients and their relatives: Verbal abuse, threats and physical assault.
• Moral distress: The inner conflict experienced when, because of a lack of resources, they cannot provide the care they know is right.
• Bureaucracy and the record-keeping burden: Time that should go to the patient being spent in front of a screen.
• Lack of control and voice: Having no influence over working conditions, the shift plan and workflow.
• Conflict and hierarchy within the team: Mobbing, humiliation and lack of recognition.
• Traumatic events: Death, serious injury, disasters and mass-casualty events.

Healthcare workers in Turkey also carry the heavy marks left in recent years by the pandemic and the 6 February 2023 earthquakes. Many healthcare workers who served in the earthquake zone, or went there as volunteers, had to cope both with their own losses and with the suffering they witnessed. Economic pressures and the tendency to go abroad to work can increase the workload of the teams that remain.

European data also show how widespread the problem is. In the OSH Pulse survey carried out in Europe, 46% of employees reported severe time pressure or work overload, and 16% reported violence or verbal abuse from customers or patients (EU-OSHA, 2022). These rates refer to all employees; it is known that these risks are experienced more intensely in the healthcare sector.

Violence in Healthcare and the White Code

Violence against healthcare workers is one of the most important feeders of burnout. According to the ILO's 2026 report, 23% of workers worldwide have experienced violence or harassment at least once in their working lives; the most common form is psychological violence, at 18% (ILO, 2026). For healthcare workers this risk is especially high because of the intense anxiety and anger of patients and their relatives.

In Turkey, the White Code (Beyaz Kod) system is used in healthcare facilities to report incidents of violence and provide a rapid response. The White Code aims to ensure that the incident is recorded, that the security team is mobilised and that the healthcare worker receives legal support. However, what matters most for the organisation is that the employee is also supported psychologically after the report.

The things to watch in the psychological dimension of the White Code process are as follows:

• Encouraging reporting: An attitude of "nothing happened, let's not make a fuss" creates a feeling among employees that the organisation does not protect them. Reporting of every incident, including verbal violence, should be supported.
• First approach after the incident: Not forcing the employee who has been subjected to violence to carry on working immediately, and offering a short break and a safe space.
• Psychological first aid: An approach based on the WHO's "Look, Listen, Link" principles offers the employee supportive, non-pressuring contact after the incident (WHO, 2011).
• Follow-up: Asking how the employee is in the weeks after the incident, monitoring changes in sleep, anxiety and willingness to come to work.
• Referral: Referral to specialist support if symptoms persist.

After a serious assault, some employees may develop post-traumatic stress symptoms. I have discussed the course of these symptoms in detail in the article on post-traumatic stress disorder. For the wider framework of customer and patient violence, you can also look at the article on customer and patient violence at work.

The White Code is a security procedure; but an employee being able to return to the same ward with confidence the next day is only possible with psychological support.

The Effect of Healthcare Worker Burnout on Patient Safety and the Organisation

Burnout has effects beyond the healthcare worker themselves:

• Patient safety: Fatigue and distraction can increase the risk of medication, dosage and recording errors.
• Quality of communication: Depersonalisation can lead to a distant and hurried attitude towards patients and their relatives; this can increase tension and complaints and feed the risk of violence.
• Absenteeism and staff turnover: Frequent sick leave, early retirement, moves to the private sector or abroad.
• Tension within the team: In burned-out teams, conflict increases and solidarity decreases.

Research supports these relationships. In a systematic review of 36 prospective studies on burnout, burnout was found to be associated with later insomnia, depressive symptoms, absenteeism, job dissatisfaction and presenteeism (Salvagioni et al., 2017).

Suppose an intensive care nurse comes on shift after a week in which she lost three patients in a row. Nobody asks her how she is, because "that's the nature of the job". That night the nurse gives a medication at the wrong time; the error is noticed early, but the next day she finds it hard to come to work, blaming herself. This picture is not the result of individual carelessness but of a burden that was not supported.

The Employer's Legal Framework

Healthcare organisations, like other workplaces, are covered by the Occupational Health and Safety Law No. 6331. Under Article 4 of the Law, the employer is obliged to ensure the work-related health and safety of employees and carries out, or has carried out, a risk assessment. Article 5/f of the Law requires the employer to develop a coherent prevention policy covering the effects of factors related to work organisation, working conditions and social relationships. Long shifts, staff shortages and violence from patients' relatives are the concrete counterparts in healthcare of these headings of "work organisation" and "social relationships".

In addition, Article 417 of the Turkish Code of Obligations No. 6098 places on the employer an obligation to protect the employee's personality and to take the necessary measures so that they are not subjected to psychological harassment. Mobbing within the team and demeaning hierarchical behaviour are also assessed within this scope. In other words, tackling healthcare worker burnout is not merely a human resources choice but also part of the employer's duty of prevention. For detailed application, it is recommended to work with the organisation's legal unit and OHS specialist.

What Can Healthcare Organisations Do?

The WHO's 2022 guidelines on mental health at work contain recommendations specific to health, humanitarian and emergency workers. For these occupational groups, organisational interventions, stress management training and mental health training for managers in these fields appear as separate recommendations; training for managers in particular is supported by a strong recommendation and moderate-certainty evidence (WHO, 2022). Based on this framework, the steps organisations can take are as follows:

At the organisational level:

1. Review workload and shift arrangements: Adequate rest between consecutive shifts, recovery time after shifts and predictable shift plans.
2. Record psychosocial risks: Article 8 of the Risk Assessment Regulation requires psychosocial sources of hazard to be identified and recorded. Violence, workload, shift patterns and relationships within the team should be part of this assessment.
3. Take multi-layered measures against violence: Physical security arrangements, information in waiting areas, active operation of the White Code process and psychological support after incidents.
4. Give employees a voice: Gathering the teams' views on shift planning and workflow increases the sense of control.
5. Reduce the record-keeping and bureaucracy burden: Support staff and simplified processes wherever possible.

At the management level:

6. Train charge nurses, ward heads and unit managers: Skills in noticing an employee who is struggling, supportive conversation and referral.
7. Team meetings after severe cases: Short meetings that are not compulsory, contain no blame and focus on operational learning. Psychological debriefing sessions in which everyone is pushed to recount the event in detail should be avoided; the WHO does not recommend this practice.

At the individual level:

8. Stress management and resilience programmes: Programmes based on cognitive behavioural approaches are among the approaches showing the greatest effect among workplace stress management interventions (Richardson and Rothstein, 2008).
9. Confidential and accessible psychological support: At times that fit the shift pattern and, where necessary, with the option of an online session.
10. Peer support: Structures in which experienced employees mentor newcomers.

The ILO's 2026 report stresses that individual measures should complement organisational measures, not replace them (ILO, 2026). Providing breathing exercise training while not changing the shift pattern at the same time will not produce lasting results.

How to Get Started in Your Organisation

1. Needs analysis: You can start by examining absenteeism, resignations, White Code reports, patient safety incidents and overtime data by unit. Then an anonymous burnout and psychosocial risk survey of employees and focus group discussions from different units are carried out. High-risk units such as the emergency department, intensive care, oncology and psychiatry should be assessed separately.

2. Programme: Priorities are set according to the analysis. This generally covers manager training, a post-violence support protocol, stress management workshops, a confidential psychological support service and improvements in the shift pattern. Programmes with reinforcement sessions, adapted to each unit's needs, should be preferred to one-off seminars. You can review the corporate training and consultancy options on the corporate services page.

3. Measurement: Repeating burnout surveys at regular intervals, absenteeism, staff turnover, the proportion of employees who receive support after White Code reports and patient safety indicators are monitored together. The results are shared with unit managers and employee representatives, and the next steps of the programme are decided together. Teams that see no concrete change after survey results answer the next survey less honestly. For this reason, carrying out at least one improvement, however small, after each round of measurement and announcing it to the teams protects the credibility of the process.

Frequently Asked Questions

Is healthcare worker burnout an illness?

The World Health Organization defines burnout not as a medical illness but as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed. However, depression, anxiety or sleep problems can develop alongside burnout; in this case a specialist assessment is needed.

What is the difference between compassion fatigue and burnout?

Burnout is more closely linked to workload, organisational problems and lack of control. Compassion fatigue is the fatigue created by constantly witnessing the suffering and trauma of others. In healthcare workers the two are often seen together.

How should an employee be supported after a White Code incident?

The employee should not be forced to carry on working immediately; they should be given a short break in a safe space and listened to without pressure. In the following weeks, they should be asked how they are, and referred to specialist support if symptoms persist. It is also important that they feel the organisation stands by them in the legal process.

Can private hospitals and small healthcare organisations also run a programme?

Yes. In small organisations the programme can be simpler: a short training for managers, a clear support flow after violence, a review of the shift pattern and a confidential psychological support service obtained externally are a good start.

• #healthcare worker burnout
• #compassion fatigue
• #white code
• #hospital management

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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