Hospice and Spiritual Care Professionals

Burnout risk was first recognized as a concern among healthcare and helping professionals in the 1970s (Pines & Maslach, 1978) and among hospice professionals (Vachon, 1978). Extensive interviews revealed that they often feel emotionally depleted with reduced motivation from protracted distress while helping clients. At that time, researchers argued that engaging empathetically with clients led to compassion fatigue. However, more recent research has shown empathetic attunement, with healthy boundaries, increases compassion satisfaction and lowers burnout risk. This research identified the features now recognized as comprising burnout: emotional exhaustion, cynicism and ineffectiveness (Craig & Sprang, 2010; Maslach, 2003), and lack of personal accomplishment, organizational recognition, and support (Vachon, 1995). Compassion fatigue (CF), first described by Figley (1995) now comprises two elements: burnout and secondary traumatic stress (Stamm, 2010).

As a hospice and healthcare professional, you experience both compassion satisfaction and compassion fatigue from caring for patients and families. My published VITAS Healthcare study, conducted from 2016-17, demonstrated that when there is a spirit of compassionate care, a organic “together” self-care being practiced at VITAS, professional wellness increases. However, a supportive hospice culture does not happen automatically. It requires commitment from the whole program. The wider hospice literature is also showing that a mindful focus on compassion towards patients, families and staff increases your well-being. Mindful self-care strategies are the central protective factors against compassion fatigue: burnout and secondary traumatic stress (Hotchkiss, 2018; Hotchkiss and Lesher, 2018). Click the below to view the article published in the American Journal of Hospice and Palliative Care.

Mindful Self-Care and Secondary Traumatic Stress mediate a relationship between Compassion Satisfaction and Burnout among Hospice Care Professionals

Living the Compassionate Life brings true joy and satisfaction that can't be bought.  A key finding of the study was that hospice staff who felt good about helping their clients tended to take care of themselves better and have lower risk for burnout and secondary traumatic stress.  VITAS staff who engaged in multiple and frequent self-care strategies experienced higher professional quality of life. Hospice organizations have begun to recognize that the pursuit of wellness among their staff is a win for both patients and staff. Staff wellness should be encouraged intentionally and holistically (Hotchkiss, 2018).  My mentor, Rev. Ruth Lesher, Bereavement Services Manager, who empowered me to do this work, joined me in publishing a national study of wellness among spiritual care professionals.

Predicting Burnout Risk Reduction from Compassion Satisfaction, Organizational Factors and the Mediators of Mindful Self-Care and Secondary Traumatic Stress among Chaplains

In addition to validating the findings from the first study, hospice chaplains were found to have higher wellness than those serving in medical centers. Organizational factors, such as a supportive healthcare culture and program, were linked to increased professional wellness (Hotchkiss and Lesher, 2018). Productivity increases and attrition decreases since healthy staff are productive staff who enjoy their work. In the healthcare professional’s journey toward wellness, mindful self-care is imperative.  One of the outcomes of the study was to implement an evidenced-based, program-wide intervention to raise compassion satisfaction and lower burnout risk. Inspired by Darci Carr and Ruth Lesher creating the Wisdom Within Retreat in 2017 for VITAS staff, I took our GMs newsletter template and launched the Compassionate Life: Wisdom and Inspiration for the Courageous Journey of VITAS Professionals. The quarterly resource exists to promote reflection, education and community-building on compassionate living, spirituality, and self-care among VITAS professionals to encourage our united focus on compassionate, sustainable. end-of-life care. Below is a sample of the resource:

The Compassionate Life: Wisdom and Inspiration for the Courageous Journey of the VITAS Professional


Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and Burnout in a national sample of trauma treatment therapists. Anxiety Stress Coping, 23(3), 319–339.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York, NY: Routledge.

Hotchkiss, J. T., & Lesher, R. (2018). Factors Predicting Burnout Among Chaplains: Compassion Satisfaction, Organizational Factors, and the Mediators of Mindful Self-Care and Secondary Traumatic Stress. Journal of Pastoral Care & Counseling, 72(2), 86-98. doi:10.1177/1542305018780655.

Hotchkiss, J. T. (2018). Mindful Self-Care and Secondary Traumatic Stress Mediate a Relationship Between Compassion Satisfaction and Burnout Risk Among Hospice Care Professionals. American Journal of Hospice and Palliative Medicine. doi:10.1177/1049909118756657.

Hotchkiss, J. T. (2017-2018). The Compassionate Life: Wisdom and Inspiration for the Courageous Journey of VITAS Professionals.

Maslach, C., & Leiter, M. P. (1997). The truth about Burnout: How organizations can cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass.

Pines, A., & Maslach, C. (1978). Characteristics of staff Burnout in mental health settings. Hospital & Community Psychiatry, 29(4), 233.

Stamm, B. (2010). The Concise ProQOL Manual, 2nd ed. Retrieved from www.proqol.org/uploads/ProQOL_Concise_ 2ndEd_12–2010.pdf.

Vachon, M. L. (1995). Staff stress in hospice/palliative care: A review. Palliative Medicine, 9(2), 91–122.

If your compassion does not include yourself, it is incomplete.
— Jack Kornfield