Self‐regulation is the ability to recognize when the sympathetic nervous system is activated (the fight‐or‐flight response) because of a perceived threat in the workplace. Examples of threats include:

The bottom line is that in such situations, our body is telling us that we are in danger. Therefore, as described above, when the autonomic nervous system is activated, physical changes happen and cognitive functioning is affected, which is exhausting. Recognizing what is going on through using skills such as mindfulness (see below) can help us to consciously change our perceptions and thereby activate the parasympathetic nervous system.

It is known that one of the main factors that keeps our sympathetic nervous system activated is perceived threats. Our minds are very good at anticipating potential dangers around us and prompting a state of high alert. It is worth asking ourselves, however: how often, when we feel threatened on a shift or during a working day, is there any actual physical danger. For most people, the answer will be ‘very infrequently’, so we can learn to ask ourselves ‘Am I in danger?’ and tell ourselves ‘No, I am not.’

However, this strategy will not automatically stop our minds perceiving threats in the workplace. These perceptions might be about the workplace, our managers or the organization as a whole.

Intentionality is the ability to hold in mind our purpose and the values that are important to us at work.

Using processes such as mindfulness (see below) can help us to recognize when we are on automatic pilot and responding to others and ourselves in ways that are not intentional or reflective of our values.

Self‐compassion is described as:

Working with distress in a stressful environment has an impact. Our immediate response can be that we aren't coping, we aren't good at time management, we aren't tough enough. If we become irritable or sad, or are getting to the point where we feel we can't face going into work, we need to recognize that this might be a sign that we have compassion fatigue and that these are normal responses to working with distress. It does not mean that you do not care or are emotionally unable to do your job. The combination of empathy and exposure to trauma will affect you and the key is to accept that it is normal and then respond to the symptoms.

We strive to take care of our patients in the way that we would like to be cared for if we were in their shoes. To achieve this, we must first take care of ourselves with kindness and compassion. As nurses, we take great pride in being kind and compassionate towards our patients but we are poor at showing ourselves the same compassion. We are very good at giving ourselves a hard time and very bad at forgiving ourselves for ‘being human’. After a difficult day or incident, our tendency is to run over and over in our mind what we could have done differently, what we should have done but didn't, what we did't know – the list can go on and on.

One important way you can begin to show yourself more compassion is to become very aware of how you talk to yourself when you are under pressure. Is your internal narrative helpful or unhelpful during times of stress? Are you actually making the situation worse by the way you are treating yourself? Think about the language you use under pressure and try to change it. As Lisa M. Hayes ([30]), a famous relationship coach, said, ‘Be careful what you say to yourself because you are listening.’

Self‐compassion is all about being warm and understanding towards yourself when you are suffering, failing or feeling inadequate rather than ignoring the pain or flagellating yourself with self‐criticism. Self‐compassionate people share some common traits (Neff [49]):

Developing self‐compassion has been shown to improve how we relate to others (Neff and Pommier [50]). It has also been shown to encourage willingness to learn from failure and try again without self‐recrimination (Gustin and Wagner [29]).

Another aspect of our intentionality is how we define ourselves. Taking on a professional role like nursing can be very significant in our lives, giving us meaning and purpose (Skovholt and Trotter‐Mathison [72]). However, it can become the dominant part of ourselves, and we may absorb society's ideas of what a nurse should be. This may mean we are unable to differentiate between our work and home lives, or between who we are and what we perceive a nurse should be.

Our perceptions of ourselves as nurses and particularly those ‘put on us by others’ make declining requests from those we work for feel like we are being less caring or committed. We can also develop an unrealistic sense of what doing a job is about as well as how we are meant to cope. It's okay to say ‘no’ to extra work or responsibilities, especially when you are feeling the effects of compassion fatigue – and, in fact, you must. You can only give so much and it's okay to need time away from work to refill your compassion and energy levels. If you keep saying ‘yes’ to everything, your body and mind will eventually say ‘no’ for you!

You ‘work’ as a nurse but you are so much more than this. You are a human being – someone's husband, wife, partner, parent, sister, brother, child, friend or colleague – the list is almost endless.

Feeling supported, heard and cared about by colleagues is crucial to maintaining our resilience (Tosone et al. [76]) and in helping to avoid compassion fatigue. As already explored, a component of compassion fatigue is exposure to the trauma, distress and suffering of others. One of the effective ways of overcoming the effects of this exposure is to share these difficult experiences with others in a relaxed, supportive and non‐judgemental environment. Research shows that sharing these experiences helps us to process and make sense of what happened (Baranowsky et al. [2]). This is known as the ‘universality of experience effect’ and is a curative factor in groups (Yalom and Leszcz [84]). However, it is essential that the group is an environment in which everybody feels psychologically safe so they can talk openly and honestly.

In recent years, changes in shift patterns, establishments and training have led to increasing isolation rather than opportunities for professional connection. The individuals most immediately available to us for support are often therefore our family and friends. If they don't have a healthcare background, we may notice them withdrawing or changing the subject when we try to share difficult experiences, with the result that we internalize the experiences and don't talk about them. If we do, we can traumatize our friends and family because they are not trained to cope and do not have any opportunity to respond to the difficult situations we describe, so they are left feeling helpless. We therefore need to deliberately be aware of and nurture our professional support network.

Our role as carers of those in distress is costly – we give of our emotional and physical energy to do it, so we need to have a plan to refuel or revitalize (Gentry and Baranowsky [28]). For each of us, how we do this will be different, but we have a professional responsibility to learn what it is that works for us and to regularly practise what will sustain our energy and hope.

Research shows that there are some core components of self‐care that help prevent compassion fatigue (Gentry and Barnowsky 2013, Skovholt and Trotter‐Mathison [72]):