Recognizing PTSD’s Effects on Health Care Professionals

Post Traumatic Stress Disorder (PTSD) is an “anxiety disorder that occurs as a result of experiencing, witnessing, or being confronted with an emotionally traumatic event. A traumatic event is defined as a situation so extreme, so severe and so powerful that it threatens to overwhelm a person’s ability to cope” (Adriaenssens, 2016, p. 1411).

When PTSD is discussed, it is almost always accompanied by a veteran’s horrific story from war or the mental struggles one is facing after being involved in a personal and traumatic event. Seldom do people associate the risk of developing PTSD with normal, everyday jobs such as being a doctor or a nurse, yet individuals in these professions experience PTSD as well. A study conducted in 2007 by the American Journal of Respiratory and Critical Care Medicine found that “24 percent of ICU nurses and 14 percent of general nurses tested positive for symptoms of post-traumatic stress disorder” (Yu, 2016). Even so, PTSD within the healthcare profession is rarely talked about. PTSD is a serious consequence of having a high stress job that encounters trauma and suffering daily, and it can take on many forms. Yet the reasons why many health care professionals suffer from this condition and the toll this is having on their mental health and job satisfaction is rarely acknowledged.

Health care professionals, specifically nurses, are routinely confronted with stressful conditions and traumatic events. According to a review of research by the National Institute for Occupational Safety and Health, “nursing has long been considered one of the most stressful professions” (Yu, 2016). Additionally, according to Jef Adriaenssens, a researcher on stress and healthcare at Leiden University, “almost one out of three nurses met sub-clinical levels of anxiety, depression and somatic complaints and 8.5% met clinical levels of PTSD” (1411). This is due to obvious reasons such as long work hours, high patient demand, and, potentially, understaffing in some hospitals. Another aspect of the profession that causes high amounts of stress is the types of traumatic events nurses are routinely faced with.

All nurses, at some point, have to deal with potentially traumatizing situations. Specifically, emergency room nurses — who, according to Adriaenssens, have the highest incidence of PTSD symptoms compared to other nursing specialties — are especially vulnerable to post-traumatic stress reactions. This can be attributed to repeated exposure to work-related traumatic events, such as witnessing the survivors of horrific accidents or “death or serious injury of a child/adolescent” which was “perceived as the most traumatizing event.” Emergency room nurses are “routinely confronted with severe injuries, death, suicide and suffering” due mainly to the fact that they are often the first to respond to situations and are often confronted with the worst injuries and the most hectic work environments (Adriaenssens, 2012, p. 1411). By working in such conditions and witnessing horrific injuries at such a rapid pace, emergency room nurses are prone to experiencing symptoms associated with PTSD brought on merely by witnessing the results of tragic events.

High rates of PTSD among military veterans occur for more obvious reasons. They are under extreme amounts of stress and are especially prone to experiencing trauma firsthand. However, PTSD in health care professionals is usually a little different. More often than not, doctors and nurses are witnessing the results of horrific and tragic events instead of having the event happen directly to them. “The natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person” is known as secondary traumatic stress. In simpler terms, secondary traumatic stress occurs when PTSD symptoms, such as anxiety, depression, flashbacks, or nightmares, occur in caregivers as a response to seeing individuals who have been involved in traumatic events (Collins and Long, 2003, p. 418). Individuals, such as doctors and nurses, can become so empathetic to the suffering of others that they begin to experience classic PTSD symptoms, almost as if the traumatic event happened directly to them.

While secondary traumatic stress is the most common form of PTSD in health care providers, vicarious trauma can also occur. Vicarious traumatization is “the cumulative effect of working with survivors of traumatic life events. Anyone who engages empathetically with victims or survivors is vulnerable” (Collins and Long, 2003, p. 417). Vicarious traumatization is extremely similar to secondary traumatic stress because empathizing with the victim can cause the care provider to experience symptoms of PTSD, as if the event happened to them directly. Vicarious traumatization is different from secondary traumatic stress because of the way individuals cope after. After a potentially disruptive event occurs, the beliefs and assumptions of an individual are challenged and they begin to perceive their world differently, a phenomenon known as posttraumatic growth. The metaphor of an earthquake has been utilized to illustrate posttraumatic growth: “The traumatic experience needs to be seismic, such as an earthquake, to severely shake an individual’s comprehension of the world. These shaken assumptions may be the person’s understanding of the meaning of life; belief that things that happen are fair…” (Beck, 2016). After caring for an individual who has been through a particularly traumatic event, the health care provider begins to make new assumptions about the world and reassess their beliefs as a way of coping with the extreme amounts of trauma and stress. “Posttraumatic growth is viewed as a positive illusion that is an adaptive function to help a person cope with trauma. A positive illusion is a positively distorted belief a person creates when faced with a traumatic experience” (Beck, 2016).

As an example, vicarious posttraumatic growth can be observed in labor and delivery nurses. The Association of Women’s Health, Obstetric, and Neonatal Nurses sent out a survey to members who were labor and delivery nurses and asked them to describe any positive changes in their ways of thinking about the world or their beliefs as a result of caring for women who had undergone very traumatic births. The study concluded that labor and delivery nurses who took care of women during traumatic births “reported a moderate amount of vicarious posttraumatic growth…Appreciation of Life was the dimension of the Posttraumatic Growth Inventory that reflected the highest growth, followed by Relating to Others, Personal Strength, Spiritual Change, and New Possibilities” (Beck, 2016). After experiencing a traumatic birth, these labor and delivery nurses were beginning to alter their ideas about life as a way of coping with the stress they endured.

Even though these nurses were altering their ideas about life in seemingly positive ways, there is little evidence that vicarious posttraumatic growth is actually a healthy and long-term, effective way to cope. One explanation is that posttraumatic growth really isn’t growth at all. Anthony Mancini, an associate professor of psychology at Pace University, explains posttraumatic growth as a “motivated positive illusion, whose purpose is to protect us from the possibility that we may have been damaged.” He further goes on to explain an experimental study that found “when an event threatens our sense of self, we are more likely to believe that the event made us better in some way” (Mancini, 2016). Posttraumatic growth can be viewed as a positive way to temporarily cope with an especially disturbing event, however, it often proves to only act temporarily and rarely actually alters the individuals’ thoughts and perceptions for the long-term.

While posttraumatic growth is a way that nurses cope with the extreme stress they endure, there is very little attention on PTSD within healthcare professionals. Yet, job dissatisfaction and burn-out are becoming prevalent, especially within the nursing profession. According to mental health researchers Collins and Long, burnout can be described as “a state of physical, emotional and mental exhaustion caused by long-term involvement in emotionally demanding situations” (Collins and Long, 2003, p. 420). This makes sense when discussing post-traumatic stress disorder. As nurses are exposed to potentially upsetting and very traumatic events over a long period of time, it is going to start taking a toll on them both physically and emotionally. As Laurie Barkin, a registered nurse, described, “nursing school does not prepare nurses for the experience of witnessing pain and suffering.” She goes on to discuss her story of beginning to experience symptoms such as nightmares, anxiety, and palpitations. She later learned that “my symptoms had a name: vicarious trauma… Unfortunately, appeals that I had made to the director of our consult service to allow staff process time were dismissed” (Barkin, 2014). Laurie Barkin’s symptoms began to control her life, and she eventually resigned from her job after the director of her consult service failed to give staff adequate time to process their emotions in a healthy way. This is a perfect example of how hospitals often dismiss symptoms of post-traumatic stress and vicarious trauma, and this dismissal could be leading to high levels of burnout and nurses being unsatisfied with their jobs.

PTSD is a serious, and often life altering condition, that health care professionals are faced with. The fact that PTSD is rarely acknowledged and discussed during nursing school and beyond is having adverse effects on nurses who find themselves faced with this disorder. With the prevalence of PTSD, secondary traumatic stress, and vicarious trauma soaring, new policies and practices must be put in place both in nursing schools and hospitals in order to aid the nurses affected. By acknowledging that PTSD is real in nurses and their feelings are valid, burnout and job dissatisfaction could be addressed, and nurses could find themselves more satisfied in their profession and living happier lives.

Works Cited

Adriaenssens, J. (2012). The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. International Journal of Nursing Studies, 49(11), 1411-1422.

Barkin, L. (2014, July 16). Nurses and compassion fatigue. Gift From Within.

Beck, C., & Eaton, C., & Gable, R. (2016). Vicarious posttraumatic growth in labor and delivery nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(6), 801-812.

Collins, S., & Long, A. (2003). Working with the psychological effects of trauma: Consequences for mental health-care workers. Journal of Psychiatric and Mental Health Nursing, 10, 417-424.

Mancini, A. (2016, June 1). The trouble with post-traumatic growth. Psychology Today.

Yu, A. (2016, April 15). Nurses say stress interferes with caring for their patients. National Public Radio.

Instructor’s Memo

Sarah’s research paper was submitted for a section of English 100 linked to a First-Year Interest Group for students interested in a possible nursing career. For earlier assignments, students had researched and read what could be termed “professional testimonial” writing about the working life of nurses––narratives from social media sites and from an excellent anthology of personal essays titled, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (L. Gutkind, ed., 2013). These narratives provide vivid and sometimes disconcerting testimony about the singular stresses that nurses may face, especially witnessing the aftermath of traumas suffered by their patients, either before they seek medical care or during treatment. One author (Schwarz) recounts a harrowing anecdote from the early days of his training, his memory of wheeling a patient with an apparently minor complaint down the hall, and looking on helplessly as the man suddenly coughs violently, vomits “a wave of blood,” and dies within moments, sitting in his wheelchair.

From the beginning of the semester, then, we were having conversations about the possibility that some nurses might very well suffer post-traumatic stress disorder as a simple condition of their daily work lives. These early readings also allowed students to critically examine some of the lasting clichés attached to the nursing profession, including expectations that nurses will be exceptionally compassionate and selfless, quietly shouldering the daily psychological burden of caring for those experiencing severe pain and suffering. Later in the semester we read articles about the national nursing shortage and the challenges that many medical facilities face because of the regular burnout of their nursing staff. Sarah’s choice of research topic for her final research paper was thus an ingenious way of drawing together several important threads of learning generated from our semester of research and writing.

For the final paper assignment, students who are interested in a similar topic work collaboratively in small research groups to gather a range of sources about that topic––including peer-reviewed studies, articles from trade publications (targeted to those in the nursing profession), and news sources for the general public, such as national magazines or public radio. Students are able to pool their resources and learn research techniques from one another through this process. They also discuss the articles they have found in order to identify ways of narrowing down that broad topic to find a research focus appropriate for a short paper. Sarah selected the challenge of synthesizing several peer-reviewed studies, specifically those that explain the intricate breakdown of post-traumatic symptoms for those ministering to patients in the context of trauma. In this essay she is able to integrate those more advanced scholarly studies with insights provided by mainstream journalists and the author of a professional website. It’s not an easy matter to make all these different voices “speak” to one another in an analytical paper. But Sarah draws evidence from all of these sources to offer a compelling critique about the lack of attention to PTSD within the nursing profession. Hopefully by the time she begins her own training in the field, there will be greater awareness about the mental health needs of nurses themselves.

–Julia Garrett

Writer’s Memo

As a pre-nursing student, I found myself fascinated with researching different aspects of the nursing profession, from the different fields of nursing to the daily duties and responsibilities to the attributes of a good nurse. As I began my critical analysis on the more cliché and positive side to nursing, I began to receive feedback and suggestions from my peers and instructor on delving into the more unspoken side of nursing, the hardships that accompany the demanding job. I decided to follow this suggestion and focus my research on a dimension of nursing that is seldom discussed: PTSD. Nursing is usually not associated with this disorder, and for that reason I at first found it hard to find credible research that covered the topic. In the end I was very glad I stuck with the very specific topic of PTSD, because through my research I gained valuable insight into the profession.

As far as revisions go, I found it most helpful to have as many people as possible read the entire paper, or even just certain sections I was stuck on, and then leave their feedback and revisions. I then would go back and read their revision suggestions multiple times and on different days, which allowed me to formulate additional thoughts and interpret their comments in new ways, ultimately adding to my paper in ways I had not originally thought of. Additionally, with a complex and very specific topic like this, I found it very easy to want to incorporate every small detail I learned about PTSD in healthcare, regardless of whether it was relevant, and lose sight of where the main focus of the paper was going. So I made sure I created a very strict and specific outline and only gathered information relevant to the topics outlined. This helped the paper maintain a nice flow between topics and remain coherent.

Before going through this process and writing this paper, I was not a huge fan of writing critical analysis research papers. After gaining the tools, knowledge, and appreciation for gathering dependable research, utilizing the research in a way that best benefits the argument of the paper, and choosing best how to articulate and present the research in a coherent way, I learned how enjoyable it can be to pick a topic you’re passionate about and want to share with others.

–Sarah Lutz

Student Writing Award: Critical/Analytical Essay