Coping responses are as unique as the individual. Part 2 of two parts.
She left nursing because of secondary traumatic stress (STS), also known as compassion fatigue. Now she works to inform others and promote awareness.
It is well-known that secondary traumatic stress (STS) can be felt on an organizational level. Negative effects include increased absenteeism, high turnover rates, decreased staff morale, and diminished patient care. Development of STS is often a predictor that a nurse will leave the profession altogether. Such was the case for me.
Unfortunately, when I decided to leave, I didn’t know what I was experiencing. What I did know was how I felt. I hope that, as more nurses become informed about secondary traumatic stress, they will recognize the symptoms and seek help, or that informed nurse leaders and administrators will realize what is going on and intervene.
Time for action
Healthcare organizations have an obligation to protect the health and well-being of employees while doing all they can for their patients. Employers spend time and effort developing protocols to ensure a safe work environment, putting risk management policies in place, and forming task forces to determine intervention strategies. Enough research on secondary traumatic stress has been done to prompt action. Now steps need to be taken to ensure staff members are not only well-informed but also encouraged to seek assistance when needed.
Experiencing STS can be very confusing. Emotions are erratic, perception is off, and complex thoughts seem too difficult to grasp. Add to that sleep disturbances, easily triggered panic attacks, and guilt and shame associated with knowing you are not coping, and it is easy to see how a sense of hopelessness can set in. A management team that is well-informed about the symptoms of STS, understands the importance of prevention, and suggests and encourages professional help can be a lifeline to a staff member struggling to stay afloat.
As I stated in Part 1 of this two-part series, research shows that personality can be a factor—individuals who are empathically inclined are more susceptible to secondary traumatic stress. STS is also more common in women. Previous history of personal trauma—especially unresolved trauma—is a factor. Staff members with limited social support, either in their personal lives or at work, have greater risk. Those who work in areas of high trauma incidence, such as emergency departments, or in more emotionally exhausting areas, such as palliative care, are also more prone to develop STS. But secondary traumatic stress can occur in any area of healthcare because, before we are nurses, we are human beings.
One size doesn’t fit all
Coping responses are as unique as the individual. Thus, behavioral changes may be the best way to identify an individual struggling with STS. The challenge is to identify how the symptoms are playing out. Some nurses may appear cold and aloof or be easily irritated, frustrated with authority, less patient with co-workers and patients, and less compassionate. These symptoms are often confused with those of burnout. Other nurses developing STS may become more prone to emotional upsets, struggle to meet the needs of emotionally demanding patients, have difficulty setting boundaries on the care they provide, and find ways to avoid placing themselves in highly emotional situations.
For both response types, there may be a noticeable change in ability to tolerate stress, cope with workload, or handle tasks that require perception, such as making accurate assessments. The employee may show an overall change in affect—emotional tone—and appear withdrawn or depressed. Because of sleep disturbances, the employee may frequently appear fatigued or exhibit an increase in negative physical symptoms that may result in increased absenteeism. Frequent job changes may also be an indicator that something insidious is going on. As nurses with STS struggle to cope, the risk of addiction increases.
What can be done?
Knowledge is key. All staff members need to learn how to identify, treat, and prevent STS. Informal in-service training about STS and the need for self-care, presented in a nonjudgmental way, can be very effective. Providing resources for additional reading can be beneficial. Promoting a milieu of understanding and encouraging team support and peer mentorship can be very constructive. What better way to process difficult emotions than to speak with others who know exactly what you are going through?
Encouraging employees to practice self-reflection can be very beneficial in helping them recognize areas of struggle. Ideally, employee-support staff should be available, including trauma therapists capable of offering stress management, eye movement desensitization reprocessing (EMDR), resilience building, and other treatment options.
Secondary traumatic stress should be covered in all nursing curricula. The best time to learn about STS is before it occurs. With knowledge, it can often be prevented. Additionally, paying attention to boundaries and what that means in nursing care, as well as dealing with loss, are topics that need to be addressed. How to strike a balance between providing compassionate care and becoming overwhelmed by feelings is another topic for discussion. Until STS becomes a standard component of nursing education, nursing schools will continue to train nurses who are clinically knowledgeable but unable to handle emotional distress, and they will leave the profession.
The negative impact of this exodus is even more pressing during nursing shortages. Aware of that fact, forward-thinking educational institutions are now making changes to their programs. The University of Windsor in Ontario, Canada, has an embedded therapist in its school of nursing to provide support to students. The medical school at the University of Ottawa has made similar changes: Meditation is a compulsory course in the curriculum of first-year medical students.
We need to know more and do more
Additional research on STS is needed, as are studies on compassion and empathy. We need to know more about prevalence, risk factors, and effectiveness of treatments. Why are some nurses immune to STS and others susceptible? How do STS and PTSD differ? We need to fine-tune screening tools for STS.
But in the end, the onus lies with healthcare personnel—nurses and others—to take the necessary steps to understand STS and guard against it by ensuring adequate self-care. Reflective practices to promote emotional processing should be part of every nurse’s life. Promising studies are being conducted on the effectiveness of stress-management techniques such as mindfulness-based stress reduction (MBSR), an approach that also increases resilience. But meditation is a discipline that requires commitment from individuals.
Having come full circle in my own experience with STS, I know firsthand that the disorder does not need to be a life sentence. No career should be cut short, no job dreaded because of the potential impact of secondary traumatic stress. But until we stop overlooking its symptoms and downplaying its effects, we will continue to lose valuable, caring nurses. RNL
Part 1: "I left nursing because of secondary traumatic stress"
Dorothy B. Wright, BScN, a resident of Springfield, Manitoba, Canada, is a freelance writer (click here to access her website and blog) and author of Side Effects: A Journey Through Secondary Traumatic Stress.