Work-related post-traumatic stress disorder (PTSD) can occur in any high-stress, high-risk job, especially those involving dangerous life-or-death situations. While this condition is often associated with occupations like military personnel, police officers, and firefighters, those in nursing and other healthcare professions routinely deal with traumatic events that can emotionally and psychologically impact them long after they’ve treated a patient.
Studies have shown that 22% of general nurses and up to 48% of critical care nurses experience symptoms of PTSD. According to the American Psychological Association, PTSD typically does not go away on its own. Left untreated, this anxiety disorder can lead to chronic pain, depression, substance abuse, and sleep problems that “impede a person’s ability to work and interact with others.” This is especially concerning in the nursing field, where bedside manner and emotional patient care play a huge role in a nurse’s success on the job.
As a professional or an employer in the nursing field, it’s important to understand the signs and symptoms of PTSD, and steps you can take if you or your staff might be experiencing it. Here’s how post-traumatic stress disorder impacts nurses and here are some strategies on how to help them recover before they burn out or resign.
Why Do Nurses Experience High Levels of PTSD?
By its very nature, nursing is a highly stressful and demanding field. Working as a nurse in any setting can be taxing, but for those who work in hospitals and urgent care facilities, a typical day at work often involves witnessing and treating a wide array of human suffering, sometimes including grave injury and death. Nurses also have to deal with the emotional fallout of families dealing with a critically or terminally ill loved one, especially if they work in environments like the emergency room, intensive care units, or trauma units.
The National Institute for Occupational Safety and Health (NIOSH) puts nurses at heightened risk for health, safety, and other issues compared to other professions. One of the biggest risks is job stress, which the NIOSH defines as “the harmful physical and emotional responses that occur” when a worker does not have adequate resources to meet the demands of their job, including proper emotional and psychological support for the traumatic events they witness.
The COVID-19 pandemic has been especially difficult on nurses, many of whom are likely experiencing pressure, fear, exhaustion, isolation, and ongoing emotional trauma. It is too soon to predict the full psychological impact of the pandemic on frontline healthcare workers, but we may see PTSD rates increase among nurses due to the constant daily pressures and loss of life that come with fighting COVID-19.
How is PTSD Diagnosed in Nurses?
Regardless of the root cause, job-related stress can affect individuals in a variety of ways. However, adults and children over 6 years old must meet certain criteria defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to be clinically diagnosed with PTSD.
For nurses, this may include the following:
- Exposure to a traumatic event (death, serious injury, sexual violence) by directly witnessing it, or through repeated exposure to aversive details of the event as they carry out their job duties.
- Presence of one or more symptoms after the traumatic event occurs:
- Recurrent, involuntary, and intrusive memories or dreams of the event.
- Dissociative reactions like flashbacks, where the individual feels or acts like the event is recurring.
- Intense psychological distress or physiological reactions in response to internal or external “cues” that symbolize or resemble aspects of the event.
- Avoidance of stimuli associated with the traumatic event, including efforts to avoid internal memories, thoughts, and feelings or external reminders of the event.
- Negative changes in mood and cognitions, such as:
- Inability to remember important aspects of the events due to dissociative amnesia
- Exaggerated negative beliefs or expectations about the self, others, or the world.
- Blaming oneself for the event due to distorted cognitions about the cause or consequences.
- Persistent negative emotional state.
- Diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Inability to experience positive emotions.
- Hyperarousal or reactivity, including irritable behavior or outbursts, reckless or self-destructive behavior, hypervigilance, startles responses, trouble concentrating, or sleep disturbance.
- Experiencing criteria B, C, D, and E consistently for more than one month.
- Significant distress or impairment in social situations, at work, and in other important areas of life.
- Criteria can not be attributed to substance use or another medical condition.
The DSM-5 notes that some individuals with PTSD may experience a delayed expression of certain symptoms and not meet the full diagnostic criteria until at least six months after the event.
How Can Nurses and Their Employers Help Treat PTSD?
A 2009 study published in “Depression and Anxiety” found that more than 18% of nurses meet the diagnostic criteria for PTSD. With the growing shortage of U.S. nurses in recent years, it’s likely that this statistic is now higher, as nurses are stretched thinner than ever before.
Post-traumatic stress disorder and associated burnout symptoms make nurses and other healthcare professionals more likely to quit their jobs, which only worsens the industry-wide shortage. So what can be done to reduce the symptoms and prevalence of PTSD among nurses?
What Employers Can Do to Help Nurses with PTSD
According to the “Depression and Anxiety” study authors, employers and managers of nurses need to understand how PTSD and burnout contribute to nursing turnover and subsequent staff shortages. Some recommended proactive strategies for employers include:
- Teaching coping strategies to nursing staff to better-equip them to deal with PTSD
- Improved communication between doctors and nurses who must treat terminal patients
- Implementing support groups for nurses struggling with stress and grief
- Creating awareness of PTSD and burnout in the workplace and identifying/instituting effective treatment strategies
What Nurses with PTSD Can Do to Help Themselves
Learning to manage stress and prioritize self-care is crucial for nurses experiencing symptoms of PTSD. Health care professionals who are dealing with high stress at work, especially during COVID-19, should try to understand how they’re responding to the pressure and stress, and then try to mitigate it.
- Acknowledge and understand your reactions. Stress, anxiety, and grief are a normal reaction to the stressors nurses encounter every day. Be kind to yourself and know that you are not alone in experiencing these feelings, and it doesn’t mean you’re weak.
- Monitor your well-being. Check-in with yourself and watch for cognitive, emotional, physical, and behavioral signs of excessive stress. If you meet the diagnostic criteria for PTSD and these symptoms are interfering with your work and home life, seek help from a licensed mental health professional or crisis helpline, such as SAMHSA’s Disaster Distress Line (1-800-985-5990).
- Take care of yourself. Breathing exercises, healthy meals, quality sleep, mindful activities, and maintaining social connections can help you combat stress by activating your parasympathetic nervous system.
- Prioritize your mental health. As a nurse serving on the frontlines of COVID-19, you may not feel like you have time to step away from your work duties for self-care. Allow yourself to take a few moments every day to reset your mind and take care of your mental health, so you can continue to best serve the patients in your care.