Do You Have Secondary Trauma?
I’ve been reading blog posts lately from nurses claiming to have PTSD (posttraumatic stress disorder) from getting their feelings hurt by management, basically. PTSD is a real and serious diagnosis not to be bestowed lightly on oneself regarding situations that are merely bothersome. I mention these posts only because they serve to offset the very real phenomenon of secondary trauma in nursing. Google “secondary trauma in nursing” for a disappointingly large list of studies on the topic. So many studies have been conducted on this topic that I’m surprised it isn’t discussed more. A simple, cursory glance through the findings of these studies indicates that secondary trauma is a significant issue for nurses, causing burnout, depression, and absenteeism and even causing nurses to leave the profession altogether.
What is it? Secondary trauma is just what it sounds like. You get traumatized second-hand, from trauma that isn’t even yours. How does it happen? Nurses do not work in the land of unicorns and rainbows, despite the ads from the Johnson & Johnson “Discover Nursing” campaign. Sometimes we do take care of cute babies who aren’t very sick, and on occasion we make a huge difference by rearranging someone’s pillow or doling out warm blankets. Mostly, however, we wade around in tragedy at least part of the time. Depending on our specialty, it can be most of the time. Nurses like me who work in emergency departments and those who work in critical care areas or hospice may be particularly susceptible to secondary trauma.
Some situations or types of situations are more obvious than others as candidates for causing secondary trauma. For example, nurses who work closely with patients (and let’s not forget their affected family members) who have been raped, brutalized, or disabled by trauma would seem obviously likely to be affected by the ongoing despair. However, nurses who do not work in trauma or critical care areas still witness personal tragedy regularly. What of the stream of elderly who have been abandoned by their families and fall into the social-work black hole where they cannot receive the care they need? What of the parade of terminally ill patients? These situations are tragic and draining as well, even if they are not trauma in technicolor.
Do you find yourself wishing more often you were somewhere else at work? Do you dread going to work at all? Are you sick more often than you used to be? Do you see specific patients or scenes behind your eyelids when you are trying to fall asleep? Are you unable to stop thinking about certain situations you have witnessed at work? Do you feel yourself putting the brakes on your compassion because you just have nothing left to give?
These are all signs of secondary trauma (and compassion fatigue, the fastest and most common result of it), and if you don’t address it, it will just get worse. Hospitals often have formal debriefing systems set up for huge obvious traumatic situations (take advantage of those when they’re offered, please), but they fall down on the job when it comes to this creeping secondary trauma which builds from multiple episodes of lesser drama and obviousness. They do often offer EAP (employee assistance program) benefits, and I don’t see a downside to taking advantage of help when it’s there waiting to be used.
It is every individual nurse’s responsibility to notice and address potential secondary trauma in ourselves, because it affects our health and our patient care. It may even eventually render us unable to do our jobs at all. The culture of nursing can sway us toward thinking that asking for help shows weakness, but we can decide to change that. Secondary trauma is unarguably an issue in our field, and it is our duty to address it.
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