The Occupational Information Network (O*NET) publishes a list of the most stressful jobs annually based on several factors, including “consequence of errors” and “time pressure.” While everyone understands that positions in law enforcement will always be the #1 most stressful job in the U.S., it may surprise many people that nursing is in the top five most stressful jobs. In fact, nursing positions beat out jobs like an air traffic controllers, surgeons and even firefighters.
Why is nursing so stressful, and why have nursing mental health issues become so pervasive in the 21st century? Even before the COVID-19 pandemic, nurses were overworked, underpaid, and burdened by a deteriorating health system that ignored their physical and emotional needs. Now, over a year after the worst of the pandemic has passed, the consequences to nurses caused by constant trauma, stress, and work overload are causing an epidemic of post-traumatic stress disorder (PTSD), depression, and serious health issues in nurses.
An excerpt from Nurse T: A Pandemic Nurse’s Diary succinctly summarizes the kind of all-consuming stress nurses is constantly subjected to:
“Most vivid is Nurse T’s representation of her work and the traumatic toll it takes on her and her colleagues. Because they work in an infectious environment, the nurses stay in hotels and rarely see their families. Because they don’t have the proper equipment and because the hospital does not have up-to-date filtration and ventilation systems, the workplace is far more dangerous and deadly than it needs to be. Because politicians and the population at large do not take the pandemic seriously and promote basic precautions, medical staff are having to treat many more patients than they would need to otherwise. Because the hospital is ill-equipped, they can’t treat patients optimally.”
Types of Trauma Faced by Nurses
Nurses are vulnerable to two major types of trauma: patient-focused trauma and nurse-focused trauma.
Patient-focused trauma (PTT) is broadly defined by how much a patient suffers due to illness. Registered and licensed practical nurses working in hospitals see patients succumb to the disease every day. However, the number of patients who pass away under a nurse’s watch is generally limited and, for the most part, expected.
PTT becomes more problematic when nurses develop an especially close relationship with a patient and their family. Nurses caring for a child with cancer, for example, may co-experience the anguish parents suffer as they do everything possible to help their child. Young nurses are more vulnerable to vicarious trauma than older, experienced nurses who have developing resiliency and coping mechanisms for emotionally overwhelming events.
Nurse-focused trauma involves but is not limited to the following:
- Insufficient resources (not enough beds, ventilators for COVID patients, lack of mental health support for nurses onsite)
- Possibility of workplace violence (especially applied to emergency room nurses)
- Working overtime due to staff shortages
- Feeling guilty when they can’t spend time with family due to nursing shortages. Alternately, nurses who are scheduled off for just one day may feel anxious and guilty for not working when they know patients may be suffering from unavoidable staff neglect
Many nurses consistently experience an overlap of patient-focused and nurse-focused trauma because the two are so intimately intertwined. A 2020 survey of over 30,000 nurses found that nearly 70 percent of nurses worried every day about their hospital being short-staffed. Almost all nurses surveyed said they are “very or somewhat afraid” to actually go to work due to anxiety over the patient or nurse-focused traumas.
Statistics on Nurses and Major Depression
The American Association of Occupational Health Nurses recently published an article that included these statistics regarding the state of mental health among nurses in the U.S.:
- RNs suffer from major depressive disorders at twice the rate of police officers, airplane pilots and all other professions
- RNs reporting symptoms of major depression to shift managers are more likely to report errors in administering medications, patient falls and a reduction in the way they care for their patients
- The highest rates of major depression affect younger, female RNs compared to younger, male RNs or older RNS (male or female)
- Depression was reported more frequently in divorced and single nurses than married nurses
- Psychiatric and intensive care nurses reported higher levels of major depression than nurses working in other departments
- Increasing age in nurses seems to be a protective factor against experiencing major depression and anxiety
Overwhelming stress, low job satisfaction, staff shortages leading to overtime burnout and the devastating consequences of psychological trauma are forcing many nurses to leave their profession to pursue other careers. In addition, a large part of the nursing workforce is approaching retirement age. According to a 2018 survey, the average age for U.S. registered nurses is 50 and an estimated one million RNs are expected to retire over the next decade.
Signs of Repressed Psychological Trauma in Nurses
Nurses often become nurses because they are strong, compassionate individuals with a deep desire and sense of calling to help others. For such amazing people, it can be hard to admit they are having difficulty adapting to a job they believe they were born to do.
Symptoms of early-onset PTSD among nurses are often attributed solely to lack of sleep, poor diet, and overwork. Neglecting to get help for the following signs of trauma can lead to rapid worsening of a nurse’s overall mental and physical health:
- Anxiety attacks that interfere with a nurse’s work performance or family responsibilities
- Feeling guilty or ashamed for no apparent reason
- Feeling dread and severe anxiety upon going to work (avoidance behavior)
- Having nightmares about work
- Relying on alcohol, drugs or behavioral disorders to numb negative emotions
- Feeling dissociated or detached from reality
- Increasing impatience and irritability towards co-workers and family (hypervigilance/overreaction response)
- Development of physical problems previously not experienced, such as ulcers, hypertension, weight gain, chronic headaches, and joint pain
Nurses who are experiencing two or more of these symptoms should consult their primary care physician to determine if an underlying disorder may be causing the symptom.
When Should a Nurse Seek Help for Psychological Trauma?
For the past five years, Mandy has been working as a pediatric nurse for a large, urban hospital. Although she regularly suffered profoundly strong emotions of sadness and heartbreak following the death of a child, she always felt she could handle the day-to-day intensity of caring for sick children. Mandy developed coping mechanisms that seemed to work for her.
When the COVID-19 pandemic began, Mandy found herself quickly overwhelmed physically and emotionally. Staff shortages, lack of PPE, and the number of severely ill people with COVID flooding the hospital started taking their toll on her. She began having nightmares, questioned her faith, cried while driving to work, and felt guilty for neglecting her family. Mandy even found herself in her own hospital ER one night when she had a severe panic attack and thought she was going to die.
If you are a nurse or know a nurse who is experiencing a similar situation, the team at FHE Health can help. Our medical and clinical professionals can provide the kind of mental and emotional counseling designed to address the specific needs of nurses, including psychological trauma. There is life after trauma. We can help you get there.