Nurses Can Be at Risk for PTSD

  1. Anyone can develop Post-Traumatic Stress Disorder (PTSD), including families of victims and nurses themselves. It can be difficult to recognize PTSD since symptoms may not manifest until long after an event occurs, and because many people don’t seek treatment. Most nurses are aware of the risk of PTSD for their patients, but many haven’t considered that they may be at risk

    Nurses Can Be at Risk for PTSD

    Post-traumatic stress disorder (PTSD) is usually associated with active and retired military members, and although they may consist of the majority of those suffering from PTSD, they're not the only group at risk. PTSD can develop after someone has experienced, or witnessed, a traumatic or terrifying event, or it could be from an ongoing, long-term trauma. This could include a physical or sexual assault, an accident, war, a natural disaster, or the unexpected death of a loved one.

    Other groups that could develop PTSD include the families of victims, children, and rescue and emergency personnel such as nurses. As nurses, and especially the nurses who work in the emergency department, we routinely deal with occupational stressors such as violence, trauma, and death that can put us at an increased risk for PTSD. While we're accustomed to screening our patients, we should remember to also assess families of victims, our peers, and ourselves for PTSD.

    Be Aware of PTSD Symptoms

    Nurses can experience intense ongoing stressors. These may be accompanied by staffing issues that leave little to no time to process a distressing event that may occur during work. Many nurses who experience PTSD think they should be able to cope with it on their own, or that they'll get over it, or believe that dealing with recurring, overwhelming stress is just part of the job. Some nurses may try to hide, deny, or not recognize the symptoms of PTSD. Or they may imagine that admitting to a need for treatment would be viewed as a weakness. This can lead to delaying, or not seeking treatment, or mistaking the symptoms for other medical conditions. PTSD rarely occurs on its own. Burnout syndrome, substance abuse, depression, or other psychiatric disorders, often coexist with PTSD.

    Symptoms of PTSD could be delayed in appearing and can vary. Emotionally there might be feelings of guilt, anxiety, anger, denial, grief, and fear. These emotions can display in an array of behavioral symptoms such as:

    • Intense fear, and feelings of helplessness
    • Flashbacks, or mentally re-experiencing the event
    • Ongoing anxiety
    • Self-destructive behaviors
    • Hyperarousal, or an exaggerated startle response
    • Withdrawal from others, or avoidance of things that remind them of the event
    • Nightmares, insomnia, or other sleep disturbances
    • Emotional outbursts or other cognitive or emotional symptoms, such as difficulty concentrating, feeling disoriented or having difficulty concentrating

    Stress vs. PTSD

    PTSD was once classified as an anxiety disorder, but it's now considered a trauma and stress-related disorder. It differs from common stress reactions because of the length of duration and how it may result in a disruption of daily life tasks and relationships. Nurses who have endured a prior trauma, have a preexisting psychiatric disorder, or lack a social support system could be at an increased risk.

    Nurses suffering from PTSD may notice symptoms:

    • That persist for at least four weeks, instead of disappearing hours, or days, after an event
    • Which may disrupt the ability to interact socially, or at work
    • May occur long after an event when something occurs that triggers a memory, or a patient reminds them of a prior traumatic experience
    • That can affect quality of life, the ability be productive at work, and to produce positive clinical outcomes for their patients

    It's Never Too Late for Treatment

    Education should be provided regarding how PTSD is related to overwhelming stress, and not a personal weakness, as this may be beneficial in encouraging nurses to seek treatment. PTSD can become a chronic condition and the treatment is usually gradual and ongoing. Nurses, and nurse leaders should be mindful of following up after an incident. Or recommend that a co-worker, or family member, consider critical incident stress debriefing (CISD) if they've experienced, or witnessed, a traumatic event.

    CISD is most effective if offered within 24-72 hours after the trauma. By offering a safe place to express anger, grief or sorrow over a traumatic event, it can assist in coping with the potential physical and psychological effects associated with traumatic events. Each individual's experience is unique, and the best treatment may vary with trauma-focused psychotherapies, medications, or other methods specific to the individual's needs to assist in processing coping with the trauma.

    Raising Awareness of PTSD

    It's never too late to begin treatment. Increasing the awareness of the prevalence of PTSD, the varied populations that it can affect, and the symptoms to be aware of, may help to inspire nurses, and others, to seek treatment.
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  3. by   NutmeggeRN
    Nice article. I couldn't agree more. we are often the ones picking up the pieces with not a lot of support. I think often our empathic nature draws us into this profession, thus we are risk throughout our career. Some areas are certainly more predisposed based on sheer volume (ER) but others may experience it is much more subtle ways.
  4. by   BeenThere2012
    I've experienced this. I wrote an article posted on this site about what I went through.

    I now know the PTSD I experienced wasn't entirely caused by the incident at work that triggered my reaction at that time, but contributed to it and/or was the Straw That Broke this Nurse's Back.
  5. by   Marre Barnette
    Thank you so much for this article!
  6. by   BeenThere2012
    I'm wondering why more are not responding to this post? Do nurses not believe they are at risk for this? Denial? I'm not saying ALL nurses get PTSD....don't get me wrong. I believe many are probably experiencing some degree of unhealthy stress, burnout, etc and don't realize how close
    they may be to experiencing it.
  7. by   River&MountainRN
    I think a lot of nurses are just used to being told "suck it up, don't talk about it, just move on" or "if you do talk about it, you'll be violating HIPAA (even if it's in some nebulous way)" and that's why they aren't responding.

    I've had two tremendously stressful, near-devastating events happen within the past two weeks with two home care patients dying (but successfully coming back)/nearly dying on me. I've been there for the patients and their families through it all, putting in extra hours to support them after the events in question. And it's like, no matter what you do, even if the outcome is that the patient actually *survived*, no one is grateful and someone is upset with you.

    I've been put into some ethically questionable positions in the name of "keeping business" for the agency, but managed to keep the patient alive and the family satisfied if not entirely happy (this one family was upset I called EMS for their full-code child, but it was absolutely necessary...extreme respiratory distress, poor oxygen saturations even on the max O2 ordered, questionable HR). I received no help/support from work as far as debriefing (just a guilt trip for getting sick with a similar illness that was going through one of my patient's homes).

    Even if non-healthcare friends wanted to listen, they still just *don't* get it. Not that we're really allowed to talk about anything that happens anyway, because of good ol' HIPAA and---in my case---small town "where everyone knows everyone else and everyone's business" mentality where, even if you don't use specific identifying information, it's very easy for people to figure out who you're talking about. On top of it, even if I were to speak with a therapist, which I've tried to do in the past, frankly they don't even understand. So you've got the perfect mix of "no matter what you do, you're wrong", multiple traumatic situations back to back (I genuinely care for my patients and become affected when they take a turn for the worse/die), and social isolation (especially since I work the night shift). I just feel like I'm mentally weak or letting everyone down for letting this affect me the way it is. So I just keep putting one foot in front of the other, one moment at a time if one day at a time is too much to handle.
    Last edit by River&MountainRN on Nov 10