Nonetheless, the researchers determined that 5.6% of the nurses studied “reported a clinically significant level of PTSD symptoms” and that more acute symptoms correlated to higher levels of stress. “Major stress sources included working in an isolated environment, concerns about personal protective equipment shortage and usage, physical and emotional exhaustion, intensive workload, fear of being infected, and insufficient work experiences with COVID-19,” the researchers wrote.
This harsh effect on nurses also became apparent in a two-year integrative review of post-traumatic stress disorder in nurses published in the Journal of Clinical Nursing in May 2020. The researchers, Boston Children’s inpatient oncology/hematology staff nurse Michelle Schuster and nurse scientist Patricia Dwyer, had a head start on the topic of nurses and PTSD before the pandemic hit.
Shuster had also already experienced the condition herself, and told the Boston Children’s Hospital blog, “I started thinking about PTSD and nurses after my first nursing job in Houston. As soon as I came to Boston Children’s, I could feel how much more supportive the environment was here. Nonetheless, I was in a state of nearly constant hyper-arousal, always waiting for something bad to happen. Finally, a therapist suggested my symptoms might be PTSD. It was the first time I realized that nurses could have PTSD.”
Though the pandemic occurred after they concluded their study, Dwyer noted, “COVID-19 is repeatedly traumatic for many of the nurses who are providing direct care. They are caring for patients with a mysterious illness, often for extended shifts, and some hospitals may not have resources in place to support them.”
The safety measures that bar relatives from visiting end of life COVID-19 patients also factor in. “It’s part of our job as nurses to be there for dying patients,” Dwyer added. “But with this pandemic, many families haven’t been able to be in the room with their loved ones. They’ve had to say goodbye over FaceTime while nurses stand by. Situations like this take a real emotional toll on nurses.”
But nurses may not associate such work experiences with a higher risk of this psychiatric disorder – a mistake made by medical professionals and the general public alike. “Trauma is often associated with something overtly violent, such as a car accident or a shooting. But Dutch philosopher Ciano Aydin describes a situation as traumatic when it ‘violates’ familiar expectations about someone’s life and world, sending them into a ‘state of extreme confusion and uncertainty,’” Scientific American explained.
SA went on to quote Wendy Dean, a psychiatrist and co-founder of the nonprofit Moral Injury of Healthcare. “In the case of this pandemic, prolonged uncertainty is compounded by the moral anguish health care professionals face when they do not have adequate resources to treat critically ill patients.”
According to Burger, part of the reason it’s so hard for nurses to recognize this medical condition is that the majority of them are women. “For many years in American history, the concept and diagnosis of PTSD was reserved for those brave men (and only men) who witnessed the horrific shock of war,” she said.
Now though, the label has become more expansive, and nurses should be aware of the implications of that shift. “The diagnosis of PTSD now includes the aftereffects of trauma associated with domestic abuse, war-zone reporting, and vicarious trauma,” Burger added. “Loss of sleep, nightmares of the event, irritability, and frequent startling to minor noises are all well-publicized symptoms, which, if lasting more than six months, are considered diagnosable as PTSD.”
Like other nurses, you may feel inclined to soft-pedal any emotional upsets you experience in these extra-traumatic pandemic days. But the opposite approach may be a lot more helpful to you. “Research has shown that nurses who take an active, problem-solving approach to stress are less likely to develop PTSD,” Dwyer said. “Reaching out for support when they need it is another positive coping strategy. On the other hand, those who deny their feelings, blame themselves, or turn to alcohol to cope with their feelings are far more likely to experience long-term effects of trauma.”
Think you might be suffering from PTSD as a result of working as a nurse in a pandemic, or perhaps due to previous experiences? Here are some signs to watch for, according to Schuster and other experts:
- Intrusive thoughts about a traumatic event, or feeling like you’re re-experiencing it. “This includes thinking about the event at home and re-experiencing it when you walk into the room where it took place,” Schuster explained.
- Avoiding any scenarios that might remind you of the event. You may find yourself unwilling to take care of the sort of patients who might “trigger bad memories,” Schuster added. In some cases, nurses with this symptom of PTSD leave the profession altogether.
- Negative feelings and thoughts that weren’t there before. These mental playlist might include anger, depression or feeling detached from family and friends, not just patients and co-workers.
- Hyper-arousal. “This is a constant feeling of being on edge, of feeling threatened when there’s no actual danger present,” Schuster noted.
- Hyper-vigilance. Burger said this is a less familiar symptom that could indicate PTSD, where “the nurse is hyper-focused on stable patients... irritable or frequently angry.”
- Being unusually down on yourself or questioning your nursing skills. “Another subtle symptom is the nurse with an exaggerated negative belief: ‘If I were a better nurse, then I would have caught that patient’s decline,’” Burger added.
- Physical symptoms like difficulty concentrating, and “non-specific somatic complaints such as body aches, headaches, and lack of overall energy,” Burger noted. “Nurses with PTSD may be calling out sick more often as a protective mechanism.”
When reviewing your feelings and physical symptoms, don’t necessarily judge your reactions by what other nurses in the same situation have experienced. “It’s important to note that different people can have different reactions to the same event,” Schuster explained. “One nurse might find a patient experience traumatic while another may not.”
Other insights might also help nurses realize that their symptoms could spell PTSD. For one thing, it’s not just a matter of how traumatic the trauma was, or is, registered nurse and licensed marriage and family therapist Patricia Pearson told Trusted Health. “It is not just about the severity of the trauma experienced, but more about a person’s experience of multiple traumas over time that can have a significant effect on a person with PTSD.” For example, someone who is exposed to trauma at a job in critical care might be at higher risk if they experienced domestic abuse earlier in life.
If you do seek help, Pearson recommends going beyond the typical EAP clinician who probably isn’t “trained to recognize and treat trauma...If nurses suspect they have PTSD, they should seek clinicians trained in trauma therapy.”
Even more importantly, throughout your potential diagnosis or treatment, keep in mind that this psychiatric disorder does not diminish you or mean you failed in some way. “PTSD is not a sign of weakness,” Pearson added. “It’s the brain’s way of protecting us from harmful experiences. The brain encapsulates the event, similar to how the body encapsulates a tuberculosis spore, yet any of our five senses can trigger the nurse to re-experience levels of the event.”