PTSD in Nurses

Nurses with symptoms of PTSD need to be encouraged and offered help.

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As a nursing manager, have you ever had employees who were dedicated and productive members of your healthcare team but suddenly experienced a personality change, exhibiting irritability, tearfulness and detachment from their work?

Did you ever consider that they were suffering from post traumatic stress disorder (PTSD)?

It's not likely PTSD was your initial thought when you were considering what may have cause the personality change in this nurse; PTSD may have been the last thing to come to your mind, in fact. However, these are symptoms of PTSD, which is an emergent healthcare issue.

As managers in the healthcare profession, we need to be cognizant that our staff is not immune to this mental illness.

PTSD Prevalence

Read More on Nurses and Stress

PTSD is often thought to be a veterans' disease because this disorder was first recognized in 1980, when Vietnam veterans were first identified to be suffering from this mental disorder.

However, three decades later we know this mental illness is not exclusive to veterans but affects much broader and diverse populations including, among others, new mothers, firefighters, emergency medical technicians, disaster victims and volunteers, and victims of crimes. Nurses also have been identified as a population vulnerable to developing this disorder.1-3

PTSD is a complex mental illness that results from an individual's response to an experienced or witnessed traumatic event, and actual death or perceived threat of death or serious injury that results in extreme fear, helplessness or horror. Those suffering from this illness experience a wide spectrum of symptoms including flashbacks and nightmares of the event, anger, anxiety, depression, irritability, impaired concentration, difficulty sleeping, panic attacks, hyper vigilance and an exaggerated startle response.1,4-5

According to the National Institute of Mental Health, 7.7 million adults or 3.5 percent of the adult population suffer from PTSD.6

When considering the current military conflicts in both Iraq and Afghanistan, the recent devastating natural disasters such as hurricanes, earthquakes in Haiti and Chile and the increase in violent crimes, it is easy to predict the number of individuals suffering from PTSD will increase.

Such disasters affect not only the victims but also the members of the healthcare team who provide the medical care for the physically injured and other survivors.

Occupational Hazard for Nurses

PTSD is an occupational hazard for nursing. It is estimated that up to 14 percent of the overall general nursing population experience symptoms that meet the criteria to be diagnosed with PTSD, which is 4 times higher than the general adult population.

Critical care and emergency department (ED) nurses have a higher incidence of PTSD symptoms. As many as 25 percent of critical care nurses 33 percent of ED nurses have screened positive for symptoms of PTSD. Contributing factors for these areas may be the repeated exposure to mortality and morbidity. Nurses in these specialty areas often have repeated exposure to both the victims of traumatic event, as nurses in these specialties witness more deaths.7-8

Other groups of nurses considered especially vulnerable to PTSD are military nurses, nurses in labor and delivery units, as well as those who are first responders to respond to disasters and may witness multiple deaths in one event. Among many other traumatic events that contribute to nurses developing PTSD are occupational hazards such as needlesticks and threats of violence from the patient and family members.

But while PTSD can be chronic and debilitating, and individuals diagnosed with it may suffer a lifetime of symptoms, early treatment can improve outcomes. Therapy has been shown to decrease symptom severity and improve overall functioning of individuals suffering with this disorder.9-10

Impact on the Workplace

PTSD negatively impacts the workplace resulting in occupational impairments that not only affect the individual but also the entire healthcare team. Individuals suffering from PTSD report increased physical symptoms and more absences from work.

PTSD also has a negative impact on retention of nurses as their symptoms can interfere with their job performance thus burdening the other members of the healthcare team. Symptoms of PTSD such as anger and irritability can interfere with working relationships with the other members of the healthcare team and can result in social isolation.3

Related Nursing Feature

Nurse managers need to take a proactive role in the prevention, identification and treatment of this disease with their staff. Proper training before responding to traumatic events and conducting debriefings after critical events are methods to help prevent the disease.3

More importantly, as nursing managers it is imperative that our staff is educated and proficient in identifying the signs and symptoms of PTSD, and also be prepared to understand how to respond to this occupational challenge with co-workers as well as patients and families. Special emphasis should be placed on the specialty areas of high vulnerability.

Leaders need to be engaged with their staff by listening, encouraging, and supporting them. Knowing employees and developing trust is paramount.

Nurses identified with symptoms of PTSD should be encouraged to share their feelings and thoughts, and to seek therapy. They should be fully supported by their nurse manager throughout their entire healing process.

References for this article can be accessed here.

MAJ Deborah A. Hood is Army Nurse Corps Officer at Walter Reed Army Medical Center, Washington, DC, and a student at the College of Notre Dame of Maryland Contemporary Leadership in Nursing in Baltimore.

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I share wholeheartedly with the comments mentioned here. I don't think this is addressed enough in the nursing profession. I have worked in ICU, trauma center ER, labor & delivery, house resource, PACU, OR and now in Mental Health. I also ran on adrenalin, until now I feel burned out, anxious and do not enjoy my chosen field like I used to. When I think of all we have seen and done in people's lives, it is like a war zone.

Barbara Roehl,  RNC, MS,  Abbott NorthwesternOctober 27, 2015
Minneapolis, MN

For 14 years I worked in an adult med-surg ICU. Our staff consisted of 2 RN's and 3 LPN's for 14 patients. Usually I cared for 2 of the most seriously ill, and passed meds for 7 patients. The work load was often impossible as we did dialysis, cared for fresh open hearts, traumas, isolations, COPD, and everything inbetween. I coped until I had to care for my parents at home who were severely ill, and later died. I recognize that I lived on adrenalin, interrupted sleep, long shifts without breaks. Doctors were sometimes verbally abusive and occasionally threw things at the staff. If we complained we were threatened by the unit manager that we might lose our jobs. Finally I transitioned to a med-surg floor where I suffered panic attacks, migraines, diarrhea, and depression until I just could not function. I stayed in nursing for over three decades. Often when in the ICU I felt as though I worked in a war zone. Although I've been out of nursing for ten years I continue to dream of the ICU every night. Meds not passed, patients dying, arguments with managers and doctors over patient care. I remember many of my patients and their families. I cared so deeply and no one took care of me.

June April 22, 2015

I have been an ER RN for the better part of twenty years and have diagnosed myself with PTSD. This article points to the fact that roughly 33% of all ER nurses suffer the same. I have no doubt that such information is correct. I have lived "life and death" situations. I have been attacked. I suffer the nightmares with the underlying theme being an inability to find the defibrillator or the inability to find the right medication or, worse yet, the inability to perform my job perfectly. Hyper-vigilance is an every day response. I've been mauled by depression and hit with anxiety attacks and adrenaline overloads. It's good that such articles are coming to the forefront. We as ER RNs need to be recognized that, on a daily basis, we are working in a sort of "war zone" as well. Losing a life on the gurney is similar to that of losing a life in the battlefield. For those of you who are long-term ER nurses, have you ever asked yourself "What could I have done better to save my patient's life?" If so, you most definitely understand why we as a group need community support and offered assistance to prevent or deal with PTSD. The word needs to get out.

Brian March 10, 2015

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