10 May Dealing with PTSD as a Nurse
According to the New York Times, one in four nurses experience post-traumatic stress disorder. Nurses witness death, unbearable chronic and acute pain, and series injuries in patients. Alongside this, they often find themselves without support from staff, coworkers, and their organisations, which can create feelings of loneliness, shame and hopelessness. 18% of RGNs meet the diagnostic criteria for PTSD, alongside 33% of traumatic care nurses.
Symptoms of PTSD in Nurses
The attributes that define PTSD in nurses include:
- Reexperiencing: involuntary memories, nightmares, and flashbacks, which physically manifest as a racing heart and sweating.
- Avoidance: avoiding similar cases that bring back memories, which can look like absenteeism.
- Negative changes in cognition and mood: difficulty concentrating, increased irritability. They might also experience a distorted sense of blame.
- Job dissatisfaction: the intention to leave a job.
PTSD is described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013) as involving a direct or indirect exposure to a single traumatic event or repetitive episodes that result in symptoms and stress responses that last greater than one month.
It affects patient care when nurses suffer from diminished concentration and cognitive ability, creating medication and sentinel errors, leading to death or trauma in patients. Nurses with PTSD may also experience compassion fatigue (lack of empathy).
Example
Kyla is a 32-year-old mental health nurse who works in the adolescent ward of a psychiatric facility. Over the last few weeks, she has cared for a 15-year-old teenager called Bruce, who has had a depressive episode. Her patient only required SSRIs and Etifoxine, but over the last few days, he has been manic. During COVID-19, the clinic had been inundated with new patients, so nurse-to-patient ratios were not ideal.
When counselling another patient, she heard a commotion coming from one of the dormitories. Staff were trying to force open the bathroom door. When they got in, Kyla tried to compress his wounds to stop haemorrhaging, but she was unsuccessful–it was too late.
Kyla becomes consumed by thoughts of what she could have done for Bruce. She awakens from nightmares of the traumatic event, often finding that her heart is racing and that she is in a cold sweat. At work, she now avoids patients who remind her of this patient and becomes anxious when she gets new patient assignments. She is also having trouble concentrating and startles easily when she hears loud noises from the dormitories. Her friends call her to get together for a walk, but she no longer takes pleasure in activities that she once enjoyed.
This case includes all the defining attributes of PTSD: reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal.
What Can You Do About It?
So, you know about what PTSD is in nurses, how it manifests, why, and what it could look like. But what can you do about it if you or a coworker might have it?
Communicate
A lot of nurses don’t feel heard in their places work. They may feel like they don’t want to be too much of a bother because there are more important things to worry about, like people dying, a code, or a medication shortage. Losing even one nurse can be expensive for a hospital– they have to contend with recruitment costs, renegotiate benefits, and possibly pay a higher salary to a newer candidate. If every one of your colleagues with PTSD quit (1 in 4), your hospital would lose millions of pounds a year just from not listening to you.
When you feel like a bother, or that you’re not important, remember that it would be more of a bother if you quit. Go forth and tell a coworker or head nurse that you can’t sleep at night since you lost Mr Smith, that you feel completely alone in the world and changed as a person. Chances are, they’ve felt similarly before and can offer you advice or comfort. Don’t keep things to yourself__ it’s dangerous to you and your patients.
Mindfulness
Everyone says mindfulness is important for mental health, but how can nurses practice it when they’re short on time?
- A 5-minute meditation from an app like Smiling Mind or Headspace
- Journaling before bed
- Listening to music you like
- Going on a 10-minute walk
If think you or a friend has PTSD, it’s important to seek help from a professional, such as a psychiatrist or psychologist. They can help you create a plan of action to manage your symptoms or prescribe medication such as antidepressants or mood stabilisers.
Remember, you are not alone.