During the five years that I worked as a psychiatric liaison nurse on the surgical/trauma unit at San Francisco General Hospital with people who had survived motor vehicle and other major accidents, fires and injuries, I listened to hundreds of trauma stories. In the course of conducting thorough psychiatric evaluations, I asked my patients about prior traumatic events in their lives. More upsetting than the circumstances necessitating hospitalization were my patients’ stories of untreated childhood trauma. These included stories of children who witnessed parental suicide and domestic violence, children who were sexually abused and worked as prostitutes, and children who endured punishment at the hands of sadistic parents.

For the first few years, I took pride in my work with these patients. Many had never told their stories to another person. By listening deeply and without judgment I validated their experiences and thus, their humanity. In our work together, I helped them identify words that best described their feelings, taught them relaxation techniques to manage these feelings, and coached them in constructing a coherent narrative to give shape to those feelings.

But such witnessing comes with a price. After a few years, I began to experience some discomforting symptoms: nightmares, palpitations, shortness of breath, anxiety, and an inordinate fear for my children’s safety. Later I learned that my symptoms had a name: vicarious trauma, a component of compassion fatigue. Unfortunately, appeals that I had made to the director of our consult service to allow staff process time were dismissed. When it became clear to me that I needed to take care of my own mental health, I resigned my position.

Nursing school does not prepare nurses for the experience of witnessing pain and suffering. Although nurses value a holistic approach to patient careone that emphasizes prevention and health maintenance—many of us wait for a crisis to ensue before we take our own medicine. (1) Not surprisingly, our bodies bear the brunt of our stress. This may be expressed in irregular eating and sleeping, musculoskeletal tension, respiratory problems, substance abuse, and decreased immune system functioning. Too many of us teeter too close to the precipice of chronic illness. It is not surprising that a study by Welch found that 35% of nurses sampled were clinically depressed. (2)

It stands to reason that happier nurses have more to give their patients than those depleted by compassion fatigue. With so much time and energy spent at work, efforts to create a supportive workplace environment should be paramount. Nurse administrators can support nursing staff members by regularly allocating time for nurses to discuss how they are coping with the stress of caregiving. They can encourage staff members to practice good self-care such as mindfulness meditation and self-compassion.(3) And they can use psychiatric liaison nurses to teach good communication skills, facilitate support groups, and consult with individual nurses, particularly newer staff members. Nurses must also take responsibility for their own care. The Academy of Traumatology/ Green Cross has proposed the following standards of self-care: do no harm to yourself in the line of duty while helping others, and, attend to your physical, social, emotional, and spiritual needs as a way of (providing) high quality services to those who look to you for support as a human being. (4)

This means that in order to take good care of others, we must take good care of ourselves. We must be fit for duty.

1. Hooper C, Craig J et al. Journal of Emergency Nursing (2010) Sept; 36(5): 420-7. Epub 2010 May 18.
2. Welsh, D. (2009) Predictors of depressive symptoms in female medical surgical nurses. Issues Mental health Nursing; 30:320-6.
3. Neff, Kristin. Self-Compassion for Caregivers. May 23, 2011. Psychology Today
4. Academy of Traumatology/Green Cross Proposed Standards of Self-Care

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