Hello, and welcome to episode 25 of The Nurse Trauma Healing Podcast.. I’m Dr. Lorre Laws, your host, and today we’ll be discussing the unique challenges faced by critical care nurses and health professionals as relates to nurse-specific traumatization, patient outcomes, nurses safety, and professional wellbeing.
Our conversation centers on The Critical Care Societies Collaborative Statement on Burnout Syndrome that was published years ago and is still relevant today. I’m using this article as an example of how the existing healthcare paradigm does not take a trauma-informed approach to ensuring nurses and other health professionals are safe, healthy, and professionally well in their roles. Join me as I navigate the complexities of Burnout Syndrome (BOS) and Nurse-Specific Traumatization (NST) to explore how urgently a trauma-informed approach to occupational health is urgently needed worldwide.
Let’s start with a few definitions.
Burnout Syndrome (BOS) is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. First described in the 1970s, BOS is a work-related constellation of symptoms and signs that usually occurs in individuals with no history of psychological or psychiatric disorders. BOS is triggered by a discrepancy between the expectations and ideals of the employee and the actual requirements of their position.
Notice how this definition is NOT trauma-informed? Since that time, humanity has endured a global pandemic trauma that left billions of people traumatized and carrying inordinate amounts of unintegrated trauma. This, on top of the myriad of individual traumas that humans experience, including these trauma categories: acute, chronic, complex, developmental, and neglect.
The classic BOS definition states that “BOS is triggered by a discrepancy between the expectations and ideals of the employee and the actual requirements of their position.” What it does not ask or consider is what if there is a discrepancy between the expectations that one should be safe, adequately staffed, and sufficiently resourced at work, only to realize that that is no longer the case?
As it turns out, BOS is the tip of a much, much bigger iceberg.
Nurse-specific traumatization (NST), as introduced by Dr. Foli’s Middle Range Theory for Nurse Psychological Trauma, refers to the unique and specific experiences of trauma and distress that nurses may encounter in their professional roles. This term encompasses the emotional, psychological, and physical impact of exposure to traumatic events, high-stress situations, and challenging patient care scenarios that are inherent to the nursing profession. Nurse-specific traumatization acknowledges the heightened vulnerability of nurses to experiencing trauma due to their direct involvement in patient care, critical decision-making, and exposure to human suffering and tragedy. This concept highlights the importance of recognizing and addressing the emotional toll that nursing can take on individuals, as well as the need for support, resources, and interventions to promote nurse well-being and resilience in the face of trauma.
We’re way past burnout. Let’s talk symptoms.
I conducted a symptom cluster analysis across numerous studies that examined burnout and trauma symptoms, guided by the Substance Abuse and Mental Health Services Administration‘s immediate and delayed reactions to trauma. Let’s unpack the stark alignment and correspondence of BOS and NST symptoms across emotional, cognitive, physical, behavioral, social and existential domains.
Emotional Domain: BOS and NST Symptom Correspondence
Persons experiencing BOS and NST have similar emotional symptomologies:
- Sense of detachment
- Depersonalization
- Helplessness
- Denial
- Overwhelmed
- Feeling out of control
- Anxiety, feeling anxious
- Depression, feeling sad or depressed
- irritable
Cognitive Domain: BOS and NST Symptom Correspondence
The symptoms in the cognitive domain similarly have a lot of overlap.
- Difficulty concentrating
- Brain fog
- Feelings of failure
- Negativism related to professional role
- Negativism related to worldviews
- Memory changes
- Distracted
- Mind racing, ruminating thoughts
Physical Domain: BOS and NST Symptom Correspondence
When assessing symptom clusters through the lenses of Polyvagal Theory, Selye’s General Adaptation Syndrome, and Naviaux’s Cell Danger Response Theory, the physical manifestation of BOS and NST symptoms are mirror images.
- Exhaustion
- Extreme fatigue
- Trembling
- Shaking
- Increased cortisol
- Decreased resistance to infections
- Mitochondrial dysfunction-related chronic illnesses
- HPA axis dysregulation
- GI disorders
- Sleep alterations
- Among many others
Behavioral Domain: BOS and NST Symptom Correspondence
How a person behaviorally develops symptoms in response to BOS and NST exhibit considerable correspondence as well:
- Decreased energy
- Decreased activity level
- Exercise intolerance
- Withdrawn from relationships, responsibilities
- Loss of motivation
- Apathetic
- Sleep habit changes
- Increased use of alcohol or substances
- Absenteeism and presenteeism
- Increased high-risk or maladaptive behaviors
- Procrastination
Social & Existential Domains: BOS and NST Symptom Correspondence
The pattern of substantial overlap between BOS and NST symptoms continues:
- Distancing from job, colleagues, friends, and family
- Increased interpersonal conflicts
- Socially isolating
- Diminished sense of personal and professional self-efficacy
- Loss of personal or professional life meaning
- Redefining personal or professional life meaning
- Hopelessness
- Loss of value or purpose
Now that we’ve reviewed the symptom cluster analysis, you might be wondering as I did . . .
Is burnout the tip of a much, much bigger iceberg?
As it turns out, the answer is a resounding YES. The evidence surrounding burnout is not trauma-informed. Plain and simple. It doesn’t wholly consider the inordinate amount of nurse-specific trauma exposure, much of which is avoidable. We’ve talked about these trauma exposures at length in prior episodes, so if you’re just joining us tune into episode 19 or skim the transcript to learn more about the individual and nurse-specific traumas that you may have or are enduring. While I could talk about these topics all day, I’m not looking to turn our time together into a long-winded lecture! 😅💯🚨
The American Association of Nurses (AACN) Weighs In on Trauma
The AACN’s trauma-informed care position statement ties it all together. As nurses, we are to assume that everyone has experienced some type of trauma in their lives. While we can’t and shouldn’t know everyone’s trauma history or try to uncover it, we must treat all patients as though they have experienced trauma.
Well, guess what.
Nurses are a subset of the “assume everyone has experienced some type of trauma”. And, we also are exposed to seven additional categories of nurse-specific trauma, four of which are avoidable. And, honestly, five of which are avoidable given that many second-victim traumas are secondary to health system or organizational shortcomings.
What that means is this:
Nurses are whole persons, with their unique individual trauma history. Then they get to work and are further traumatized in practice. It’s a perfect storm, a tsunami if you will, of way too much occupational trauma exposure with little to no trauma prevention or recovery services available. Nurses are among the high-risk group for trauma exposure, right up there with combat military personnel and first responders.
Our colleagues are provided with the resources and support that they need to mitigate and ameliorate occupational trauma exposure. Why are nurses not similarly being supported in occupational-related trauma exposures? The answer makes my skin crawl. It’s because nurses are perceived as second-class citizens and pawns on a corporate chess board. It’s cheaper for an organization to “churn and burn” or “hire to fire” with a revolving door staffing model. It’s cheaper for them to hire a new grad than it is to create safe, trauma-informed workplaces.
That strategy is no longer working.
Social media has been a game changer in exposing the realities behind a nursing career. It’s not Gray’s Anatomy here. It’s a cruel game of “Survivor” in the most literal and Polyvagal Theory informed sense of the word. Nurses do not feel safe at work because they are all too often not safe at work.
The BOS and NST symptom cluster analysis shine a huge light on the fact that nurses are literally being traumatized in their roles, with 4.5 of the 7 categories being avoidable. Nurses are suffering across all health dimensions: physical, mental, emotional, behavioral, relational, and existential.
So, please. Let’s stop with the outdated burnout narrative that was first introduced in the (gasp) 1970’s. More than a half of a century later, we need a paradigm shift. Let’s call it what it is. Nurse-specific traumatization.
If you’re curious to learn more, please purchase my upcoming book that discusses these topics and offers a four-step, evidence based pathway to healing and full recovery. It’s time to end nurse-specific traumatization and enter a new paradigm – what I call Nursing 2.0. The Nurse Safety & Professional Wellbeing Edition.
If you or someone you know has been affected by nurse-specific traumatization, please seek support immediately. I and my team are standing by to support nurses. Please join my Nurse Trauma Masterclass or schedule a personal call with me to explore the best healing options for you.
Until next time, thank you for all that you are and do.
I see you.
I feel you.
I hear you.
And I am here for you.
From my healer’s heart to yours,
Dr. Lorre 💕