Written by Samantha Wall, LCSW
Vicarious Trauma: What is it? How can we combat vicarious trauma in nursing?
Vicarious Trauma is a big phrase that has a lot of implications. First, I want to talk about what vicarious trauma is not. Vicarious trauma is not the same as burnout. Burnout typically builds over time and has to do with being tired and worn out because of the job responsibilities. It can often be treated by making changes such as shifting job responsibilities or finding a new position. Vicarious trauma is associated with working with patients that are going through trauma, occurs more quickly than burnout, and often involves more extensive treatment than changing a routine, such as therapy. In thinking about this past year, I cannot imagine the amount of stress nurses were under because of COVID-19. Many more nurses than other years could have experienced vicarious trauma from their patients due to COVID-19.
Common signs of vicarious trauma are:
- Experiencing prolonged feelings of anger, rage, and sadness about a patient’s victimisation
- Overly involved emotionally with a patient or patients with similar circumstances
- Bystander guilt, shame, and feelings of self-doubt
- Struggles controlling thoughts and thinking about patients outside of work
- Over-identification with patients
- Loss of hope, pessimism, cynicism about patients and our work
- Distancing, feelings of numbness, detachment, cutting patients off, staying busy in and out of work
- Avoiding listening to patients story of traumatic experiences
- Difficulty maintaining healthy professional boundaries with patients, such as overextending at work and trying to do more than is in your role for the patient
- Dreams about work and patients
- Increased conflict with staff
- Low motivation at work
- Increase in errors at work due to struggles with concentration/attention to detail
How can we combat vicarious trauma?
Self-monitor: know your limits and keep track of your symptoms. You can also take assessments such as the Professional Quality of Life Scale: https://www.wendtcenter.org/wp-content/uploads/ProQOL_5_English.pdf or other online self assessments.
Self-Care: It is just as important for us to care for ourselves as it is for our patients. Keep a routine, rest, eat balanced meals and exercise, do things that you enjoy, and make time for yourself. Taking time for yourself to re-center during your work day and days off is important for you to self-monitor and check in with your own needs!
Separate Yourself: You provide space for many emotions such as stress and grief daily for your patients and their families, remind yourself: “This is not my pain, I am just holding it for a little while.”
Set Boundaries: Monitor how you are setting boundaries with your patients and workplace. Are you working overtime for a specific client? Are you overextending yourself to cover shifts?
Be Honest: Ask yourself the hard question, am I experiencing the symptoms of vicarious trauma? It does not mean there is something wrong with you if you need to take time off, increase boundaries with clients or work, and/or seek support through therapy. Be honest with yourself and others about your needs, it will benefit you and others if you are honest with your level of regulation at work. You may come to the conclusion that you do need to change jobs due to the amount the vicarious trauma affects your daily life.
Seek Support through Therapy: There are many things we can do to support our regulation and prevent the vicarious trauma from affecting our daily life. There are some situations that people need to process through extra support such as therapy. If you find a situation or period of time at work continues to be in your thoughts or you experience triggers at work, therapy is a way to not only identify the trauma and regulate, it is a place where you can process the situation to decrease overall distress about the situation. Trauma is not something that will go away if you ignore the signs, triggers, and stressful situations. If you experience prolonged stress from a traumatic situation, I would recommend just setting up a therapy session with a trauma therapist to see how they can support you in processing the traumatic situations experienced.