Nurses and Secondary Traumatic Stress from COVID-19

COVID-19 is taking an unprecedented toll on our country’s healthcare system—and putting healthcare professionals at risk of secondary traumatic stress and moral injury.

“As we see heroes rise, we must also remember the reasons they are called heroes are the very difficult conditions that call us to greatness, challenge our resiliency, change us forever and remind us that we are human” said Cole Edmonson, DNP, RN, FAAN, chief experience and clinical officer for AMN Healthcare. “Our colleagues across the frontlines are extraordinary human beings, who suffer from the same failings, challenges and who need support, love and care during a crisis and after.”

“With this global pandemic happening, the amount of people who are going to be experiencing this is startling,” said Briana Bonicelli, BSN, RN, CCRN, clinical manager for AMN Healthcare. She is one of about 60 professionals supporting healthcare professionals nationwide. AMN aims to serve as a support network for nurses to help them stay in the profession and get help for secondary traumatic stress and moral injury.

Greater awareness and proactive steps can help nurses heed the warning signs and build resilience to survive—through the pandemic and beyond.

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Secondary Traumatic Stress and Moral Injury

In healthcare, secondary traumatic stress (STS) occurs when a provider is affected by a stressful and emotional event, Bonicelli said.

The U.S. Department of Health and Human Services defines secondary traumatic stress as “a natural but disruptive by-product of working with traumatized clients. It is a set of observable reactions to working with people who have been traumatized and mirrors the symptoms of post-traumatic stress disorder (PTSD).”

“It might not happen at the time of caring for a patient who was a victim of a violent crime or somebody diagnosed with coronavirus,” Bonicelli explained. “You might not feel it right away, but later, after the experience has passed. It continues to impact you long after the experience. You cannot put it in a box and walk away from it.”

Moral injury refers to what happens with repeated episodes of secondary trauma, especially when healthcare practitioners know what care patients need but are unable to provide it due to constraints that are beyond our control.

During the current pandemic, patient surges, equipment shortages and regulations that keep families apart have fueled moral distress for nurses and others caring for patients.

Secondary trauma and moral injury can lead to burnout and nurses leaving the profession, during a nursing shortage.

Recognizing Secondary Traumatic Stress

Nurses may not initially be aware they are experiencing secondary traumatic stress and moral injury. The first sign Bonicelli noticed, while working in critical care, was a lack of empathy and less emotionally connected to her work as an ICU nurse. She recognized that something was up and she was not the way she used to be.

Secondary traumatic stress can impact a nurse’s cognitive, behavioral and emotional functioning, according to a recent article in the American Nurse journal, written by a team from Vanderbilt University School of Nursing. The authors noted that the condition can manifest itself in decreased concentration, apathy, feelings of guilt or sadness, appetite changes, sleep interruptions, anxiety and a wide range of other symptoms.

Mitigating The Effects

Taking care of oneself will help in mitigating the negative effects of secondary trauma and moral injury.

“Nurses don’t do a good job overall at taking care of ourselves,” Bonicelli said. “We take care of others but do not put ourselves first or second or third.”

Bonicelli recommends prioritizing these self-care practices:

  • Allow for downtime
  • Exercise regularly
  • Eat healthy foods
  • Spend time with friends (even if virtually)
  • Pursue hobbies and things that bring you joy

Additionally, having a network of people in health care who you can talk with can help. For instance, a nurse might say to a colleague, “Remember that case from a few days ago? It’s still bothering me, and I need someone to talk to about it.”

Travel nurses may not have the same type of relationships and ability to connect with colleagues as a staff nurse, but support among fellow nurses going through this crisis is widespread.

Where Travel Nurses Can Find Help

Bonicelli encouraged travel nurses to network and take advantage of the benefits AMN Healthcare offers its travelers, such as the employee assistance program (EAP). Currently, mental health practitioners answer all EAP phone calls, so nurses can receive emergency counseling.

Travelers on an AMN Healthcare insurance plan can talk to a physician or therapist virtually at no charge. They also can access the Calm website and app for free, which offers meditation, mindfulness and relaxation tools. AMN also offers a discounted online gym program.

Resiliency can happen when you know yourself, gain insight into what things negatively affect you and are able to process those difficult situations.

“You learn to make yourself stronger by doing the self-care things, talking to someone if you need to, and using your time off to rest and recuperate,” Bonicelli said.


COVID-19 Resources for Healthcare Professionals – AMN Healthcare

Secondary Traumatic Stress – Dept. of Health and Human Services

Easing the Psychological Impact of COVID-19 for Nurses - American Nurse Journal (ANA) – website and app

Want to help? AMN Healthcare company, has crisis response jobs across the U.S. 

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