Nurses' psychological trauma: “They leave me lying awake at night”

Published:April 15, 2020DOI:


      • Insufficient resource trauma, a new form of nurse-specific trauma, is present when needed resources are lacking.
      • Psychological trauma affecting nurses may be avoidable or unavoidable.
      • Outcomes of psychological trauma indicate nurses' mental health and career issues that need to be addressed.



      To describe nurses' personal and professional psychological trauma.


      A content analysis of 372 responses surrounding personal and professional trauma was performed.


      Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care.


      Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.


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        • Aiken L.H.
        • Cimiotti J.P.
        • Sloane D.M.
        • Smith H.L.
        • Flynn L.
        • Neff D.F.
        Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.
        Medical Care. 2011; 49: 1047-1053
        • American Association of Critical-Care Nurses
        AACN standards for establishing and sustaining healthy work environments: A journey to excellence.
        2nd ed. 2016 (Author)
        • American Nurses Association
        Code of ethics with interpretive statements., Silver Spring, MD2015
        • American Nurses Association
        Position statement: Incivility, bullying, and workplace violence.
        (Retrieved from)
        • American Nurses Association
        ANA’s principles for nurse staffing.
        3rd ed. 2020 (Author)
        • American Psychiatric Nurses Association
        Position statement: Workplace violence.
        (Retrieved from)
        • Andersson L.M.
        • Pearson C.M.
        Tit for tat? The spiraling effect of incivility in the workplace.
        Academy of Management Review. 1999; 24: 452-471
        • Beck C.T.
        Secondary traumatic stress: A systematic review.
        Archives of Psychiatric Nursing. 2011; 25: 1-10
        • Centers for Disease Control and Prevention
        Behavioral Risk Factor Surveillance System ACE Data.
        (Retrieved from
        • DeSantis L.
        • Ugarriza D.N.
        The concept of theme as used in qualitative nursing research.
        Western Journal of Nursing Research. 2000; 22: 351-372
        • Dziadzkoa V.
        • Dziadzkob M.A.
        • Johnson M.M.
        • Gajica O.
        • Karnatovskaiaa L.V.
        Acute psychological trauma in the critically ill: Patient and family perspectives.
        General Hospital Psychiatry. 2017; 47 (Retrieved from): 68-74
        • Elo S.
        • Kääriäinen M.
        • Kanste O.
        • Pölkki T.
        • Utriainen K.
        • Kyngäs H.
        Qualitative content analysis: A focus on trustworthiness.
        SAGE Open. 2014; 4: 1-10
        • Elo S.
        • Kyngäs H.
        The qualitative content analysis process.
        Journal of Advanced Nursing. 2008; 62: 107-115
        • Farnsworth J.K.
        • Drescher K.D.
        • Nieuwsma J.A.
        • Walser R.B.
        • Currier J.M.
        The role of moral emotions in military trauma: Implications for the study and treatment of moral injury.
        Review of General Psychology. 2014; 18: 249-262
        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • Williamson D.F.
        • Spitz A.M.
        • Edwards V.
        • Marks J.S.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.
        American Journal of Preventive Medicine. 1998; 14: 245-258
        • Figley C.R.
        Treating compassion fatigue.
        Brunner Routledge, New York, NY2002
        • Foli K.J.
        • Thompson J.R.
        The influence of psychological trauma in nursing.
        Sigma Theta Tau International, Indianapolis, IN2019
        • Foli K.J.
        • Reddick B.
        • Zhang L.
        • Edwards N.E.
        Where legal, medical, and personal collide: Substance use in registered nurses.
        Journal of Nursing Regulation. 2019; 10: 45-54
        • Foli K.J.
        • Reddick B.
        • Zhang L.
        • Krcelich K.
        Substance use in registered nurses: ‘I Heard About a Nurse Who….’.
        Journal of the American Psychiatric Nurses Association. 2020; 26: 65-76
        • Frankfurt S.
        • Frazier P.
        A review of research on moral injury in combat veterans.
        Military Psychology. 2016; 28: 318-330
        • Frederick D.
        Bullying, mentoring, and patient care.
        AORN Journal. 2014; 99: 587-593
        • Griffin B.J.
        • Purcell N.
        • Burkman K.
        • Litz B.T.
        • Bryan C.J.
        • Schmitz M.
        • Maguen S.
        Moral injury: An integrative review.
        Journal of Traumatic Stress. 2019; 32: 350-362
        • Hall L.W.
        • Scott S.D.
        The second victim of adverse health care events.
        Nursing Clinics of North America. 2012; 47: 383-393
        • Hesse E.
        • Main M.
        Second-generation effects of unresolved trauma in nonmaltreating parents: Dissociated, frightened, and threatening parental behavior.
        Psychoanalytic Inquiry. 1999; 19: 481-540
        • Houck N.M.
        • Colbert A.M.
        Patient safety and workplace bullying.
        Journal of Nursing Care Quality. 2017; 32: 164-171
        • Institute of Medicine
        To Err Is Human: Building a Safer Health System.
        National Academy Press, Washington, DC2000
        • Isobel S.
        • Delgado C.
        Safe and collaborative communication skills: A step towards mental health nurses implementing trauma informed care.
        Archives of Psychiatric Nursing. 2018; 32: 291-296
        • Isobell S.
        • Goodyear M.
        • Furness T.
        • Foster K.
        Preventing intergenerational trauma transmission: A critical interpretive synthesis.
        Journal of Clinical Nursing. 2019; 28: 1100-1113
        • Koehn A.R.
        • Ebright P.R.
        • Draucker C.B.
        Nurses’ experiences with errors in nursing.
        Nursing Outlook. 2016; 64: 566-574
        • Lynette J.
        • Echevarria I.
        • Sun E.
        • Greene Ryan J.
        Incivility across the nursing continuum.
        Holistic Nursing Practice. 2016; 30: 263-268
        • Magnavita N.
        • Heponiemi T.
        Workplace violence against nursing students and nurses: An Italian experience.
        Journal of Nursing Scholarship. 2011; 43: 203-210
        • Melnyk B.M.
        Burnout, depression and suicide in nurses/clinicians and learners: An urgent call for action to enhance professional well-being and healthcare safety.
        Worldviews on Evidence-Based Nursing. 2020; 17: 2-5
        • Merrick M.T.
        • Ford D.C.
        • Ports K.A.
        • Guinn A.S.
        Prevalence of adverse childhood experiences from 2011–2014 Behavioral risk factor surveillance system in 23 states.
        JAMA Pediatrics. 2018; 172: 1038-1044
        • Merrick M.T.
        • Ford D.C.
        • Ports K.A.
        • Guinn A.S.
        • Chen J.
        • Klevens J.
        • Mercy J.A.
        Vital Signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention — 25 States, 2015–2017.
        Morbidity and Mortality Weekly Report. 2019, November 8; 68: 99-1005
        • Missouridou E.
        Secondary posttraumatic stress and nurses’ emotional responses to patient’s trauma.
        Journal of Trauma Nursing. 2017; 24: 110-115
        • Najafi F.
        • Fallahi-Khoshknab M.
        • Ahmadi F.
        • Dalvandi A.
        • Rahgozar M.
        Antecedents and consequences of workplace violence against nurses: A qualitative study.
        Journal of Clinical Nursing. 2018; 27: e116-e128
        • National Academies of Sciences, Engineering, and Medicine
        Taking action against clinician burnout: A systems approach to professional well-being.
        The National Academies Press, Washington, DC2019 (doi:10.17226/25521)
        • National Center for Trauma-Informed Care
        About NCTIC.
        (Retrieved from)
        • Needleman J.
        • Liu J.
        • Shang J.
        • Larson E.L.
        • Stone P.W.
        Association of registered nurse and nursing support staffing with inpatient hospital mortality.
        BMJ Quality and Safety. 2020; 29: 10-18
        • Nolte A.G.
        • Downing C.
        • Temane A.
        • Hastings T.M.
        Compassion fatigue in nurses: A metasynthesis.
        Journal of Clinical Nursing. 2017; 26: 4364-4378
        • Parker A.M.
        • Sricharoenchai T.
        • Raparla S.
        • Schneck K.W.
        • Bienvenu J.
        • Needham D.M.
        Posttraumatic stress disorder in critical illness survivors: A Metaanalysis.
        Critical Care Medicine. 2015; 43: 1121-1129
        • Phillips J.M.
        • Stalter A.M.
        • Winegardner S.
        • Wiggs C.
        • Jauch A.
        Systems thinking and incivility in nursing practice: An integrative review.
        Nursing Forum. 2018; 53: 286-298
        • Raveis V.H.
        • VanDevanter N.
        • Kovner C.T.
        • Gershon R.
        Enabling a disaster-resilient workforce: Attending to individual stress and collective trauma.
        Journal of Nursing Scholarship. 2017; 49: 653-660
        • Scott S.D.
        • Hirschinger K.R.
        • Cox M.
        • McCoig M.
        • Brandt J.
        • Hall L.W.
        The natural history of recovery for the healthcare provider “second victim” after adverse patient events.
        Quality & Safety in Health Care. 2009; 18: 325-330
        • Seys D.
        • Scott S.
        • Wu A.
        • Van Gerven E.
        • Vleugels A.
        • Euwema M.
        • Vanhaecht K.
        Supporting involved health care professionals (second victims) following an adverse health event: A literature review.
        International Journal of Nursing Studies. 2013; 50: 678-687
        • Shay J.
        Moral injury.
        Psychoanalytic Psychology. 2014; 31: 182-191
        • Sinclair S.
        • Raffin-Bouchal S.
        • Venturato L.
        • Mijovic-Kondejewski J.
        • Smith-MacDonald L.
        Compassion fatigue: A meta-narrative review of the healthcare literature.
        International Journal of Nursing Studies. 2017; 69: 9-24
        • Struthers R.
        • Lowe J.
        Nursing in the Native American culture and historical trauma.
        Issues in Mental Health Nursing. 2003; 24: 257-272
        • Substance Abuse and Mental Health Services Administration
        SAMHSA News.
        Key terms: Definitions. Spring 2014; 22 (Retrieved from)
        • U.S. Department of Health and Human Services
        • Health Resources and Services Administration
        • National Center for Health Workforce Analysis
        Brief summary results from the 2018 national sample survey of registered nurses.
        Rockville, Maryland2019
        • Vagharseyyedin S.A.
        Workplace incivility: A concept analysis.
        Contemporary Nurse. 2015; 50: 115-125
        • Wheeler K.
        A call for trauma competencies in nursing education.
        Journal of the American Psychiatric Association. 2018; 24: 20-22
        • Wu A.W.
        Medical error: The second victim: The doctor who makes the mistake needs help too.
        British Medical Journal. 2000; 320: 726-727