Prior to the pandemic, nurses faced ethical and personal safety dilemmas during disasters and other emergencies. They saw patients suffer, not only from illness itself, but because of health care interventions, otherwise known as medically induced trauma (think of a patient on a ventilator).
Demands for resources largely ignored for decades
More recently, there has been a shortage of PPE (personal protective equipment) throughout US hospitals. But I know nurses who were told by employers to take care of Covid-19 patients regardless of whether or not adequate PPE was available. Clearly this was a danger to both nurses and patients; surely this qualifies as a traumatizing experience.
Other nurses — some new, some working previously in non-acute care — have been deployed to critical care units. Understanding the technology of these complex environments requires a steep learning curve. The knowledge, then, to competently care for these patients may be considered an insufficient resource.
The toll on patients and nurses
Nurses, more than anything, strive to deliver high-quality care and connect with patients during their most vulnerable times. But often there isn’t the time. The inability to achieve that goal causes stress. Imagine being forced to choose between giving morning meds and sitting down with a patient newly diagnosed with cancer — or spending time with the family of a patient with Covid-19. Choices like that leave nurses focused on tasks and morally injured.
Some traumas may be unavoidable. That happens when the nurse fully engages with the patient and co-experiences suffering. This is called secondary or vicarious trauma. That’s why we need to offer trauma-informed care to both nurse and patient. Meaningful connections with others is critical, but so is psychological safety.
Compassion helps to heal
While I haven’t been at the bedside for a number of years, I still remember how it felt to report to the acute care center at the hospital, hoping no one had called in sick. When that happened, I was assigned an extra patient or two. I knew I couldn’t give the care I wanted to the paraplegic young man. I knew I couldn’t spend more time communicating with the older adult who had a sudden right-sided stroke. I couldn’t give them the things so important to healing — the physical care, the nursing presence and the compassion they needed and deserved.
Those experiences stay with you. It’s a heck of a feeling.
Nursing care is both an art and a science; it is a distinct profession that wields enormous influence on those who need the most help. They do not merely follow instructions from other providers. It’s a beautiful profession, unlike any other, founded on intellect, judgment and a caring spirit. It pushes a person to examine values such as social justice and the ethics of life, and it becomes a part of who a nurse is.
Until all of us see nursing this way — and until organizations provide sufficient resources to prevent avoidable trauma, which will allow nurses to provide safe, quality care — nurses will continue to suffer. More will choose to leave the profession. Particularly now, that’s a loss society can’t afford.
Karen J. Foli is an associate professor at the School of Nursing, Purdue University. Disclosure: Foli received funding for her research from the National Council of State Boards of Nursing: Center for Regulatory Excellence. She receives royalties from her book, “The Influence of Psychological Trauma in Nursing.”