As a nursing manager, have you ever had employees who were dedicated and productive members of your healthcare team but suddenly experienced a personality change, exhibiting irritability, tearfulness and detachment from their work?
Did you ever consider that they were suffering from post traumatic stress disorder (PTSD)?
It's not likely PTSD was your initial thought when you were considering what may have cause the personality change in this nurse; PTSD may have been the last thing to come to your mind, in fact. However, these are symptoms of PTSD, which is an emergent healthcare issue.
As managers in the healthcare profession, we need to be cognizant that our staff is not immune to this mental illness.
PTSD is often thought to be a veterans' disease because this disorder was first recognized in 1980, when Vietnam veterans were first identified to be suffering from this mental disorder.
However, three decades later we know this mental illness is not exclusive to veterans but affects much broader and diverse populations including, among others, new mothers, firefighters, emergency medical technicians, disaster victims and volunteers, and victims of crimes. Nurses also have been identified as a population vulnerable to developing this disorder.1-3
PTSD is a complex mental illness that results from an individual's response to an experienced or witnessed traumatic event, and actual death or perceived threat of death or serious injury that results in extreme fear, helplessness or horror. Those suffering from this illness experience a wide spectrum of symptoms including flashbacks and nightmares of the event, anger, anxiety, depression, irritability, impaired concentration, difficulty sleeping, panic attacks, hyper vigilance and an exaggerated startle response.1,4-5
According to the National Institute of Mental Health, 7.7 million adults or 3.5 percent of the adult population suffer from PTSD.6
When considering the current military conflicts in both Iraq and Afghanistan, the recent devastating natural disasters such as hurricanes, earthquakes in Haiti and Chile and the increase in violent crimes, it is easy to predict the number of individuals suffering from PTSD will increase.
Such disasters affect not only the victims but also the members of the healthcare team who provide the medical care for the physically injured and other survivors.
Occupational Hazard for Nurses
PTSD is an occupational hazard for nursing. It is estimated that up to 14 percent of the overall general nursing population experience symptoms that meet the criteria to be diagnosed with PTSD, which is 4 times higher than the general adult population.
Critical care and emergency department (ED) nurses have a higher incidence of PTSD symptoms. As many as 25 percent of critical care nurses 33 percent of ED nurses have screened positive for symptoms of PTSD. Contributing factors for these areas may be the repeated exposure to mortality and morbidity. Nurses in these specialty areas often have repeated exposure to both the victims of traumatic event, as nurses in these specialties witness more deaths.7-8
Other groups of nurses considered especially vulnerable to PTSD are military nurses, nurses in labor and delivery units, as well as those who are first responders to respond to disasters and may witness multiple deaths in one event. Among many other traumatic events that contribute to nurses developing PTSD are occupational hazards such as needlesticks and threats of violence from the patient and family members.
But while PTSD can be chronic and debilitating, and individuals diagnosed with it may suffer a lifetime of symptoms, early treatment can improve outcomes. Therapy has been shown to decrease symptom severity and improve overall functioning of individuals suffering with this disorder.9-10
Impact on the Workplace
PTSD negatively impacts the workplace resulting in occupational impairments that not only affect the individual but also the entire healthcare team. Individuals suffering from PTSD report increased physical symptoms and more absences from work.
PTSD also has a negative impact on retention of nurses as their symptoms can interfere with their job performance thus burdening the other members of the healthcare team. Symptoms of PTSD such as anger and irritability can interfere with working relationships with the other members of the healthcare team and can result in social isolation.3
Nurse managers need to take a proactive role in the prevention, identification and treatment of this disease with their staff. Proper training before responding to traumatic events and conducting debriefings after critical events are methods to help prevent the disease.3
More importantly, as nursing managers it is imperative that our staff is educated and proficient in identifying the signs and symptoms of PTSD, and also be prepared to understand how to respond to this occupational challenge with co-workers as well as patients and families. Special emphasis should be placed on the specialty areas of high vulnerability.
Leaders need to be engaged with their staff by listening, encouraging, and supporting them. Knowing employees and developing trust is paramount.
Nurses identified with symptoms of PTSD should be encouraged to share their feelings and thoughts, and to seek therapy. They should be fully supported by their nurse manager throughout their entire healing process.
References for this article can be accessed here.
MAJ Deborah A. Hood is Army Nurse Corps Officer at Walter Reed Army Medical Center, Washington, DC, and a student at the College of Notre Dame of Maryland Contemporary Leadership in Nursing in Baltimore.