Nurses face significant stress throughout a standard work shift, much of it normalized as inherent to the nursing field and clinical practice. However, providers, nurses, and patient aides frequently fail to recognize acute stress reactions until symptoms compound into longer-term, chronic symptoms or psychological distress. Common stressors many nurses experience including leading patient restraints, performing CPR, being verbally harassed, or having physical space invaded. Because of the normalized nature of this workload, both individual nurses and healthcare organizations frequently resume routine care immediately after high-stress events. However, repeated exposure to stress and trauma can result in burnout, fatigue, depression, anxiety, and more.
Understanding trauma
Trauma is a psychological, physiological, or emotional response to a perceived stressful event. Various factors, including social contexts, beliefs, and values. can contribute to how one reacts to a stressful event. The American Psychiatric Association defines trauma more specifically, with diagnoses such as posttraumatic stress disorder or acute stress disorder requiring actual or threatened death, serious injury, or sexual violence, including by directly witnessing the traumatic event. Secondary trauma, as defined by Rauvola and colleagues, refers to the exposure of a traumatic event through another individual, often by sharing it verbally. McCann and Pearlman define vicarious trauma as a change in worldview due to repeated exposure to trauma.
Trauma can be considered on a spectrum, and what may be traumatic for one nurse may not be for another. There is no way to accurately predict an individual’s trauma reactions, which frequently are based on psychological traits like resilience that develop across the entire lifespan. Implementing standard operating procedures for individual or organizational response after a traumatic or stressful exposure can prove beneficial, even if staff seem “fine.” Checking in with staff even days after a stressful exposure can help nurses recover.
Problem-solving trauma exposures and trauma reactions
The education and preparation can help nurses manage stress and trauma. He and colleagues found a significant association between organizational climate and trauma-informed care knowledge, attitude, and practice. While often taught as a style of intervention, trauma-informed care is a bilateral approach. Nurses with specific training in trauma-informed care are better suited to recognize trauma in their patients as well as in themselves.
Both the nurse and the organization are responsible for creating a space that allows for recovery after traumatic exposures. Some researchers, such as Sim and colleagues, have attempted to develop programs meant to focus on posttraumatic growth, defined as the ability to recover after significantly stressful events. In offering space for reflection and support, nursing students demonstrated a marked increase in resilience, emotional processing, hope.
Interventions to manage trauma can be applied at every level of an organization. At the unit-level, nursing leadership can facilitate debriefings after traumatic exposures. These debriefings can be one-on-one or in a group setting. Research by Ho and colleagues suggests that even a 15-minute debrief can be useful in managing stress, enhancing staff and nursing leader relationships, and fostering resilience. How these huddles are facilitated may change their usefulness.
The culture of an organization significantly impacts nursing well-being. Copeland and colleagues found that nurses tended to view violence as part of the job, and nurses believed they would be blamed for the patient’s violence. This frequently is seen when organizations immediately ask, “What could you have done differently?” Although asking nurses to critically reflect on how they could have reacted differently is important, it’s also necessary to reinforce the nurse’s resilience by focusing on their strengths and offering a moment for coping and regulation. In addition, “toxic positivity” may prove ineffective at managing nurse wellness. Instead, empathetic approach that recognizes the sacrifice and potential damage the nurse has endured can help them feel seen and supported.
Nurses also have an individual role in fostering a community of support and recovery. A study by Maassen and colleagues found that nurses who collaborated with their teams felt a higher sense of solidarity and increased autonomy. Nurses who can recognize the signs of trauma in their peers have the opportunity to provide relief by offering emotional support, solidarity, or a brief break.
Even if it seems that a nurse hasn’t struggling with trauma exposures, creating a positive work culture, implementing regularly scheduled check-ins, or offering a debrief that implements coping skills can be preventive rather than reactive. This is especially true as many of the symptoms of secondary traumatic stress can go unnoticed. Barmawi and colleagues highlighted that some of the most reported symptoms after secondary traumatic stress include exhaustion, fatigue, and anger with work or peers. Therefore, even if a nurse presents with subclinical symptoms of trauma or appears to be functioning as usual, a check-in can prove beneficial.
Early detection of trauma symptoms aids in managing well-being. Part of trauma-informed care is self-reflection. Rather than asking ,“What could I have done better?” try asking, “Why am I having this reaction?” The intention of this question isn’t to judge, but to identify contributing factors and defusing the thoughts, feelings, and behaviors from those factors. If a nurse is upset because a previous patient assaulted them, that nurse is at a higher risk of seeing the next patient as more aggressive. Identifying contributing factors also can help differentiate what stressors stem from work and what stressors stem from external considerations such as interpersonal relationships.
Additional resources
Nurses who want to understand more about trauma should contact their state licensing boards, schools, or other professional organizations, such as the Society of Occupational Medicine or the American Nurses Association.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text rev. Washington, DC: American Psychiatric Association; 2022. doi:10.1176/appi.books.9780890425787
Barmawi MA, Shahrouri BE, Hadid LA, et al. Measuring the prevalence, warning signs, and preventive measures of secondary traumatic stress among critical care nurses. BMC Psychiatry. 2025;25:450. doi:10.1186/s12888-025-06840-1
Copeland D, Potter M, Tipton S, Culter D. Nurses’ perceptions and expectations of patient violence: Language matters. Nurs Rep. 2025;15(3):85. doi:10.3390/nursrep15030085
De Vos AJBM, de Kok E, Maassen SM, Booy M, Weggelaar-Jansen JW. Learning from a crisis: A qualitative study on how nurses reshaped their work environment during the COVID-19 pandemic. BMC Nurs. 2024;23:515. doi:10.1186/s12912-024-02177-4
He L, Luo Y, Chen J, Gong R, Liao D. The knowledge, attitude, and practice of nurses regarding trauma-informed care for traumatic injured patients: A multicenter cross-sectional study. J Nurs Manag. 2025;2025:2449177. doi:10.1155/jonm/2449177
Ho SS, Sosina W, DePierro JM, et al. Promoting resilience in healthcare workers: A preventative mental health education program. Int J Environ Res Public Health. 2024;21(10):1365. doi:10.3390/ijerph21101365
Sim JC, Lee D, Park J, Im SY. Can fostering posttraumatic growth prevent burnout and promote resilience in future nurses? Front Public Health. 2025;13:1665351. doi:10.3389/fpubh.2025.1665351
