Don’t hesitate to ask for help
If you can’t stop thinking about a particular case, you have to acknowledge the problem and seek help, urges Billie Z. Lawson, MSW, ACSW, associate director of the social work department at Harborview Medical Center in Seattle. "If you are feeling overwhelmed, there has to be somebody designated whom you can call any time of day or night and talk about it," she advises. "These things don’t just go away."
Here are ways to cope with secondary trauma:
• Talk to someone.
If you feel overwhelmed, reach out to someone you feel comfortable with, advises Alice Kramer, MS, RN, CEN, clinical nurse specialist for emergency services at St. Luke’s Medical Center in Milwaukee. "If the hospital doesn’t have an employee assistance program or counseling, you might want to talk to your manager or a clinical nurse specialist," she says. "Your facility should acknowledge the effect of occupational stress and address it appropriately."
Also, your hospital should be prepared to manage secondary trauma on a large scale, if there is a community disaster or a single case that is especially traumatic, notes Kramer.
• Ask for a critical incidence stress debriefing.
EDs should develop a program through clinical nurse educators or employee assistance, Lawson says. "So, if any individual nurse finds themselves overwhelmed by a particular case, they can debrief at the end of that shift."
The St. Luke’s ED has a crisis team consisting of a group of ED nurses, a clinical nurse specialist, and social workers who are specially trained in critical incidence stress debriefing, Kramer reports.
"In our system of several hospitals, this is a team that can be brought in within the first 48 hours of a traumatic event," she says. "We do an immediate debriefing of anyone involved."
• Don’t live in denial.
As an ED nurse, you are bound to be affected by the trauma around you, says Kramer. "You need to realize working in this kind of environment is going to transform you, and there’s no getting around that," she explains. "That’s not a bad thing — it makes you more knowledgeable and deepens your empathy."
However, to ignore or minimize the negative impact is not good, Kramer explains. "You are seeing violence and cruelty, but you also see compassion and heroism, which can be wonderful and uplifting," she says. "That’s the exciting thing about being an ED nurse. You just need to be aware and take care of yourself."
You might tend to say, "I don’t need a critical incidence stress debriefing. That happened three patients ago, and it didn’t bother me at all." But that attitude isn’t always healthy, says Lawson.
There should be some flexibility in terms of scheduling and who is going to take the next case, Lawson recommends. "Nurses need to be able to say, I need a little less exposure right now,’ without recrimination."
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