As frontline healthcare professionals, nurses and midwives work with patients, residents and clients who may experience trauma.

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Being repeatedly exposed to trauma through their first-hand accounts and showing empathetic engagement can trigger vicarious trauma.

Often referred to as the cost of caring, vicarious trauma occurs when, over time, carers such as nurses and midwives start to experience trauma symptoms themselves.

An experienced registered nurse, Nurse & Midwife Support’s Consultant and Stakeholder Engagement Manager Mark Aitken describes vicarious trauma as the psychological, emotional, and physical impact experienced by healthcare workers when, following repeated exposure, they connect and over empathise to the trauma of others.

Traumatic countertransference, where carers unconsciously relate to a patient or client they are looking after, is particularly common among nurses and midwives, Mr Aitken says.

“They’re taking it on [the trauma], they’re absorbing it, it’s impacting them and they’re over empathising and not consciously acknowledging or dealing with it.”

Some of the signs of vicarious trauma include:

• Invasive thoughts of the trauma of someone you are caring for
• Feeling hyper vigilant, numb or a loss of empathy
• Frustration
• Fear and anxiety
• Irritability, disturbed sleep and nightmares
• Problems managing personal boundaries (such as taking on too much work)
• Difficulty leaving work
• Loss of pleasure in daily activities

“Nurses and midwives often engage in the rescuing of people, particularly in emotional situations, because we’re actually trained to fix things,” Mr Aitken explains while considering some of the underlying reasons as to why vicarious trauma develops.

“We don’t often understand boundary setting or the fact when somebody’s telling us they’re distressed that we actually don’t have to do anything about it. The power is in hearing their story and showing empathy, concern and support.”

Mr Aitken stresses that the emergence of vicarious trauma in nurses and midwives is not about blame.

“It’s not about blame or failure. You’re not a good nurse because you don’t understand this. It’s just that the profession we’re in is quite complex and multilayered and often you have to understand the intricacies of it to go ‘I understand what’s going on here’ or ‘I can deal with it or get support’.”

Mr Aitken says nurses and midwives who care for people who have faced significant traumatic experiences such as sexual assault or family violence may potentially be more at risk of developing vicarious trauma. However, he says all nurses and midwives are susceptible if they do not realise what’s going on and do not access appropriate supports.

Nurses and midwives work in a variety of diverse settings where trauma can emerge, he adds. For example, recent bushfires where nurses and midwives supported devastated communities, and nurses working in aged care amid the COVID-19 pandemic.

“It’s situational in relation to whatever trauma is experienced and being experienced and the more prolonged that trauma is, the more at risk people are.”

Mr Aitken says vicarious trauma differs from burnout because burnout, often triggered by work overload and exhaustion, is not fundamentally linked to trauma.

Similarly, compassion fatigue often relates to exhaustion and the toll of caring and showing compassion, rather than trauma.

Mr Aitken acknowledges that nurses and midwives work in challenging and stressful settings that often create a pressure cooker environment. With each of these conditions, he says it’s important to find a circuit breaker and invest in self-care strategies.

“If you want to be there for other people, you have to be cared for and supported yourself.”

Mr Aitken says vicarious trauma can happen to anyone.

On reflection, he believes he experienced elements of vicarious trauma as a young nurse during the AIDS epidemic of the 1980s and 90s.

“There were so many complexities to the AIDS epidemic and on top of that my own friends and peer group were getting sick and dying,” he recalls.

“The impact of that took quite a toll on me and that’s why I eventually studied counselling, because I wanted to have a heightened understanding, awareness and knowledge of what the issues were and what was happening, not only so I could support myself, but so I could support other people.”

Mr Aitken suggests vicarious trauma isn’t generally well understood among the nursing and midwifery professions but that awareness about its importance is growing.

He believes there is a great opportunity for organisations to dedicate more resources to preventing and reducing vicarious trauma among nurses and midwives.

Mr Aitken shares his top 5 strategies to mitigate vicarious trauma.

Embed clinical supervision and reflective practice

Mr Aitken says clinical supervision and reflective practice is vital for all nurses and midwives and that they should have access to it.

“Unfortunately, in most areas of nursing it’s underdone and under-accessed. The reason is multifactorial but key components are the perceived time that it would take and require, giving people time off their regular work to do it, and cost.”

Early intervention

“Once you start to feel you’re not ok or there’s signs of vicarious trauma you actually need to get help and support earlier rather than later,” Mr Aitken advises.

“What we see through both Nurse & Midwife Support and the NMHPV is that nurses seem to ignore their issues until they become full-blown or they relate to a health impairment.

“Nobody wants that because it’s bad for everyone. We encourage health promotion, engage in those activities that fill your cup and make you feel better, like your own self-care and wellbeing.”

Support

Mr Aitken says support is key, especially from organisations, managers and leaders. It starts with governance and building a culture that supports staff health and wellbeing.

Workload management

Nurses and midwives work in fast-paced, challenging and complex environments. Mr Aitken believes there needs to be a shared understanding of situation awareness surrounding this and creating permission for nurses and midwives to say ‘I’ve had some really challenging patients for the last five days, after today I’m going to have a few days off, I just need a circuit breaker, can I have a reduced load?’

If work arrangements are flexible, nurses and midwives can do something else rather than interacting with patients, such as training, education or quality work.

Practice self-care strategies

Mr Aitken says nurses and midwives need to practice self-care strategies and find what suits them best.

“It’s about what works for you to make you feel good about life. Refreshed, restored, re-energised, and renewed.

Key elements typically include good nutrition and hydration, sleep, rest, exercise, and socialising.

Nurse & Midwife Support provides free and confidential support 24/7 to nurses, midwives and students Australia wide. If you’re experiencing vicarious trauma and would like to speak to someone call 1800 667 877 or visit www.nmsupport.org.au