“Secondary Traumatic Stress In NICU Nurses”

What are the most common responses you hear when you tell people about your job as a neonatal therapist? It seems as though I always hear one of two responses. I hear “You get to work with little babies?! Awwww!”  

More commonly I tend to hear “That would be so hard/sad, I could never do that!” I usually respond by saying that, while certain aspects of the job are difficult at times, there is so much good happening in the NICU, which is what inspires me to continue. I think most of us would say that it is a true honor work alongside babies and families during some of their darkest days. However, I think many of us would also attest that the nature of such work has caused us emotional distress at some point in our careers. 

Secondary traumatic stress has been defined as the same characteristic symptoms of PTSD, but resulting from clinicians indirectly experiencing a traumatic event through patients who are directly encountering the stressor (Figley, 1989). While secondary traumatic stress has been well documented in the nursing literature, until recently no study had focused specifically on secondary traumatic stress among NICU nurses. Researchers at the University of Connecticut surveyed members of National Association of Neonatal Nurses (NANN). Participants (n=175) completed the Secondary Traumatic Stress Scale (STSS), and were also given the opportunity to describe their traumatic experiences caring for babies in the NICU. In this sample, 49% of NICU nurses’ scores on the STSS indicated that they have experienced moderate to severe secondary traumatic stress.  Five themes emerged from the qualitative data including what intensified NICU nurses’ traumatic experiences (bad outcomes when the nurse feels attached to the baby and parents, resuscitation of the baby while parents are present, neonatal abstinence syndrome, and abandonment of the baby by parents), parents insisting on aggressive treatment, performing painful procedures, questioning their skills, and the “contagious” grief of the family. Of note, the average years of experience for this sample was 22 years, indicating that many neonatal nurses still experience emotional trauma even after many years of experience.   

Although this study surveyed neonatal nurses, it is reasonable to assume that neonatal therapists are also prone to secondary traumatic stress, albeit with some different themes. Secondary traumatic stress and self-care are not often part of our conversations, and there is an overall paucity of research examining secondary traumatic stress in NICU clinicians.  

Many units have services available to help staff process secondary trauma, such as staff reflection times or grief counselors. As neonatal therapists, we can advocate for use of these services, and utilize them ourselves when needed. Additionally, we can help by supporting and listening to our colleagues who have recently witnessed trauma, and assist in finding outlets for self-care. Overall, more research is needed to more fully understand the traumatic experiences of NICU clinicians, including neonatal therapists, in order to promote better caring for caregivers. 

Beck, C.T., Cusson, R.M., & Gable, R.K. (2017). Secondary traumatic stress in NICU nurses: A mixed-methods study. Advances in Neonatal Care, 17(6), 478-488.

Link to abstract:  https://journals.lww.com/advancesinneonatalcare/Abstract/2017/12000/Secondary_Traumatic_Stress_in_NICU_Nurses__A.9.aspx


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