In 1945, Dorothy Still, a nurse in the United States Navy, met with a Navy psychiatrist to discuss disturbing symptoms she had been experiencing. Miss Still was one of 12 Navy nurses who had been held prisoner of war by the Japanese military in the occupied Philippines during World War II. For more than three years, Miss Still and the other nurses had provided care to diseased, starving and destitute civilian inmates in a makeshift infirmary at the P.O.W. camp.
In the months after liberation, Miss Still found she often cried without provocation and had trouble stopping her tears. She most likely suffered from what today we could call post-traumatic stress disorder, but the Navy psychiatrist offered no support or solutions. Instead, he called her a “fake” and a “liar.” Nurses, he claimed could not suffer the kind of shell shock from war that sailors or soldiers could.
Mental health experts now recognize that PTSD can indeed affect nurses, both military and civilian. As many as 28 percent of nurses experience PTSD at some point in their careers, said Meredith Mealer, an associate professor at the Anschutz Medical Campus at the University of Colorado, Denver, though health care providers still often struggle to treat it.
“It’s probably improved from Dorothy’s experience, but we still have a ways to go,” Dr. Mealer said.
PTSD, as defined by the DSM-5, the psychiatric professions’ official manual of mental health disorders, can arise after a person has been exposed to a traumatic event, typically involving or threatening death, injury or sexual violence. Someone might experience the trauma first-hand or witness it happening to someone else, learn it happened to a loved one or repeatedly hear details about a violent event. The result can be intrusive symptoms such as unwanted memories, nightmares, flashbacks and overwhelming feelings of stress when exposed to reminders of the event.
The stressful environment of nursing can support many the “triggers and traumas of PTSD,” Dr. Mealer said. “Nurses see people die. They work on resuscitating patients. They try to control bleeding. They have end-of-life discussions. And sometimes they are verbally or physically abused by patients or visiting family members.”
Nurses also often repeatedly hear distressing details that relate to their area of care, said Cheryl Peterson, the vice president of nursing programs for the American Nurses Association.
“There are so many aspects of nursing that could lead to these kinds of events,” Ms. Peterson said. “A nurse who is in the military, or a nurse caring for trafficked individuals. Nurses who are in trauma. Nurses who are in psychiatric care. Nurses caring for opioid addictions. Any one of these individuals has the potential to suffer from burnout or PTSD.”
Although burnout and PTSD both can lead to a state of heightened professional distress, Dr. Mealer said the two conditions are distinct. Burnout typically refers to the emotional exhaustion, depersonalization and feelings of low sense of accomplishment that can arise from overwork and lack of regard.
A recent study in the Journal of Heart and Lung Transplantation found as many as 48 percent of nurses working in a critical care transplant unit met the criteria for PTSD symptoms included upsetting dreams about a traumatic event, difficulty falling asleep, irritability or outbursts of anger, and upsetting memories about the event that arose against the person’s will. Rates of burnout among nurses in some specialties may be even higher.
High rates of burnout and PTSD in the nursing profession are likely to contribute to a high rate of nurse turnover, which ranges from 13 to 21 percent, depending on the region of the country. The south and west are expected to experience continued nursing shortages through 2030, according to a 2012 study in the American Journal of Medical Quality.
“We know PTSD is present, and it drives nurses away from the bedside,” Ms. Peterson said. “We don’t treat nurses very well, and the work environment is very challenging.”
PTSD and burnout are not unique to nurses; doctors, medical students and other health care professionals also suffer relatively high rates compared to many other professions. Organizations including the American Nursing Association and other medical societies are calling for more research into the topic, in the hopes of better identifying who is at risk. Effective treatments are also often lacking.
Dr. Mealer is studying resilience in nurses and said preliminary research is finding that psychological characteristics associated with resilience, such as humor, optimism and social support, can be taught to help nurses cope with the stresses of the job. “We approach resilience as something we can bolster with behavioral changes,” she said.
Such support never came for Dorothy Still or the other Navy nurses who were prisoners of war. She received an honorable discharge from the military shortly after the psychiatrist’s appointment. She married a naval officer and moved home to Southern California. She had three children and eventually returned to nursing. She spoke little of her experience for decades, but she began opening up in the 1990s and agreed to interviews with historians.
When she died in 2001, her family arranged for her to be buried at Arlington National Cemetery. Following the ceremony, the Navy Nurse Corps arranged for a Passing of the Flag in her honor. Although the ceremony is reserved for officers of a certain rank, her successors in the corps respected her ordeal and deemed her worthy of the honor.
Emilie Le Beau Lucchesi is the author, most recently, of “This Is Really War: The Incredible True Story of a Navy Nurse POW in the Occupied Philippines.”