Career advice

Burnout in nurses: coping with trauma and when to seek help

An RCN Nurse of the Year describes how work pressures combined with a traumatic event led to her experiencing PTSD – and how she learned to prioritise her well-being

An RCN Nurse of the Year describes how work pressures combined with a traumatic event led to her experiencing PTSD – and how she learned to prioritise her well-being

A nurse in scrubs sitting on the floor looking exhausted
Picture: iStock

In April 2022, I was a paediatric NHS nurse and in a bad place emotionally.

I was extremely anxious, felt unable to cope and was having nightmares. I was also experiencing what I now know are flashbacks.

Culture of stoicism left us with no time to repair ourselves

A series of traumatic events had led me to this point, then an incident with a young patient tipped me over the edge and I realised I needed help.

During the pandemic, I worked non-stop and, like many nurses, I went into survival mode to cope with the immense pressures we were under.

‘We took on everyone’s pain and suffering. With no family allowed at bedsides, we held the hands of dying patients, made everyone comfortable and carried their fear for them’

The NHS was struggling before COVID-19, with many of us already feeling the strain from lack of funding and resources, and inadequate staffing levels.

We were already a little broken – then the pandemic hit and the pressure on healthcare workers to prioritise patients and sacrifice themselves was heightened.

We took on everyone’s pain and suffering. With no family allowed at bedsides, we held the hands of dying patients, made everyone comfortable and carried their fear.

Normally, when a traumatic event happens, we would have the opportunity to seek help and repair. But for most of us, there was no time to recover from the trauma. A culture of stoicism and the expectation to ‘just get on with it’ kept many of us from even asking for help.

Our jobs are challenging and we learn to cope in a variety of ways, whether it is a drink in the pub for peer support, going for a walk or doing sports or hobbies. But the pandemic had taken away a lot of my coping mechanisms and I was starting to struggle.

Then I was involved in an incident on a paediatric ward where a vulnerable young patient with significant mental health issues tried to take their own life.

Although I managed to get to the patient in time and they survived, I was the most senior nurse on shift and felt hugely responsible for not spotting the signs sooner and not protecting the patient or the staff who witnessed the attempt.

A lack of control that has haunted me

This event is not unique, and many colleagues will have faced similar circumstances. With child and adolescent mental health services (CAMHS) struggling to keep up with recent unprecedented demand, incidents such as this could become more common, as more young people in acute mental health crises are admitted to paediatric wards.

Though the young patient’s survival is what I needed to focus on, the incident started to affect me more and I was struggling to deal with it. I still find it hard to explain why, but it was the lack of control and the realisation that I could not keep everyone safe.

This is something that has haunted me since the pandemic – that despite all our efforts, we are limited in our ability to help everyone.

Advice on how to help yourself overcome burnout

A few months later, I started to experience symptoms of post-traumatic stress disorder (PTSD), although I did not know at the time that this is what they were. I decided to book myself in to see the trust’s psychology support team – the best decision I have ever made.

Four months on, I am a different person. I have learned to recognise my symptoms, I have more clarity and am kinder to myself. I have also learned that it is okay to prioritise my own health and well-being. Here are some of the things I learned that have helped me do this.

Accept when it is time to stop: One natural reaction when faced with an adrenalised experience is ‘fight, flight or freeze’. The suicide attempt of a young patient had a huge impact on me and caused me to freeze. Knowing what I do now about PTSD, I realise that my mind decided that I had reached my limit with trauma, so I did not process the event.

Not processing it correctly meant my memories remained in an emotional stage, which led to acute stress – but instead of stopping, I worked harder. I did not think I had the right to be so affected by this when other people were suffering more. I didn’t work in intensive care, none of my relatives had died, and the young person had survived, so I thought I should be fine.

The shame and guilt I felt pushed me to work more hours and pick up more projects, and I thought that by working harder I could distract myself from intrusive thoughts. But after a lot of work with psychological support services, I have realised that I cannot carry everyone’s pain. We need to recognise that there is a limit, and that to look after other people, we have to look after ourselves.

Ask for help: Reach out to your GP, colleagues, family and friends – they are there for you.

My GP was kind, my managers were supportive, and my sister helped me find an eye movement desensitisation and reprocessing (EMDR) therapist who supported me to process the traumatic event. This is the only reason I can speak about it calmly now.

My friends were also there when I needed them, but it was still tough.

Don’t feel ashamed: Vulnerability is not weakness, yet there is still judgement and shame related to taking time to look after yourself.

I felt ashamed about needing to take time off work and felt like a failure, but my GP helped me realise that I shouldn’t feel shame.

This is something I have to work on every day, with the help of the psychological support services I accessed. Their support also helped me to navigate the complexity of the services available to us.

Get a hobby: I was told to try and relax, but how? I could not remember what I did before work took over my life. What did I like to do? I used to belly dance. I used to read. I used to see friends and make people laugh. But then I did nothing but work for four years – more than 60 hours a week on average. When I had a spare moment, I would feel guilty about relaxing.

When I was told to nurture myself, I laughed. ‘But I do nurture myself – I love being a nurse,’ I said. ‘No,’ said my therapist, ‘It’s time to treat yourself.’

Physical relaxation was the hardest. I did a lot of exercise at first, but that triggered my flashbacks as adrenaline was linked to many of my traumatic experiences. You have to work through these flashbacks and I was taught to keep doing exercise but to mix it with more relaxing activities, such as swimming, yoga or walking.

I was also told to deep breathe – I couldn’t at first, so I forced myself to attend the London Buddhist Centre, which offers free breathwork sessions. It was such a safe and welcoming space. When I felt so raw and vulnerable, this was revolutionary.

Though I am still trying to find the old me, eventually I found the strength to see people again. I saw friends who I knew I could be myself with, went for long walks, and as I got better, I started to read again. But all of this had to start with me recognising that I needed help and needed a break.

Educate yourself: I wanted to hide and pretend that what I was experiencing wasn’t happening, but I couldn’t. A book that resonated with me is Burnout: The Secret to Unlocking the Stress Cycle. It made me realise that I wasn’t alone and opened the door to me accepting the decision to take a break from work, look after myself properly, and start to move forward with my life.

I have since read other books and listened to a number of audiobooks about burnout and stress, which has helped me understand these feelings. I have also started to meet other colleagues who have experienced similar symptoms, which has helped me feel less alone.

Prepare your imaginary self-care bag: Equip yourself with items or activities you can pull out of your ‘bag’ when things get tough.

In my bag I have taking a break from social media, socialising with friends and family, a podcast, gardening, exercise, a book and a hug – and definitely no work emails.

Find your kind inner voice: My inner voice wasn’t kind. I felt immense shame for having PTSD, weak and embarrassed that I had not coped.

My compassion wasn’t strong enough, I wasn’t a good enough nurse, I told myself. I am the daughter of an emergency department nurse who worked for 42 years in different countries, and here I was, only seven and a half years in and broken.

But this negative, mean inner voice needed to be recognised as just that – a voice I could switch off. I needed to be kinder, so I had to pick someone else to listen to. Surround yourself with people who will be kind to you, and give yourself time. Taking a break from work enabled me to realise that I was a priority and that to care for others, I needed to care for myself. This is something I have to work on every day.

Some days are harder than others, so when it gets tough, I impose strict rules on myself: no phone, no social media. I need to disconnect in this way to reconnect with myself on a kinder level.

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