The concept of secondary traumatic stress (STS), also called compassion fatigue, is not new in nursing, but the pandemic has only exacerbated it. COVID-19 care can be like a “war zone.” The stressful, fast-paced environment of acutely ill patients with complex, multisystem care needs — in addition to patients’ and families’ unprecedented suffering and need for emotional support— add to the situation. Plus, the lack of certainty, lack of resources and constant change with so many ethical dilemmas make it clear that the pandemic has caused unprecedented caregiver trauma.

Nurses’ compassion and empathy can become exhausted — physically, mentally, spiritually and even economically. Nurses must know how to identify STS and utilize well-being strategies to be healthy caregivers.

What Is STS?

STS is a condition that results from the stress of caring for a traumatized individual. A traumatized person (or animal) is one with significant physical or emotional pain and suffering. The condition is often also understood as variations of compassion fatigue or PTSD (post-traumatic stress disorder). According to research, it may be “vicarious traumatization” or “secondary traumatization.” STS differs from burnout, but the two can co-exist.

In nursing, the condition results from a combination of profound physical, emotional or spiritual distress from caring for patients who have considerable distress in various forms. It is trauma, and just because it is called secondary does not mean it is insignificant.

How Common Is STS Related to COVID-19?

No matter where they live or practice, all nurses continue to be impacted by COVID-19, especially those where infection rates are high. The International Council of Nurses COVID-19 Update report from January 2021 describes the “mass trauma experienced by the global nursing workforce.” It cites significant stress, anxiety, trauma and burnout among nurses working in various countries and continents.

In the U.S., one survey published in December 2020 found that of almost 1,200 healthcare workers, 93% of caregivers experienced stress and 76% reported exhaustion and burnout. The American Nurses Foundation continues to follow nurses’ mental health and wellness. Its first survey of approximately 11,000 nurses showed that 60% reported difficulty sleeping or sleeping too much, and 38% stated they were overeating.

How Do You Recognize STS?

Nurses need to recognize STS in themselves and their colleagues. The first thing to note is often the desire to isolate or detach from others. STS can have a set of symptoms, including physical, emotional, and workplace-related ones:

  • Physical: sleep disturbances, memory or concentration issues, headaches, fatigue, gastrointestinal symptoms and other signs of stress
  • Emotional: oversensitivity, anger, outbursts, anxiety, depression, mood swings, irritation, resentment and more crying over patient’s condition
  • Workplace: blaming others, reduced patient compassion, dreading work, us-versus-them mentality

Nurses may experience intrusive/recurring thoughts, flashbacks or recurring nightmares. They may use unhealthy coping skills, including substance abuse.

How Do You Fight STS?

There are a couple of ways to address STS. Here are some to get you started:

The COVID-19 pandemic and the drastic changes in healthcare delivery have caused many nurses to question their ability to provide holistic, compassionate care. However, as the world pivots to post-pandemic life, nurses need to re-group and focus on dealing with STS and preventing it in the future.

Learn more about Eastern Michigan University’s online Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) online program.


American Nurses Association:
Pulse on the Nation’s Nurses COVID-19 Survey Series: Mental Health and Wellness
Well-Being Initiative

American Psychological Association: Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized

Ausmed: Identify Stress and Vicarious, Secondary, Indirect Trauma in Nurses

Catholic Health Association of the United States

Compassion Fatigue Aware Project

Good Therapy: The Cost of Caring: 10 Ways to Prevent Compassion Fatigue

GW School of Medicine & Health Sciences: The GW Institute for Spirituality & Health

Healthcare Finance: Healthcare Workers Experiencing Burnout, Stress Due to COVID-19 Pandemic

International Council of Nurses COVID-19 Update

Johnson and Johnson Mental Health & Well-Being

Lippincott Nursing Center: Nursing on Empty: Compassion Fatigue Signs, Symptoms, and System Interventions

Nursing Centered: I Left Nursing Because of Secondary Traumatic Stress

Ons Voice: Practice These Five Self-Care Strategies in Less Than Five Minutes

Psychology Today: Mindfulness Practice in 5 Minutes or LessScience Direct: Traumatic Stress in Emergency Nursing: Does Your Work Environment Feel like a War Zone?