If you work in mental health, you know the job isn’t just about diagnostics and medication. You’re often guiding patients through their darkest moments on a daily basis. For psychiatric and mental health nurse practitioners (PMHNPs), this comes with a hidden cost: secondary traumatic stress (STS). A recent qualitative study offers insight into how it’s affecting nurses and why we should all pay attention.
Read the study here: Secondary Traumatic Stress and Coping Experiences in Psychiatric Nurses Caring for Trauma Victims: A Phenomenological Study
The study, published in the Journal of Psychiatric and Mental Health Nursing, examined the experiences of 18 psychiatric nurses navigating STS in a public hospital in Turkey. Through semi-structured interviews, researchers identified common emotional reactions, coping mechanisms, and institutional barriers that mirror what many psychiatric NPs report anecdotally. While the setting was international, these experiences are universally familiar.
What Does Secondary Trauma Look Like?
Nurses described absorbing the emotional intensity of their patients’ trauma to the point of personal distress. They experienced symptoms ranging from chronic anxiety and restlessness to flashbacks and difficulty sleeping. Many described a sense of powerlessness, especially when systemic limitations prevented them from offering the care they felt patients truly needed.
Coupled with the emotional toll it takes on victims, secondary traumatic stress lends itself to the broader issue of burnout. We talk a lot about workload, documentation burdens, and staffing ratios. Equally corrosive is the emotional labor of holding space for other people’s pain without enough time or support to process your own. This erosion of emotional bandwidth can be easy to dismiss as just part of the job. But over time, it can undercut both personal wellbeing and clinical effectiveness.
Several participants described trouble detaching from work, ruminating over patient stories long after their shift ended. Some reported becoming emotionally withdrawn in their personal lives. Others said their empathy felt dulled over time, as if their internal resources had simply run out. All of these reactions are part of the emotional residue that comes from bearing witness to another’s trauma. And in psychiatric care, that’s part of the job description.
Why It’s So Hard to Talk About
One of the most compelling takeaways from the research was how rarely these nurses felt safe expressing their struggles. Despite working in emotionally intense environments, many participants described a professional culture that discouraged vulnerability. Sharing emotional struggles was often perceived not as a normal response to difficult work, but as a potential sign of weakness or even professional incompetence.
Psychiatric NPs may recognize this pattern. During training, supervision and mentorship are built in, along with the support that comes from these figures. After certification, however, you’re often expected to “just handle it.” That mindset can leave even the most experienced clinicians feeling isolated.
Even when nurses wanted to engage in reflection or seek support, they faced the harsh reality of time scarcity. Packed schedules, staff shortages, and constant demands made it difficult to prioritize their own wellbeing. The result is a cycle in which secondary trauma accumulates quietly, largely unspoken and unsupported.
When Work Follows You Home
When exposure to traumatic stress is part of the job, emotional regulation strategies become necessary to soldier on and keep working. Participants described a range of coping strategies; some constructive, others less so. Some participants relied on peer support, personal therapy, or physical exercise. Others resorted to avoidance, distraction, or shutting down. One participant said that they listened to music for hours on end after stressful shifts until the events of the day faded from memory.
On the other end of the coping mechanism spectrum, some participants admitted that they approached their work with detachment, or avoided showing any emotion at work, instead releasing it at home. Others overworked themselves to the point of exhaustion to distract themselves.
Regardless of how participants chose to cope with STS, a common theme was that many didn’t feel comfortable being fully honest about how much they were struggling, especially in settings where emotional vulnerability was seen as unprofessional or weak. Some of these behaviors may sound uncomfortably familiar. The truth is that many NPs are scraping by, but they’re emotionally exhausted. Without teams and systems that support emotional reflection and recovery, it becomes harder to stay grounded in the work.
Why This Matters for All NPs
If you’ve ever gone home feeling defeated or powerless, lying awake replaying something you witnessed on the job, or wondering if you’re just “too sensitive” for the work, you’ve likely experienced the effects of STS firsthand. What this study shows is that many nurses and NPs are navigating similar struggles, often in isolation. When STS goes unmitigated, the resulting emotional fatigue can cloud judgment or lead to disengagement, directly impacting clinical decision-making and job satisfaction. It’s called compassion fatigue, and it’s a real phenomenon that many nurse practitioners experience.
Talking about this phenomenon is a crucial first step in destigmatizing these struggles. Your ability to stay present and effective with patients hinges on your own emotional health. It can also wear down your empathy, the engine that makes patient relationships meaningful and effective. Often, that human connection is why you chose to enter the field in the first place.
Emotional fatigue also contributes to attrition in the workplace. Several nurses in the study said they considered leaving their jobs or switching specialties because the emotional weight was too much. We talk about burnout a lot on this platform (and if you’re new here, feel free to browse some of our other articles on the topic!), but STS is part of that broader picture. It’s one of the invisible forces shaping why many nurses and NPs are struggling to stay in a field they love.
So, What Can Be Done?
This research sheds much-needed light on a topic that’s hard to talk about, but it isn’t a fix-all. Still, the authors point to some actionable insights at the institutional level that could really benefit mental health and psychiatric clinicians regularly exposed to STS:
Regular, structured support systems can help mitigate emotional overload and provide space for reflection. Organizational cultures that validate emotional experiences as part of clinical practice rather than signs of weakness can make it safer to speak up. Even when this support is peer-led, it can lead to more positive outcomes for PMHNPs and all NPs working in environments where secondary trauma is part of the job.
The researchers also pointed to more formal training around understanding and addressing STS in nursing education as a potential way to address the burden. More attention in training to the emotional realities of mental health care could better prepare NPs entering specialties where secondary trauma exposure is a routine concern.
It’s also worth remembering that just naming this experience matters. If you’ve ever felt drained, haunted by a case, or unsure why your personal bandwidth seems so low, STS might be wearing you down.
Acknowledging and addressing secondary trauma is a is a necessary step towards sustaining the emotional health of compassionate practitioners and deserves greater attention across the profession. As psychiatric and mental health care needs grow, so too does the need for robust support systems and systemic recognition of emotional labor as core components of nursing practice.
Source: Gülirmak Güler, K., Uzun, S. and Emirza, E.G. (2025), Secondary Traumatic Stress and Coping Experiences in Psychiatric Nurses Caring for Trauma Victims: A Phenomenological Study. J Psychiatr Ment Health Nurs, 32: 402-413. https://doi.org/10.1111/jpm.13121
