COVID-19 Creates Vicarious Trauma Among Healthcare Workforce

Ellen Fink-Samnick, discusses how the pandemic is creating trauma among healthcare professionals and what can be done about it.

Editor's note: On July 23, Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP, DBH(s), will present the 60-minute webinar, "Vicarious Trauma: Tackling Occupational Hazards of the Pandemic." Follow this link to register.

This article appears in the September/October 2020 edition of HealthLeaders magazine. 

In a pandemic that has gripped the United States since January, there have been over 3 million confirmed COVID-19 cases to date. With symptoms ranging from mild to death, the virus has left its mark on the nation, and, in particular, on healthcare systems and healthcare professionals as they care for patients with the disease.

As COVID-19 has spread across the country, it has also left the effects of vicarious trauma in its wake.

Vicarious traumatization, also called secondary traumatic stress, is a term coined by Laurie A. Pearlman and Karen W. Saakvitne in 1995. It describes a significant shift in a helping professional's world view when they work with individuals who have experienced trauma. Helping professionals who experience vicarious trauma report that their fundamental beliefs about the world are changed and possibly damaged by repeatedly being exposed to "traumatic material."

"We have a whole interprofessional workforce that is on not only the frontlines, but also in other areas that are not getting as much attention, like primary care clinics and outpatient programming and outpatient clinics where nurses, nurse practitioners, social workers, and different types of case managers and rehabilitation professionals are," says Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, DBH(s), of EFS Supervision Strategies, LLC, a company that provides professional speaking, training, and consultation to empower the interprofessional workforce. "You've got the whole workforce impacted directly by having to work amid so many unknowns."

In a recent interview with HealthLeaders, Fink-Samnick discusses the concept of vicarious trauma, how it affects healthcare professionals, and how to improve the mental health of the workforce.

The following transcript has been edited for brevity and clarity.

HealthLeaders: Can you explain what vicarious trauma is?

Ellen Fink-Samnick: Vicarious trauma is all the emotional "stuff" that comes up when professionals have to deal with the realities of their patients. So, [the patients'] real-life experiences impact us because, at the core of it, we're all human.

For example, I've been a clinical social worker for 37 years and a professional case manager for almost 30. I'm a person first, but I have professional training that helps me keep boundaries and helps me manage normal stress, normal tension, normal anxiety. And then even, I have had to deal with trauma that my clients or patients bring to the party.

But now you've got a pandemic and, every day, we get a different story. Healthcare professionals and behavioral health professionals [are getting] different renderings of when it's safe to start seeing people in person. This not only has a community-based impact; it's global. It impacts us on a profound, personal level. So, we've got this whole element of—what I call and a lot of other experts are calling—shared trauma. You've got the patient, the professional, and the overall population experiencing all of this 24/7. Every practitioner, nurse, social worker, physician—they are worried for their own health. They're worried they're going to bring this home to family members. They're worried they can't see their family members. They are feeling exhausted from it. They're petrified. They're dealing with human emotions because this has gone now beyond just stress; this is full-fledged trauma.

HL: How does vicarious trauma differ from stress and burnout?

Fink-Samnick: When you look at stress, there's all of those factors that we deal with that we feel something about and there's usually some sort of physical, chemical, or emotional factor that causes some sort of physical or mental tension. We worry about job stability normally, right? Perhaps you take a new position. You hope it's going to work out. You hope you're going to pay your next bill. You have a fight with your partner, and it causes some stress the next day. There's normal stress. There's even good stress. For example, you get married or you buy a house.

Trauma then is those experiences that are amped up a notch. They are more intense physical and psychological reactions. They might see a single episode, or it could be multiple circumstances like when we're talking about repeated abuse, neglect, domestic violence, sexual assault, or verbal abuse. People that live in communities that are greatly impacted by crime, poverty, constant unemployment, intergenerational violence, as a result, have this physical, emotional, harmful, long-lasting response to these events.

That's trauma. When you go to vicarious trauma, that's the shared experience.

The standard definition of burnout … the outcome can look the same—poor quality, poor response, total team disintegration.

The other part of it is, healthcare professionals, we have a habit of processing and rolling. We don't take care of ourselves. We barely address stress. We certainly barely address trauma, which is what creates that vicarious trauma response. But now we've got this whole shared trauma dynamic because we're all going through the same fear, the same worry, the same vulnerability together, the same losses together, and people are petrified. And if someone's traumatized, they're going to be burned out.

But this [COVID-19 pandemic] is a collective trauma. It's trauma that's gone viral. Vicarious trauma is trauma on steroids.

HL: What are some strategies to manage vicarious trauma in the healthcare workplace?

Fink-Samnick: First of all, [healthcare professionals] have to give themselves permission to stop. They need to do things like debrief. They need to be able to accept support from each other. It doesn't imply that they're being weak.

One thing they have to do is limit social media. [Try to] engage in more energy-fulfilling activities, which are things like virtual get-togethers, virtual dinners, and virtual happy hours. Don't talk about COVID stuff.

Another example is, someone who I know works in an emergency department of a fairly large hospital, and they had "bring a picture of your pet" day. It's not going to change the reality, but it can help shift the narrative [to something positive] because if we don't shift it, no one's going to do it for us.

Eat well—protein and healthy carbs—and hydrate. Sleep hygiene is a biggie. One of the biggest issues that's happening is people are working multiple shifts and then they are not sleeping. The Sleep Foundation website has tools specific to sleep hygiene. For example, when you're off, you just want to sleep all day. I get that but that's the worst thing you can do. You want to limit those naps and be in a normal routine. You want to keep up with your exercise and avoid things that stimulate you at bedtime; no scrolling through Facebook and getting upset about what's fact and what's fiction.  

The one thing that is not working is bringing in crisis counselors. [Healthcare workers are] not wanting to utilize those resources in the moment. You can refer folks and remind them that they're there, but they need a break. What they don't want to do is sit and talk about it even though it's healthy and cathartic.

HL: What do you think the long-term effects of COVID are going to be on our healthcare workforce?

Fink-Samnick: I think we're going to have a generation with PTSD to deal with amongst our own. I've been worried about it with the uptick of mass violence we were seeing. We're going to have to make sure that there is more acceptance and understanding and less stigma for seeking behavioral health.

It's not a bad thing. This is why there are so many wonderful resources out there being built on virtual platforms strictly for professionals. If we can't attend to our own human condition, we are useless to care for the human condition of others. Mental health is not a dirty word. There's no weakness in acknowledging we need help. We have to use the resources. We have to seek therapy and not rationalize that just because you're in the "business," you know what to do. That doesn't give you the objectivity or certainly the skills and expertise to do it. There are wonderful short-term interventions.