Mass Shootings’ Effect on Nurses’ Mental Health

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Paramedic nurse checks a patient with a chest wound

In October 2015, the Emergency Nurses Association held its annual conference in Orlando, Florida, during which presenters shared their thoughts on leadership and management, discussed advocacy strategies and participated in advance practice seminars. While a few of these sessions addressed mass casualty and mass disaster scenarios, none of the attendees could have predicted that just a few months later, a nearby nightclub would become the site for the deadliest mass shooting in American history.

Even though mass shootings dominate public discourse, conversations about the traumatizing effects of these attacks — and more generally gun violence — on first responders like nurses are uncommon.

Read on to learn more about:

How does gun violence affect nurses?

Although emergency nurses and physicians do their best to avoid thinking about the gut-wrenching scenarios that lead to patient injuries, studies have found that some can get “vicarious traumatization” from their constant contact with trauma.

In essence, a patient’s traumatic event can become a part of a health care providers’ own life. These triggers happen more often than RNs or MDs on trauma teams like to admit, experts say. Ultimately, treating gun violence can leave unforgettable impressions on those working in health care. Patients arrive at hospitals with bullet wounds from semiautomatic weapons like AR-15s and AK-47s, the sort of weapons that destroy bones, blow off limbs and leave patients permanently paralyzed.

In the past, hospitals possessed limited knowledge and conducted little training for these kinds of events, but as violence has escalated, there has been an ever-greater need to understand these kinds of injuries and civilian casualties. Health care leaders have gone as far as saying mass shootings are not a matter of if, but a matter of when.

Yet, those working in emergency rooms who experience post-traumatic stress disorder (PTSD) tend to avoid treatment, even though the longer they remain in the ED, the higher the rate of those symptoms.

In a June 2016 article, Modern Healthcare found that despite increased efforts to prepare for active shooter scenarios, no hospitals have programs that address the emotional toll and exposure nurses and other employees face when dealing with everyday gun violence.

Beyond the terrible emotional toll this almost omnipresent violence takes on health care providers, gun violence also has staggering economic consequences for hospitals and the American population as a whole.

In a May 2015 report, Mother Jones concluded that each gun death costs about $6 million, with the total annual cost of gun violence coming out to nearly $230 billion. With some trauma centers, like Chicago’s Stroger Hospital serving close to a thousand gunshot victims each year, it’s not difficult to see how the costs add up.

Community-violence prevention programs: a solution?

Anti-violence programs have been a part of major metropolitan cities as well as small rural towns for years. Advocacy groups, police departments and other governmental agencies have long engaged in strategies to curb violence, especially in the inner city. But more recently, some organizations have suggested that hospitals, and primary care providers like nurses in particular, have a role to play in improving community life as well.

These programs argue hospitals should be doing more for victims of violence than treating wounds and handing them off to a local community agency. The Center for Disease Control and Prevention and countless other groups acknowledge that gun violence is a public health crisis. Therefore, they believe a public health response is necessary to fully combat the problem.

These types of programs are based on three basic tenets:

  1. The most accurate predictor of violence injury is if an individual has already experienced a violence injury.
  2. Experiences in trauma rooms can trigger epiphany-like moments where the victim may listen to those calling for life changes that would otherwise be ignored
  3. Specially selected case workers — sometimes called violence interpreters — from the local community can build rapport that may not be possible with an overworked, office-based social worker employed by most hospitals.

CeaseFire, a Chicago-based organization that partners with hospitals to help end the cycle of reactionary street violence, estimates that 80 metropolitan areas could use these types of programs based on their per-capita rates of intentional violent injury. However, only eight programs exist now, and many are at risk of losing funding because only limited research has been conducted on their effectiveness.

Advocates argue hospitals and nurses should be doing more to understand why patients end up back in the hospital with critical wounds. Just as it would be almost unthinkable today to discharge a victim of domestic violence into an abusive home without any sort of help, community violence programs are hoping to gain the same sort of acceptance from hospitals when they release patients back into their community.

Organizers also hope these efforts will reduce the chronic health care costs that emerge because of previous exposure to violence. For example, research has shown that adverse childhood experience can lead to lifelong chronic health problems like high blood pressure and poor insulin regulation because the body is kept in a near constant state of hypersensitivity.

What does the future hold for nurses?

Despite reports of falling crime rates, homicide remains the leading cause of death for black males ages 15 to 24. The most recent data from the CDC also shows that the per-capita rate of death by homicide for young adults is at its highest in at least eight years, and an article in the New England Journal of Medicine found that an average of 88 Americans die each day from firearm violence.

Nurses are in a position to help influence discourse for this enormous public health challenge and make strides to improve safety and education through a variety of channels. Some have suggested nurses and doctors should talk more with patients about whether they have guns in their home and what precautions they have to maintain safety, much in the same way patients are already asked about seat belt use and the number and placement of smoke detectors in their home.

Others have argued more programs are needed to address violence as a whole in the U.S., including those related to bullying and spousal abuse. Eliminating the stigma around mental health and providing better insurance options may also help reduce gun violence.

What isn’t working however, is a strategy that avoids these personally sensitive topics, whether they occur between nurses and patients or on trauma teams as a whole. More awareness between nurses and their team members can reduce feelings of isolation and detachment that lead to needless hostility and confusion. And perhaps, more conversations and greater involvement with patients after they leave the hospital can help reduce the cycle of violence.

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