By Dr. Paul Kelly, C.Psych. | Founder & Clinical Director, Nurse Wellness Program | May 16, 2026
It’s not something that happened to you. It’s something you witnessed — over and over, shift after shift, in one of the most intense clinical environments in medicine.
The baby who didn’t make it. The family receiving news that changed their life in the few minutes you spent with them. The code that you ran and ran until it was over. The grief on a mother’s face when the periviable birth went the way everyone feared it would.
Secondary traumatic stress (STS) is the trauma response that develops not from a direct traumatic event, but from sustained exposure to others’ traumatic experiences. It is common among NICU and ICU nurses — and it is frequently neither recognised nor named by the nurses experiencing it, because it doesn’t fit the cultural template of ‘real’ trauma.
This article explains what STS is, why it develops in critical care environments, what it looks like in practice, and what stabilisation and treatment involve.
Table of Contents
- What secondary traumatic stress is — and isn’t
- Why NICU and ICU nurses are particularly vulnerable
- What STS looks like in practice
- What stabilisation and treatment involve
- When to seek professional support
What secondary traumatic stress is — and isn’t
Secondary traumatic stress was formally described by Charles Figley in 1995 as ‘the natural consequent behaviours and emotions resulting from knowing about a traumatising event experienced by a significant other.’ It is sometimes called compassion fatigue, though the two concepts are technically distinct — STS refers specifically to the trauma response component, whereas compassion fatigue is a broader syndrome that includes STS alongside burnout and other elements.
STS is closely related to post-traumatic stress disorder (PTSD) in its symptom profile. The diagnostic distinction is in the mechanism: PTSD typically requires direct exposure to traumatic events or a direct threat to one’s own life or safety, while STS develops through witnessing or being aware of others’ traumatic experiences.
For NICU and ICU nurses, this distinction is both clinically important and personally validating. You are not ‘being dramatic’ about someone else’s trauma. You have been working in an environment of sustained, concentrated traumatic exposure — and your nervous system has responded accordingly.
Secondary traumatic stress is a recognised clinical phenomenon with a specific symptom profile, evidence-based treatment approaches, and a clear neurobiological mechanism. The fact that the trauma was not your own does not diminish the validity or the severity of the response. Repeated, intensive exposure to others’ suffering is genuinely traumatising — and critical care nursing involves exactly that kind of exposure, reliably and at scale.
Why NICU and ICU nurses are particularly vulnerable
Several features of critical care nursing create elevated risk for STS, beyond what most other healthcare contexts involve.
Sustained, not episodic, exposure. Unlike many other clinical roles, NICU and ICU nurses don’t encounter traumatic events occasionally. They encounter them regularly, across 12-hour shifts, over years of practice. The cumulative exposure is substantial, and it increases risk markedly compared to shorter or less intensive clinical contact.
Deep relational engagement. Critical care nurses often develop meaningful connections with patients and families across extended admissions. The traumatic events they witness are not happening to strangers — they are happening to people the nurse has come to know. This relational dimension intensifies the traumatic imprint.
High-fidelity sensory encoding. Traumatic memories are disproportionately encoded in vivid sensory detail — the sounds, smells, visual images, and physical sensations associated with the event. In critical care environments, these are intense and specific: the sound of a particular alarm, the smell of a unit, the visual memory of a specific resuscitation. These sensory details become powerful triggers.
Absence of post-event processing. In most critical care units, nurses return to active patient care immediately after traumatic events. There is no structural opportunity to process what just happened before the next demand arrives. This means the traumatic material is compressed and stored without adequate consolidation, which increases the likelihood of intrusive re-experiencing.
What STS looks like in practice
Secondary traumatic stress in nurses often presents in a cluster of recognisable patterns. Not all need to be present, and severity varies significantly.
Intrusive re-experiencing. Specific images, sounds, or fragments from clinical events that appear unbidden — in quiet moments, while trying to sleep, in unrelated everyday situations. These are not ordinary memories. They arrive with an immediacy and emotional intensity that is qualitatively different from normal recall.
Hypervigilance and heightened startle response. An exaggerated alertness that persists outside of work — a heightened sensitivity to sounds similar to alarms, a difficulty relaxing or feeling safe, a generalised sense of being ‘on guard’ that doesn’t switch off between shifts.
Avoidance. Subtle or explicit avoidance of reminders — specific patient types, conversations, clinical areas, or even news stories that activate the traumatic material. Avoidance is adaptive in the short term; it becomes problematic when it begins to restrict functioning.
Emotional numbing or shutdown. A progressive blunting of emotional response, sometimes described as ‘I know I should feel something, but I just don’t.’ This is a dissociative-spectrum response to overwhelming emotional content — the nervous system’s protective mechanism.
Sleep disruption with trauma content. Nightmares or disturbing dreams with clinical content, or difficulty initiating sleep because of intrusive imagery. This is distinct from ordinary shift-work insomnia.
Somatic symptoms. Physical manifestations of the stress response — GI disturbance, headaches, chronic muscle tension, fatigue that exceeds what sleep debt alone would explain.
What stabilisation and treatment involve
Secondary traumatic stress responds well to treatment when it’s appropriately identified and addressed. The approach is staged: stabilisation before any direct processing of traumatic content.
Phase 1 — Stabilisation
The goal in the first phase is to reduce the intensity and frequency of intrusive symptoms enough that the person has sufficient psychological stability to engage in processing. This phase involves:
- Psychoeducation — understanding what STS is, why it’s happening, and that it is a normal response to an abnormal exposure load. This reframe alone reduces shame and normalises help-seeking.
- Grounding techniques — evidence-based approaches for reducing the intensity of intrusive symptoms in the moment. Eyes-open orienting (naming five things you can see, four you can hear, three you can touch) activates the prefrontal cortex and reduces the amygdala’s threat response. These are brief, practical, and can be used on shift.
- Containment — the deliberate use of imagery or writing to create a temporary ‘parking space’ for distressing content. ‘I can think about this later, when I have support.’ Not suppression; intentional deferral.
- Sleep protection — because sleep deprivation dramatically worsens all trauma-related symptoms, stabilising sleep is often the highest-priority early intervention.
Phase 2 — Processing
Once stability is sufficient, processing the traumatic material using evidence-based trauma approaches — EMDR, Cognitive Processing Therapy (CPT), or trauma-focused CBT — allows the traumatic memories to be integrated rather than continuing to intrude. Processing does not mean erasing or forgetting; it means changing the relationship to the memory so that it no longer arrives with the same urgency and intensity.
Phase 3 — Reconnection
The final phase involves reconnecting with meaning, purpose, and relational support — the dimensions of professional life that STS most erodes. This includes narrative work, values clarification, and rebuilding the sense that the work, despite its costs, can still be a source of meaning.
When to seek professional support
STS that is unaddressed tends to worsen over time. Consider reaching out if:
- Intrusive images or memories from specific clinical events are occurring regularly and are difficult to control
- Your sleep is being disrupted by clinical content — either difficulty initiating sleep or disturbing dreams
- You’ve noticed emotional numbing, or a significant reduction in your capacity to feel engaged or present
- Hypervigilance or a heightened startle response is persisting outside of work
- You’re avoiding specific reminders — patient types, conversations, or situations — in a way that is restricting your work or your life
- You’re experiencing physical symptoms that don’t have another adequate explanation
Important: start with stabilisation, not detailed retelling.
If you seek support for secondary traumatic stress, it is important that your therapist begins with stabilisation before any detailed processing of specific events. Recounting traumatic material without adequate stabilisation can re-traumatise rather than heal. A trauma-informed therapist will sequence the work appropriately. This is a key question to raise in an initial consultation.
The Nurse Wellness Program therapists are trained in trauma-informed approaches and understand the specific clinical reality of secondary traumatic stress in critical care nursing. The program begins with stabilisation, adapts the pace to your current capacity, and moves toward processing only when the foundation is adequate.
Secondary traumatic stress responds well to the right support.
Connect with the Nurse Wellness Program at The Mindfulness Clinic.
