The COVID-19 pandemic may be pushing physician stress and fatigue to new heights. Yet the issue itself isn’t new – especially among critical care providers.

Research over the past 20 years has shown that up to 66% of intensivists in neonatal and pediatric intensive care settings experience some symptoms of secondary traumatic stress (STS), which refers to the cumulative emotional toll derived from helping others who are experiencing crisis, trauma or suffering. STS has been conceptualized as closely related to the experience of compassion fatigue, and the terms are sometimes used interchangeably.

The experience of stress can be healthy and adaptive because it jolts us into action, according to Dailyn Acosta, Ph.D., a licensed psychologist serving the Level IV Neonatal Intensive Care Unit at Children’s Health℠ in Dallas and Assistant Professor at UT Southwestern. “Human beings aren’t designed to experience high levels of stress over long periods of time. Finding ways to break the periods of stress can make a tremendous difference.”

Every day, Dr. Acosta sees the impact working in an intense environment has on providers – and she’s eager to share insights and tips that can help mitigate the strain.  

Recognizing the signs of compassion fatigue

Stress affects people differently and there’s no single indicator of when a manageable amount of stress will tip into STS. Noticing when feelings and behaviors deviate from their baseline is a good rule of thumb. STS can affect people in several ways:

• Emotionally – guilt, anger, sadness, numbness or helplessness
• Cognitively – difficulty concentrating on tasks, preoccupation with details, or apathy
• Behaviorally – withdrawing from relationships at home and the workplace, absenteeism, lower productivity

Increased heart rate and medical issues, changes in sleep and eating habits, and the inability to stop thinking about negative experiences and feelings are also common issues associated with STS. Over time, these feelings and behaviors can affect the individual, the level of care they provide and the health care system they work in.

Strategies that work

Understanding emotions and practicing some straightforward coping techniques are surprisingly effective at mitigating the cumulative impact of working in a trauma-heavy setting.

“People tend to label what they feel as positive or negative, and back away from negative emotions. But the idea that acknowledging negative emotions leads to burnout is wrong. Being able to feel emotions in your work and feel compassion in the work you do is actually protective against the experience of secondary traumatic stress,” says Dr. Acosta

Just knowing that emotions – even ones of extreme duress – don’t last very long can be profoundly beneficial, as can taking a few moments to disconnect. Dr. Acosta suggests trying guided meditation, some deep breathing or another activity to emotionally reset.

Being intentional about what you do and why you do it is also protective against secondary traumatic stress. Dr. Acosta recommends:

• Focusing on what you can control: Create healthy routines, practice gratitude, and find ways to experience joy in and outside of work.
• Re-connecting to the meaning of your work: Lean into the value and purpose of your work.
• Engaging with your emotions in a mindful way: This includes observing yourself and naming what you are feeling or doing, without judging yourself or trying to control your experience. For example, if you are perseverating on a difficult situation, awareness and acceptance of those difficult thoughts and emotions are a good starting point for breaking the loop.
• Avoiding isolation and prioritizing relationships: Connecting with others – at work, socially, emotionally and spiritually – is an important buffer to stress.
• Connecting with nature and activities that bring joy: Doing things you enjoy provides balance and lets your system reset.
• Practicing mindfulness and meditation: Check out apps like Headspace, Insight Timer and Calm.

Stigma impedes action

Mitigating STS is important because of its significant impact on individuals and health care organizations. At the system level, it results in increased absenteeism, staff turnover and medical errors, as well as decreases in the quality of care, the quality of patient/physician interaction and overall patient satisfaction.

Yet many physicians shy away from acknowledging the emotional toll of their work due to concerns about how they’ll be perceived in the workplace.

“Even within the medical field there’s still a lot of stigma around mental health. We’re making leaps and bounds in this area, but the tendency to separate the physical aspect of the human from the emotional is still strong. These things are interrelated, and can’t actually be separated,” says Dr. Acosta. “Normalizing the need to address the emotional impact of working in high-intensity settings will help providers feel more comfortable addressing it.”

Our Level IV NICU team is dedicated to the emotional and physical health of patients, families and team members. Learn more about our team and program.