We are witnessing a unique and complex occupation trauma affecting the collective nursing profession. These challenges have created a new type of trauma, one Debriefing the Front Lines has trademarked Cumulative Care Taking Trauma®.

Cumulative Care Taking Trauma® is the over exposure day in and day out of abnormal and traumatic events with no time for acknowledgement, discussion, processing and recovery resulting in physical, emotional and spiritual suffering.

Manifestations of Cumulative Care Taking Trauma® include

• Not being able to delineate where one trauma ends and another begins - very common in high acuity specialties 

• Inability to rest, increased anxiety and feelings of continual urgency

• Living in a state of sympathetic activation - leaving you paralyzed in your trauma 

• Feelings of shame, guilt, grief, unworthiness and soul exhaustion that easily spills over into life outside of work - this spillover is most commonly felt within relationships

• Exacerbation, episodes or flashbacks of personal and childhood trauma outside of nursing

• Persistent limiting beliefs - I’m not a real nurse if I don't work in ICU (insert specialty here)

• Paralyzed in the trauma  and you don't know where to start

• Detachment (Reminder: Detachment Is not a measure of professionalism - it is a fast track to secondary trauma)

  Cumulative Care Taking Trauma® is a result of not only this overexposure of abnormal and traumatic events but the systemic factors that contribute to the complexity of the job - unsafe staffing, limited resources, lack of mentorship, verbal abuse, lateral violence. These complex systemic factors further perpetuate Cumulative Care Taking Trauma® resulting in institutional betrayal.

  Institutional Courage® is a term trademarked by the Center for Institutional Courage and is defined as “an institution’s commitment to seek the truth and engage in moral action, despite unpleasantness, risk, and short-term cost. It is a pledge to protect and care for those who depend on the institution. It is a compass oriented to the common good of individuals, institutions, and the world. It is a force that transforms institutions into more accountable, equitable, effective places for everyone.”

  As this scope of trauma changes so must the way we approach post traumatic response recovery. Institutional courage lives in dialogue that you have with your team and colleagues. Institutional courage is creating policy change even though we have “always done it this way.”

• How do you show institutional courage?