Women are more likely to suffer PTSD. What does that mean for nurses?

Posttraumatic stress disorder is commonly associated with combat, and men are traditionally the ones to fight a nation's wars. It's only natural to assume that more men than women would experience PTSD, though science tells us the opposite is true. Women are two to three times more likely to have PTSD than men, which leaves nurses particularly vulnerable. Not only do women make up nearly 91 percent of the nursing profession, but also the battles involved in the nursing experience – military or not – increase a person's risk of PTSD.

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According to a 2007 study publicized in the peer-reviewed Nursing2019 journal, critical care nurses are the hardest hit, due to their repeated exposure to trauma and stress. That study found "24% of ICU nurses tested positive for symptoms of PTSD related to their work, compared with 14% of general nurses. There was no difference in the level of stress outside work for the two groups."

Registered nurse Anne Naulty described what she and her fellow nurses experience in a May 2019 post on the KevinMD blog. "Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time," Naulty said. "As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest."

She described PTSD factors like working a 12-hour shift that turns into 13 and often involves either no breaks or shifting a debilitating workload onto a fellow nurse to be able to take a break. "We also are often asked to float to other areas of the hospital — without training," she added. "This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. ...A cardiologist would not be asked to fill in for a neurologist."

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Naulty went on to describe the insidious creep of the chronic stress that leads to PTSD. "It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as 'another part of the job.' We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again."

Why women have more PTSD than men

Another study published online in the European Journal of Psychotraumatology in 2017 offered insight into why all women, nurses among them, are more likely to have PTSD. The study's author, psychiatrist Miranda Olff of the University of Amsterdam, focused on three areas that may account for the prevalence of female PTSD sufferers:

Type of trauma. Women tend to be exposed to more "high-impact trauma (e.g. sexual trauma) than men, and at a younger age," the study emphasized. "Trauma early in life has more impact, especially when it involves type II trauma interfering with neurobiological development and personality. Traumatic stress affects different areas of the brains of boys and girls at different ages."

Psychobiological reactions and effects of oxytocin: "Although only 2% of psychobiological research has been conducted in females (mainly rats), sex differences have been shown. Women appear to have a more sensitized hypothalamus-pituitary–axis than men, while men appear to have a sensitized physiological hyperarousal system. PTSD has consistently been associated with amygdala hyperactivity."

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Nurses and PTSD: What needs to happen next

Olff also used her research to make a broader point: "To date, we are still behind in gender- and sex-sensitive research and reporting," she explained in the study abstract.

Hospitals and the greater American approach to health care are also stalled in seeking a solution to nurse PTSD, according to Nault. She called out the entire health care system on its participation in creating nurse PTSD. "Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called posttraumatic stress disorder."

How women cope with stress: "In the acute phase, women generally score higher than men on acute subjective responses, e.g. threat perception, peritraumatic dissociation and known predictors of PTSD," the study explained. "Women handle stressful situations differently and have evolved differentially to support these different behaviours. For instance, women in stressful situations may use a tend-and-befriend response rather than the fight-or-flight response that is often assumed."

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Like many individual nurses, Naulty is hyper-aware of the momentous shifts that would be required to combat PTSD for nurses. "Nurses need support from our hospitals, our government officials and our communities," she said. "We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves...We need to be able to process all of the emotions that we feel that have always been discarded as 'part of the job.' We need to talk about our issues, and we need to feel like we are being heard."

In short, said Naulty: "We need to heal."