Vicarious Trauma and Nursing Empathy

Vicarious Trauma and Nursing Empathy

Think about the last time something about your work scared you. Was it a dangerous patient, dangerous staffing levels, insufficient PPE, or even challenges in terms of what we can realistically achieve with the resources at hand? Many of these things are out of our control, but the one thing within our control, our empathy, in conjunction with our fears and distresses, can do us more harm than good if we do not recognise the warning signs of our response to accumulated trauma.

Vicarious Trauma

Vicarious trauma (VT) is ‘the negative transformation in the helper that results (across time) from empathic engagement with trauma survivors and their traumatic material, combined with a commitment or responsibility to help them’ (Pearlman and Caringi, 2009, 202-203).

As nurses, midwives, and care workers, we work within and alongside various challenging situations with those we care for. We learn of their traumas, their frustrations, their emotional distress. We bear witness to incredible difficulties and form therapeutic relationships with our patients. This however comes at a personal cost. We are often told about concepts of burnout, or compassion fatigue, however the Post Traumatic Stress Disorder symptoms of VT can also be very real and debilitating if intervention is not done in a timely manner.

Five common recurring factors have been identified as markers of VT:

  1.    Unmodulated affect in response to client’s trauma narratives e.g. intense emotional responses to a client’s trauma disclosures
  2.    Somatic complaints e.g. recurring headaches, aches and pain without apparent illness or injury
  3.    PTSD symptoms e.g. hyper-vigilance or re-experiencing aspects of disclosed traumatic events in intrusive images or symptoms such as dissociation
  4.    Impact on personal frame of reference e.g. clinicians may report pessimistic world and life views
  5.    Symptoms of acute stress disorder, depression and anxiety e.g. including insomnia, social withdrawal and patterns of work and social avoidance (Wilson &
    Thomas, 2004).

A strong organisation which values its staff well-being provides interventions to manage any early signs of VT, and has a cohesive team approach with self-care, professional support and social support opportunities built into the working day. However, we are not always working within such a utopia, and can only control our own actions. Part of this is to prioritise our own self-care skills and devote the same energy and empathy we provide to others to ourselves – you cannot pour from an empty cup – and you deserve the commitment to yourself.

If you are struggling personally, the Nurse & Midwife Support service has further information on the signs and symptoms of VT and what you can do to protect your own mental health at or contact them for free, confidential 24/7 advice on 1800 667 877.

If you are experiencing issues in your workplace, please contact our Member Support Team on


Pearlman, L. A., & Caringi, J. (2009). Living and working self-reflectively to address vicarious trauma. In C. A. Courtois & J. D. Ford (Eds.), Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (pp. 202-224). Guilford Publications

Wilson, J. P., & Thomas, R. B. (2004). Empathy in the treatment of trauma and PTSD. New York: Brunner/Routledge.

Updates correct as at 23 July 2020.
Authorised by Emily Shepherd, ANMF Tasmanian Branch Secretary

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