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Secondary Stress and the COVID-19 Pandemic

Editor(s): Donnelly, Gloria F. PhD, RN, FAAN, FCPP, Editor in Chief

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doi: 10.1097/HNP.0000000000000438
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Night after night the evening news features nurses working on the front lines of the pandemic—caring for dying patients isolated from loved ones, working extra shifts for lack of staff, protecting their families through self-imposed isolation, grieving deaths of both patients and colleagues, ruminating over the quality of care, and agonizing over whether to remain a nurse. In addition to the normative stressors of any career, nurses experience secondary stress—that extra layer of stress that is the result of caring for others sometimes referred to as burnout, moral distress, or compassion fatigue. Living and practicing through a pandemic have produced secondary stress at unprecedented levels. As we hopefully approach the end of pandemic and the associated clinical nightmares, let's explore opportunities for “posttraumatic growth,” when one deliberately mines the lessons of secondary stress.

Between the years 2013 and 2015, 13 500 registered nurses completed the American Nurses Association's (ANA's) health risk appraisal.1 The results of this survey revealed a startling statistic; 82% of respondents considered workplace stress a health risk. The ANA's Healthy Work Environment initiative is a comprehensive strategy for addressing workplace stress including the importance of “self-care.” One can only imagine what the survey results might be post pandemic.

In Overcoming Secondary Stress in Medical and Nursing Practice, Wicks and Donnelly2 explore the nature of secondary stress and its effects on the health and well-being of nurses, physicians, and physician assistants practicing during the pandemic. The practice vignettes illustrate the strain, conflict, and suffering experienced by direct care providers, leading not only to burnout but also to posttraumatic stress disorder, depression, and even suicide. Wicks and Donnelly2 make the case for preemptive self-care including conscious efforts to raise awareness of one's mindset and perspective, to explore the roots of reactivity, and to use a self-awareness questionnaire that leads to the design of a personal, self-care protocol.

Every major crisis, like the pandemic, can be fodder for innovation and improvement, not only in care and treatment but also in honoring the self through intentional and continuous self-care efforts. It is not enough for professional organizations to lead the charge for self-care and improved work environments. Nursing programs must include self-care content in the curriculum and employing health care institutions need to invest in nurse well-being as an integral part of staff development. Finally, every professional nurse must discover his or her own path to mediating stressful environments and maintaining health and well-being. COVID-19 will eventually pass, but there will future major health disruptions for which we need to be prepared. It starts with self-care!

—Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief


1. Carpenter H. ANA's health risk appraisal: three years later. Am Nurse Today. Published January 2017. Accessed June 17, 2020.
2. Wicks R, Donnelly G. Overcoming Secondary Stress in Medical and Nursing Practice. New York, NY: Oxford University Press; 2021.
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