Vicarious Trauma in the OR: Protecting your Mental Health
By: Courtney Klink, EdD, MBA, RN
Published: 9/16/2025
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Periop nurses carry a weight of responsibility that extends far beyond the sterile environment. Periop nursing demands expertise, focus, and critical thinking under pressure within a high-stress environment. Daily encounters with trauma, patient suffering, and life-or-death situations make perioperative nurses susceptible to vicarious trauma (VT). This article provides perspective on VT, examines its relevance to perioperative nursing, and offers strategies to mitigate its effects.
Understanding Vicarious Trauma
VT, also referred to as secondary traumatic stress, arises from exposure to the traumatic experiences of others.¹-³ In the operating room (OR), nurses witness the pain, fear, and vulnerability of patients undergoing surgical procedures. This repeated exposure can affect their emotional and psychological health.
It is essential to differentiate VT from burnout and compassion fatigue, although these conditions may overlap. Burnout, by emotional exhaustion and depersonalization, often stems from chronic workplace stress,¹ whereas compassion fatigue arises from the emotional demands of caring for others, which can lead to diminished empathy.¹ VT distinctively arises from exposure to the trauma of others, which may fundamentally alter the nurse's inner experience.
Risk Factors for Perioperative Nurses
Several aspects of periop nursing increase the risk of experiencing VT.¹
- Exposure to graphic surgical procedures and patient emergencies: Periop nurses often witness invasive procedures and handle medical emergencies, exposing them to potentially disturbing sights and sounds.
- Working with vulnerable patients and their families: Nurses interact with patients and families experiencing high levels of stress, anxiety, and grief, absorbing some of their emotional burden.
- Witnessing the emotional toll of surgery on patients and their loved ones: Observing the emotional impact of surgery on patients and their families can be emotionally taxing for nurses.
- High-pressure environment: The fast-paced, high-stakes nature of the OR leaves little time for reflection or emotional processing during work hours.
Recognizing Vicarious Trauma
VT manifests through a range of psychological, emotional, and behavioral symptoms. Psychologically, nurses may experience intrusive thoughts, vivid nightmares, and increased anxiety related to surgical procedures or patient emergencies.¹-³ Emotionally, nurses may exhibit heightened emotional reactivity, including increased irritability, sadness, or detachment. ¹-³ Furthermore, nurses might demonstrate behavioral changes, such as social withdrawal, difficulty concentrating, or avoidance.¹-³ Organizations should recognize that these symptoms often develop insidiously, potentially affecting nurses' well-being and job satisfaction, and overall quality of patient care.
Strategies for Self-care
To safeguard their mental health, periop nurses can proactively adopt self-care and emotional processing strategies.¹-³
- Mindfulness and meditation: Practicing mindfulness exercises and meditation techniques can help nurses stay present, manage stress, and cultivate inner peace. Even a few minutes of daily mindfulness can make a difference.
- Emotional expression: Finding healthy outlets for emotional expression is essential. Journaling; creating art; or talking with a trusted friend, family member, or therapist can provide a safe space to process difficult emotions.
- Setting boundaries: Establishing clear boundaries between work and personal life is essential to prevent emotional exhaustion. This includes setting limits on work hours, avoiding work-related discussions outside of work, and prioritizing personal time.
- Seeking social support: Connecting with colleagues, friends, or family members for emotional support and understanding is invaluable. Sharing experiences and feelings with others who understand can reduce feelings of isolation.
- Professional counseling: Seeking professional counseling or therapy is a sign of strength, not weakness. Therapists can provide guidance, support, and evidence-based treatments to help nurses cope with VT.
Conclusion
VT poses a considerable challenge for periop nurses. By recognizing risk factors, understanding symptomatology, and actively implementing self-care and emotional processing strategies, nurses can safeguard their mental health while maintaining exceptional patient care. Recognizing the mental health and well-being of periop nurses is not merely a matter of personal responsibility but an ethical duty that directly impacts the sustainability of this essential health care workforce.
References
- Ferguson K, Carnevale T. When caring hurts. Nursing Made Incredibly Easy!Published online March 27, 2025.
- Isobel S, Thomas M. Vicarious trauma and nursing: An integrative review. International Journal of Mental Health Nursing. 2021;31(2):247-259.
- Wu Y, Bo E, Yang EO, et al. Vicarious trauma in nursing: A hybrid concept analysis. J Clin Nurs. 2023;33(2):724-739.
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