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Workforce Trauma: A Vital Dimension of Mass Violence

by Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP on 02/25/18

Over the past several weeks, countless articles have explored the cause for the upsurge of mass violence across society:

·      Only one third of the patients with a mental health diagnoses receive care (Heath, 2018).

·      Flaws in the mental health system (Barnhorst, 2018)

·      Lack of true mental health parity (Medrano, 2018; Ollove, 2015)

·      Deinstitutionalization and closure of psychiatric hospitals (Carey, 2018; Raphelson, 2018)

·      A connection (or not) between gun violence and mental illness (Qui and Bank, 2018)

·      Social Media (Wright, 2018)

·      Video games triggering real world violence (Ferguson, 2018)

·      Gun violence escalation, with use of automatic and semi-automatic weapons (Gilligan and Lee, 2018; Ingraham, 2018; Qiu and Bank, 2018)

·      Gun violence as a public health problem (Zhang, 2018) 

However, here’s the thing; there is no single cause. Each of the above articles makes a compelling argument. The one point of agreement is that multiple factors have contributed to the rise of mass violence in society.

Since the events in Parkland, Florida I’ve engaged in many conversations with colleagues and students: some to debrief and others to engage in debate about the $64 million dollar question of mass violence’s cause. While the differing views of etiology are important, a more paramount concern presents. The impact of repeated mass violence episodes on the health and behavioral workforce is taking a considerable toll.

Our interprofessional workforce renders necessary treatment to victims of every mass violence event. We provide crisis intervention to support involved families and support systems. We address the vicarious emotional wounds of surrounding communities plus all who experience the events 24/7 across social media. We engage in critical incident debriefing for colleagues. Yet despite the amount of care rendered, the workforce intimately has to reconcile feeling they have not done enough. In light of the egregious nature of each attack, involved professionals on the front lines often underestimate the value of their intervention. Yet, the smallest act can easily provide the largest impact. This impact can extend far beyond the scope of the individual’s presenting need, whether physical and/or emotional. 

I’m reminded of the video that showed an interview with a physician who cared for victims of the 2016 Pulse shooting in Orlando. He vowed to keep on the sneakers he wore the evening of June 12, 2016, until the last patient from the shooting was discharged. The pictures of those bloody sneakers went viral across social media (Miller, 2016). Reports of first responders who so tenderly cared for the victims and community impacted by Sandy Hook detailed the profound trauma experienced by all; it was forceful and invasive. I will never forget sitting with my colleagues at the nurses’ station on 9/11; we worked at the hospital closest to the Pentagon that cared for the majority of victims. As much as we had done on that memorable day, nobody could leave; surely there had to be more we could do for someone.

The occupational hazards for any member of the workforce are abundant. Along with the uptick in mass violence, other types of violence have put the health care industry on heightened alert. Workplace violence has contributed to major safety and quality issues for patients, plus concerns around workforce retention and exposure to trauma. Studies show health and behavioral health professionals (e.g. mental health professionals, nurses, and physicians) have alarmingly high rates of post-traumatic stress disorder symptoms (Fink-Samnick, 2015; Skogstad, Skorstand, Lie, Conradi, Heir, and Weisaeth, 2013). 

The incidence of workforce burnout is at an all time high. I’m notorious for calling out colleagues to be especially mindful of when they feel ‘crispy’ around the edges. But given the data, my hypervigilance with respect to the consequences of workplace stress, if not trauma, is mandated:

·      30-45% of social workers leave within two years, with turnover rates 215% higher than other roles (Public Consulting Group, 2018)

·      43% of new nurses leave their jobs within three years; turnover for a bedside RN resulted in the average hospital losing up to $8.1 million annually  (Nursing Solutions, Inc., 2016; StreamlineVerify, 2016)

·      Average national burnout rate for physicians is 54%, with costs between $500,000 and $1 million to replace one physician (Rosenfeld, 2018)

As long as violence is woven within the fabric of society, health and behavioral health professionals will serve on the front lines to combat it. Along with minimizing the value of our role, we can minimize the impact of the experience for ourselves. Becoming desensitized to the human condition is a cautionary alternate path to take. This will put any professional at further risk of vicarious trauma down the road.

What can you do?

1.     Process and roll only works for so long: Many of my colleagues admit to being good in a crisis. However doing what I fondly call ‘process and roll’, or going immediately from one task to another is for the short term only. For the long term, this pattern yields errors, and sets you up for burnout. Be mindful!

2.     Debrief PRN: Reach out to colleagues, supervisors, and mentors who understand what you have been through.

3.     Accept support: Health and behavioral health professionals are notorious for minimizing the impact of a situation, thinking it somehow indicates weakness. Truth be told, admitting you’ve hit a limit is a sign of strength.

·      Accept support from colleagues, and

·      Friends and family

4.     Recharge your resilience: Keep a current list of things that ground you at your disposal. You won’t automatically know what those things are, since in moments of stress we all lose sight of what we need. You might:

·      blast your favorite tunes through a mobile device

·      dance like nobody’s watching

·      take reflection time over a cup of jasmine tea

·      hit the gym, or

·      head out to dinner with your BFF or partner

5.     Turn off that professional switch: I’ve been a health care professional for 35 years, so know just how hard this is to do. Besides, we wear our professional cape always, right? NOPE! We were human beings long before the health and behavioral health professionals we are now, so:

·      Make it a ritual when you leave work to do a happy dance

·      Have peers who are NOT in the biz

·      Set limits for yourself

·      Just say no to peers and family members who need your ‘Professional Advice’

One more vital point to remember: the real significance of our interaction is often not up to us to evaluate. The value is often defined by the unique meaning our contact holds for the recipient of care. When intervention occurs at a time of crisis, the worth of our presence is immeasurable. Our presence is a rare privilege at a time of raw emotion and vulnerability for others.

Stay Resilient,



Barnhorst, A., (2018) The Mental Health System Can’t Stop Mass Shooters, February 20, 2018, The New York Times 

Carey, B. (2018) Opening Mental Hospitals Unlikely to Prevent Mass Shootings, February 22, 2018, The New York Times 

Duwe, G. and Rocque, M  (2018) Actually, there is a clear link between mass shootings and mental illness, February 23, 2018 Los Angeles Times

Ferguson, C.J. (2018) It’s Past Time to End the Debate on Whether Video Games Trigger Real World Violence, February 19, 2018, Business Insiders 

Fink-Samnick, E. (2015) The New Age of Bullying and Violence in Health Care: Interprofessional Impact, July/August 2015, 20(4), pg. 165-174

Gilligan, J. and Lee, B. (2018) A Look at the Root Causes of Gun Violence, February 21, 2018 NPR 

Heath, S. (2018) Patient Access to Care Low For 1/3 of Mental Health Patients, February 14, 2018, Patient Engagement Health IT

Ingraham, C. (2018) The Real Reason Congress Banned Assault Weapons in 1994- and why it worked. February 22, 2018; The Washington Post

Kimball, A. (2017) End this discrimination against people with mental illness and provide them with care, December 11, 2017, The Hill  

Medrano, K. (2018) There’s No Emergency Mental Health System in America, February 23, 2018, Teen Vogue 

Miller, N (2016) Doctor still wearing bloody shoes; 1 patient remains in the hospital, July 20, 2016. Orlando Sentinel 

Neel, J. (2016) Work Can Be A Stressful And Dangerous Place For Many, Workplace and Your Health, July 11, 2016, NPR 

Public Consulting Group (2018) The Cost of Social Worker Turnover 

Ollove, M. (2015) Despite Laws, Mental Health Still Getting Short Shrift, May 7, 2015, Stateline, Pew Charitable Trusts

Qiu, L., and Bank, J. (2018) Checking Facts and Falsehoods about Gun Violence and Mental Illness After Parkland Shooting. February 16, 2018, The New York Times

Raphelson, S., (2017) How the Loss of U.S. Psychiatric Hospitals Led to a Mental Health Crisis, November 30, 2017, NPR 

Rosenfeld, J. (2018) Calculating the financial costs of physician burnout, February 15, 2018, Medical Economics, 

Skogstad, M.,  Skorstad, M., Lie, A., Conradi, H.S.,  Heir T.,  Weisæth, L. (2013) Work-related post-traumatic stress disorder. Occupational Medicine, Volume 63, Issue 3, 1 April 2013, Pages 175–182 

Streamline Verify (2016) Nurse Turnover Rate Infographic, March 16, 2016

Wright, M. (2018) School Shootings, Teen Suicide; the Hidden Consequences of Social Media, February 19, 2018, The Hill 

Zhang, S. (2018) Why Can’t the U.S. Treat Gun Violence as a Public-Health Problem? February 15, 2018, The Atlantic

Comments (4)

1. Patrick said on 2/25/18 - 10:59PM
Thanks Ellen. Timely and insightful as always.
2. Ellen said on 2/26/18 - 09:44AM
Most welcome, Patrick! Share the messaging with all your staff, from new hires to those more seasoned.
3. Gail said on 2/26/18 - 11:42AM
Outstanding and timely.
4. Judith R. Sands said on 2/26/18 - 02:24PM
Thanks for sharing the statistics and approaches for resilience and "recharging". The work environment has changed and we are challenged to adapt and thrive in the new "normal".

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