by Shari Finnell, editor/writer, Not-for-profit News

“Burnout.” “Compassion fatigue.” “Secondary traumatic stress.” “Vicarious trauma.” More than likely, you’re somewhat familiar with these terms, especially if you work or volunteer for an organization that supports individuals struggling with addiction, abuse, unemployment, food insecurity, homelessness, damaged relationships, or grief.

In the aftermath of the COVID-19 pandemic outbreak, the term “burnout,” in particular, gained increased attention as nonprofits disproportionately face an exodus of employees, along with an increased demand for services.

However, many people are using the terms interchangeably — which can make organizations vulnerable to other ways that various mental health conditions among their employees can undermine their mission, according to Dr. Cara Berg Raunick, the director of clinical quality at Health Care Education and Training (HCET), a nonprofit organization based in Indianapolis. Berg Raunick also is a former sexual assault nurse examiner (SANE) consultant for the Indiana Coalition to End Sexual Assault and Human Trafficking.

As leaders seek to support mental health programs, it’s important to gain a deeper understanding of each of the conditions and how they can impact an employee differently and, as a result, the organization, said Berg Raunick, who conducted extensive doctoral research on the vicarious trauma experienced among sexual assault nurse examiners.

Berg Raunick said the focus on “burnout” as a concept can be related to its perceived connection to a high voluntary turnover rate in the workforce. According to Nonprofit PR, 45 percent of nonprofit employees surveyed said that they would be seeking new employment by 2025 — which could further exacerbate disproportionately high voluntary turnover rates in the nonprofit sector.

While those concerns can be legitimate from an institutional and workforce perspective, employers also need to address the various types of secondary trauma that nonprofit and healthcare workers often face, Berg Raunick said.

“Burnout can be the easiest one to figure out why it matters,” she said. “People quit when they experience burnout, which can cost us money in training time, staff deficits, and a loss of institutional knowledge and expertise. However, unlike secondary trauma, burnout isn’t strictly trauma related. It can be caused by any challenging work scenario.

“While it certainly can be linked to working with folks who have experienced trauma, it’s important to recognize that people who experience any kind of secondary trauma have an increased risk of burnout,” she added.

In many cases, symptoms of secondary trauma — which is an umbrella term that describes what happens to people who are peripherally impacted by another person’s direct trauma — amy not be readily addressed in the workplace because they may appear to only impact the employee, Berg Raunick said.

Yet, secondary trauma can result in disconnected employees who are ineffective in supporting the organization’s mission, she noted.  According to the U.S. Department of Health and Human Services, symptoms of secondary trauma can include isolation, depression, anxiety, physical ailments, disassociation.

Berg Raunick stressed the importance of recognizing and addressing secondary trauma symptoms among employees — both to support employees’ overall well-being and the organization’s mission.

“In nonprofit and healthcare environments, working as a unit and supporting each other matters immensely,” she said. “It can lead to a decreased connection to patients, clients, and other team members.

“We’re losing a lot of our leaders over time to burnout,” she added. “But those who are staying may be disconnecting and losing their ability to have compassion and empathy. There’s a prevailing attitude that we should be strong, and we should be able to just carry on. We must approach not only our patients and clients and from a trauma-informed lens, but our workforce as well.”

Addressing secondary trauma in the workplace

Based on Berg Raunick’s research on vicarious trauma, which includes cognitive changes that occur with prolonged exposure to trauma, employees supporting traumatized people are likely to experience the highest levels of detrimental effects if they also have a personal history of trauma. 

However, as the research revealed, nurses without a personal history of sexual trauma but who examined sexual assault victims scored similarly in cognitive changes as obstetrics nurses who did have a personal history of sexual trauma — but did not work with sexual trauma victims in their roles. 

It’s important to create trauma-informed organizations and practices, including opportunities for self-care, in the workplace without setting the expectation that lack of resilience is a personal failure, said Berg Raunick.

“A huge part of it is learning about it, prioritizing it, and trying to create space to address it,” she said. “In some ways COVID taught us the importance of addressing it. We experienced immense trauma on so many levels, and the world slowed down for a bit.” 

Since there are many terms that have been associated with secondary trauma, understanding of the differences among them can be confusing, she noted.

“For example, compassion fatigue originated as a less stigmatized term for secondary traumatic stress, but now it is defined as a combination of secondary traumatic stress and burnout,” she said. “Compassion fatigue (as a description) makes a lot of intuitive sense. When we say compassion fatigue to someone, anyone who does any caring or any work in nonprofits, health care, or education, intuitively understands what that means.”

“With vicarious trauma, the changes aren’t pathologic,” she said. “They are normal and expected with this type of work. But while the changes themselves are normal, the effects can be harmful. We need to stress, ‘There’s nothing wrong with you. This isn’t a deficit if you’re experiencing this.”

Employers also should consider increasing awareness around the varying secondary trauma concepts as part of the onboarding process and continual employee engagement, Berg Raunick said. “By nature, most people who head into these kinds of fields have great resilience,” she said. “But it’s important to create trauma-informed organizations and practices, including opportunities for self-care, without setting the expectation that lack of resilience is a personal failure.

“A huge part of it is learning about it, prioritizing it, and trying to create space to address it,” she added. “In some ways COVID taught us the importance of addressing it. We experienced immense trauma on so many levels, and the world slowed down for a bit so that we can focus on it.”  

Ideas for practicing self-care

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), self-care tips to prevent and mitigate the impact of secondary trauma, such as those experienced by teams responding to a natural disaster.

• Focus on the four core components of resilience: adequate sleep, good nutrition, regular physical activity, and active relaxation (e.g., yoga or meditation).
• Get enough sleep or at least rest. This is of great importance, as it affects all other aspects of your work—your physical strength, your decision making, your temperament.
• Drink enough fluids to stay hydrated and eat the best quality food that you can access.
• Complete basic hygiene tasks like combing your hair, brushing your teeth, and changing clothes when possible. Wearing clean clothes can make you feel better.
• Try to wash up, even just your hands and face, after you leave your work shift. Think of it as a symbolic “washing away” of the hardness of the day.
• Make time to learn about the people with whom you work. Taking time for conversations will help foster feelings of positive regard toward yourself and others.
• Engage with your fellow workers to celebrate successes and mourn sorrows as a group.
• Take time to be alone so you can think, meditate, and rest.
• Practice your spiritual beliefs or reach out to a faith leader for support.
• Take time away from the work when possible. Removing yourself from the disaster area can help you remember that not every place is so troubled.
• Try to find things to look forward to.
• Communicate with friends and family as best you can. If you do not have Internet or cell phone access or ways to mail letters, write to loved ones anyway and send the letters later.
• Create individual ceremonies or rituals. For example, write down something that bothers you and then burn it as a symbolic goodbye.
• Focus your thoughts on letting go of stress or anger or on honoring the memory, depending on the situation.