The government has passed legislation that will make life a little easier for first responders struggling with PTSD. But nurses are now left wondering why the day-to-day trauma in their profession is not being acknowledged as a trigger for mental illness.

“When I first started nursing in 2002, I never imagined that 12 years later, I would be crippled by nightmares, anxiety and depression as a result of my job,” says Julie Prince. “Yet that’s exactly where I ended up.”

A full-time labour and delivery RN for three years, who also worked occasionally in the neonatal intensive care unit (NICU), Prince describes feeling immense anxiety at the start of each shift for at least a year before she decided to leave bedside nursing in the fall of 2014. She says she felt as though she “just didn’t want to take care of anyone anymore.”

Two months after her departure, her symptoms of post traumatic stress disorder (PTSD) began to peak, and she couldn’t even drive past the hospital without experiencing anxiety. During those initial months away from work, she says “the grief and depression was unbearable at times.” Many evenings, she would just sit on her couch crying. “While I sobbed, all I could see were the images of dead babies and feel haunted by the multitude of tragic stories where I had played a role as a nurse.”

Prince was formally diagnosed with depression and PTSD in December 2014. “I thought I was burned out and….I was,” she explains. “I just didn’t realize the complexities of all that was happening within my psyche.”

Prince kept silent about her diagnosis until she heard about the provincial government’s Supporting Ontario’s First Responders Act (Bill 163), which received royal assent on April 6 this year. When she learned the new legislation does not recognize nurses as first responders – which means nurses are not afforded the same accommodation as other first responders seeking support for job-related PTSD – Prince took to Facebook to open up about her own mental health challenges directly related to her day-to-day work as an RN.

“My story is just one of many,” she says. “While I have held this part of my life very private for more than a year now, I do believe that good can come out of my decision to share…and I am seeing that already.” In fact, her Facebook post on April 5 has been viewed by more than 21,000 people. It has been shared more than 3,100 times. “I have had responses from many, many nurses, and also families that have been on the other side,” Prince says. “It has been very moving and also a step of healing on my own journey. I am remarkably encouraged because it is getting nurses talking about the day-to-day traumas and cumulative sorrow that we face.”

Bill 163 recognizes that first responders develop PTSD during their employment, and entitles them to improved access to benefits under the Workplace Safety and Insurance Act. The legislation covers firefighters, fire investigators, police officers, paramedics, emergency medical attendants, and workers in correctional institutions or secure custody.

Appalled by the omission of nurses, the Registered Nurses’ Association of Ontario (RNAO) issued an action alert on April 8, and sent an open letter to Premier Kathleen Wynne and Minister of Labour Kevin Flynn, urging an immediate fix to this mistake.

“It is both offensive and ludicrous to exclude nurses as first responders when they are regularly among the first to assist during emergency situations,” RNAO wrote in its letter to the premier. “How fast is our government forgetting the SARS crisis, or the Ebola scare? And, how little do political leaders know about what nursing work entails?”

Nurses experience physical violence, oftentimes from patients who are cognitively or mentally impaired, the letter notes, suggesting triggers that lead to PTSD can also be associated with work-related violence. And it is not just limited to in-patient settings either.

“In the community, nurses work in neighbourhoods with high crime rates, and in home care, nurses enter patients’ private residences to provide care. Nurses also have roles during events that require immediate action at their organizations…that could trigger the onset of PTSD: cardio-respiratory arrests, violent persons, missing patients, infant abductions, hostage situations, bomb threats, pandemics, and patients with life-threatening blood loss.”

In 2006, Brenda Leonard was working in the ICU. The RN with 30 years of nursing experience was caring for a patient who began losing blood so rapidly that it went from the bed to the floor and onto Leonard’s hands. “I literally had blood on my hands,” she recalls of the incident that triggered her PTSD. She had to leave the job she loved to go on disability for two years, and when she was formally diagnosed with PTSD and approached the Workplace Safety and Insurance Board (WSIB) for help, she received nothing. ““This is part of your everyday job.” That’s what I was told over and over again,” Leonard said in an emotional television interview following the passing of Bill 163.

Going public with her story was not easy, but Leonard says she did it because people – particularly nurses – don’t talk about this, and they need to. “I felt so much shame and I held that shame for years,” she says. “Nobody would recognize nurses get post traumatic stress, and I had nowhere to go.”

The one place Leonard knew she would not go was back to the bedside, but she didn’t want to let that stop her from moving on with her career in nursing. She headed back to school, and 10 years later, she has master’s degrees in both counseling psychology and education. Leonard now runs her own business and provides counseling to individuals with anxiety, depression and PTSD.

“I’m very proud of where I am today. It made me who I am today. But I wish it didn’t have to be this way, because for 10 years, it was really hard,” she says. “And I think it could have been a lot better if there were people to support me.”

In his remarks during the opening ceremonies of RNAO’s annual general meeting in May, Ontario’s Health Minister Eric Hoskins told nurses he knows about the realities of PTSD. “I am very understanding of your disappointment,” he acknowledged, adding that he wants to “…keep this conversation going.”

The admission is welcome by nurses, but not without cautious optimism given the legislation falls under the ministry of labour, not the ministry of health. Whether it leads to legislative change, and an acknowledgement of nurses as first responders, remains to be seen. Meanwhile, the realities of everyday practice – and the risk of PTSD in the nursing workforce – continue to weigh heavy on the minds of RNs.