As you provide care for your trauma patient - one of multiple gunshot wound victims to be transported to your facility in the last hour - you hear the sound of gunshots ringing through your unit.

You immediately freeze, questioning what you just heard.

You hear a “Code Silver” being called overhead, indicating an active shooter in the building. Instantly, the buzz of hysteria and chaos confirms your greatest fear as you rush to implement lockdown protocols while still caring for and securing your patient. As police pour in and quickly outnumber staff, you realize the shooting is a gang-related retaliation whose target is your patient.

No active shooter drill could prepare you for this moment of intense anxiety and sheer panic that permeates your entire unit as it becomes a battleground.

This could be a scene found in any hospital in the United States as the world grapples with rising gun violence. Nurses and frontline healthcare workers are among the most at risk for dealing with the tragic events surrounding all acts of gun violence. The first point of contact while caring for these individuals and their families - nurses are left holding the shattered pieces that remain after these horrific events that are unfolding daily. There is no time to process these traumas before moving on to the next patient and situation, all of which have a cumulative mental health effect that can lead to severe health issues. This leads to extreme burnout, compassion fatigue, and moral distress that continue to fuel the Great Resignation in healthcare.

Public bickering over how gun violence should be managed on state and federal levels only adds to the profound emotional toll. 

Gun violence is a public health crisis that requires a comprehensive approach. According to the American Public Health Association (APHA), gun violence is a leading cause of premature death in the United States. More than 38,000 people are killed and nearly 85,000 non-fatal injuries occur yearly due to gun violence, and nurses have a front-row seat to these horrendous tragedies. Caring for victims of mass casualty shootings, and feelings of a loss of control over these acts of violence and their effects, creates immense internal conflict and moral distress that are harmful to nurses.

Nurses are experiencing exponential rates of secondary trauma stress (STS) related to caring for victims of gun violence and their families, which remains hidden behind organizations' closed doors. In a study conducted by the Emergency Nurses Association (ENA) to evaluate the prevalence of traumatic stress and its effects, nurses reported impaired sleep and functionality, feeling depressed, and disengagement from their lives. Symptoms of STS among participants included paranoia, hypervigilance, heart palpitations, anxiety, nightmares, and flashbacks.

Congress recently passed bipartisan gun safety legislation, which received kudos from the American Nurses Association president Ernest Grant, PhD, RN, FAAN. In a moving statement, he commended the work of Congress in coming together to tackle this issue head-on:

“The passage of the Bipartisan Safer Communities Act marks one of the most significant steps Congress has taken to reduce gun violence in decades. As the nation’s largest group of health care professionals, nurses know firsthand the horrible toll that guns have taken on our families and communities. 

This bill begins to address some of the core issues underlying the public health issue of gun violence by implementing common-sense policies that nurses and other healthcare professionals have long supported. Critically, this legislation is the result of bipartisan compromise. I want to thank its champions in the United States Congress who worked tirelessly across the aisle to ensure this package crossed the finish line.”  

This is one step toward addressing this multifaceted public health epidemic. Many healthcare providers, among them nurses, experience higher rates of anxiety coming into work for fear of the unknown related to increased acts of violence. Resilience training, active shooter drills, unit debriefing sessions, and implementing new safety measures are only scratching the surface of strategies to tackle the growing effects of gun violence.

Identifying, treating, and healing the trauma endured by frontline healthcare workers so they can continue to provide care for others is critical in a growing climate of violence.