The intensive care unit (ICU) is a stressful environment due to high patient mortality and morbidity, daily confrontations with ethical dilemmas, and a tension-charged atmosphere (1). After exposure to a traumatic event, individuals with post-traumatic stress disorder (PTSD) experience persistent recollections, avoid reminders of the events, and have symptoms of increased arousal (2). Critically ill patients who survive their ICU stay can have symptoms of PTSD that occur more frequently than United Nations soldiers who served in politically unstable regions (3). In addition, one-third of family members of ICU patients reported mild to moderate post-traumatic stress symptoms mostly related to their participation in end-of-life decisions and discussions (4).

There are approximately 400,000 critical care nurses in the United States who work in this demanding ICU environment. The vacancy rate for nurses in critical care positions is approximately 17%. Due to the increased demand for ICU beds in the United States, there will be an estimated 114,000 vacant critical care nursing positions in the United States by 2015. One component of the ICU nursing shortage is an increased exodus of critical care nurses from their profession. In a national telephone survey of 700 registered nurses, the most common reason nurses consider leaving their jobs is a desire for a less stressful position (5, 6).

The psychological effects on critical care nurses related to their work environment are relatively unexplored (7-9). Critical care nurses are repeatedly exposed to work-related stresses in the ICU, including addressing specific needs at the end of life, performing cardiopulmonary resuscitation, postmortem care, and prolonging life by artificial support to critically ill patients (1). Repetitive exposure to extreme stressors and the inability to adjust to this environment may result in the development of significant psychological disorders, such as symptoms of PTSD or depression, in some critical care nurses.

We hypothesized that critical care nurses may be at increased risk for developing symptoms of PTSD and other psychological disorders. Therefore, we surveyed critical care and other nurses throughout a metropolitan area and performed a more complete psychological assessment on a subset of the respondents. Some of the results of these studies have been previously reported in the form of an abstract (10).