When the Wounded Walk: Exploring the Lived Experience of Secondary Traumatic Stress in the Emerging Nursing Workforce

The purpose of this study was to explore undergraduate nursing students' lived experiences with secondary traumatic stress.

The design was an interpretivist, hermeneutic-phenomenological approach. Data collection took place in the United States from September through November of 2024. Undergraduate nursing students who scored ≥ 38 (moderate, high, or severe) on the Secondary Traumatic Stress Scale were purposively recruited for face-to-face interviews with biometric and audiovisual recordings. Data analysis followed an iterative, inductive approach using principles from Heidegger's hermeneutic approach and Benner's interpretive framework for nursing.

Four main themes emerged from the data, illuminating student lived experiences on (1) How an Event Becomes 'Traumatic,' (2) Maladaptive or Ineffective Coping in Response to an Event, (3) Nursing Culture as a Conduit for Secondary Traumatic Stress and (4) The Student Journey Toward Effective Coping.

Findings revealed largely unaddressed secondary traumatic stress in undergraduate nursing students, a hidden driver of burnout and early exit from the profession. During synthesis, a four-step cascade emerged: (1) an emotionally charged event, (2) experiencing distorted thoughts, (3) symptoms of physiological arousal and (4) demonstrated behavioural avoidance, intensified by an underlying professional expectation of stoicism. Although students reported using relational, spiritual, cognitive and physical coping tools, these strategies alone rarely interrupted the cascade.

Three educational imperatives follow: (1) embed explicit secondary traumatic stress literacy in educational modules, (2) normalise brief peer/faculty debriefings and (3) train preceptors to frame vulnerability as a form of competence. Trauma-informed pedagogy built on these steps can foster integrated (rather than sustained) trauma, curb attrition and help secure the future nursing workforce. WHAT PROBLEM DID THIS STUDY ADDRESS?: Undergraduate nursing students frequently experience secondary traumatic stress during clinical training, yet curricula and clinical cultures provide little explicit preparation or support. This gap accelerates burnout and early departure from the profession, worsening nurse shortages and threatening patient safety. WHAT WERE THE MAIN FINDINGS?: The study uncovered a four-step STS cascade: a clinical event led to distorted thoughts, which resulted in physiological arousal and produced behavioural avoidance (amplified by the hidden curriculum of stoicism misinterpreted as professional resilience). Students improvised multi-layered coping toolkits, but these alone were perceived as insufficient. Targeted, real-time interventions can interrupt the cascade and transform distress into manageable, integrated memories. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The research will influence educators, clinical mentors, and health-system managers who shape the day-to-day experiences of nursing students and new graduates, with ripple effects for patient safety and workforce sustainability across comparable healthcare contexts worldwide.

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This study did not include patient or public involvement in its design, conduct, or reporting.