Factors influencing vicarious trauma among Generation Z nursing interns in ICU practice: a cross-sectional study

The ICU is a high-stress environment characterized by frequent exposure to patient suffering and traumatic events, making vicarious trauma a significant occupational hazard for nurses. Generation Z nursing interns face unique challenges during ICU rotations due to insufficient skills and limited resilience. However, their current status regarding vicarious trauma and the factors influencing it still remain underexplored. This study aims to investigate the levels of vicarious trauma and its key influencing factors within this cohort.

A cross-sectional study was conducted in Zhengzhou, China, from July to September 2025, recruiting 240 Generation Z nursing interns through convenience sampling. The instruments used included a demographic characteristics questionnaire, the Vicarious Trauma Questionnaire for Disaster Rescuer (VTQ), the Simplified Coping Style Questionnaire (SCSQ), the Professional Identity Scale for Nursing Students (PISNS), and the Perceived Social Support Scale (PSSS). Data were analyzed using independent t-tests, one-way analysis of variance, Pearson correlation, and multiple stepwise linear regression.

The mean VTQ score for Generation Z nursing interns was 80.50 ± 26.49, with one-fifth exhibiting vicarious trauma reactions. Significant associations were observed between VTQ and negative coping styles, PISNS, and PSSS (r = -0.195 to -0.216, p < 0.01), as well as between VTQ and positive coping styles (r = 0.250, p < 0.01). The coefficient of determination (R² = 0.443) indicated that the ICU rotation sequence, daily working hours, night shift frequency, patient death exposure, perceived workload, sleep quality, coping styles, and perceived social support together explained 44.3% of the variance in vicarious trauma.

This study offers a comprehensive understanding of vicarious trauma among Generation Z nursing interns by identifying multiple influencing factors, including the clinical environment, work arrangements, individual psychology, and social support. To address these issues, the nursing education system should implement measures such as optimizing the clinical environment, adjusting internship arrangements, and enhancing educational guidance to support the mental health of Generation Z nursing interns and reduce the risk of vicarious trauma.