The demands of nursing extend far beyond long shifts and heavy workloads—nurses regularly navigate the emotional, ethical, and psychological challenges that come with patient care. Some of these stressors are unavoidable and deeply tied to the profession itself. While they don’t have a widely recognized name, we define them as “manageable stressors” to highlight the need for awareness and proactive support in addressing their impact. Unlike removable stressors (which result from inefficient policies or systems and can be changed), manageable stressors are inherent to caregiving and require strategies for management. 

At the Oregon Center for Nursing, our RN Well-Being Project has identified four key manageable stressors nurses may face: 

1. Vicarious trauma
2. Moral and ethical misalignment
3. Compassion fatigue
4. Secondary traumatic stress. 

These challenges are not symptoms of burnout, nor do they stem from system inefficiencies. Instead, they are fundamental aspects of nursing that, if left unaddressed, can impact mental health, occupational well-being, job satisfaction, and quality of care.

Vicarious Trauma: When Empathy Hurts

Nurses are trained to be present with patients through their deepest pain. Over time, witnessing trauma—without adequate systemic support—can fundamentally change a nurse's view of themselves, their relationships, and the world around them. This is vicarious trauma.

Unlike general workplace stress, vicarious trauma isn't about feeling busy or overwhelmed. It's about carrying the echoes of others' suffering so deeply that it erodes a nurse’s sense of trust, safety, and connection.

Calling it out means recognizing that compassion has a cost. Addressing it requires systems to go beyond lip service and provide structured debriefing, clinical supervision, and genuine psychological support.

Moral and Ethical Misalignment: When the System Forces Compromise

Every nurse knows what good care should look like. But too often, system constraints—like short staffing, lack of resources, or rigid protocols—force nurses to act against their professional judgment. This leads to moral stress, moral distress, and, over time, moral injury.

The cost isn't just internal anguish. Moral injury erodes trust in institutions, increases burnout, and drives talented nurses out of the workforce.

Calling it out means no longer treating moral stress as a personal failure to “cope.” Addressing it means designing healthcare environments that uphold professional integrity, allow ethical concerns to be voiced, and value the moral agency of caregivers.

Compassion Fatigue: When Caring Depletes

Caring for people in crisis day after day is emotionally demanding. When that emotional labor isn't supported or replenished, nurses can experience compassion fatigue—a state of exhaustion, numbness, and withdrawal.

Compassion fatigue isn't a character flaw. It's an occupational hazard made worse by high workloads, unsupportive management, and limited opportunities for emotional recovery.

Calling it out means moving beyond telling nurses to “practice more self-care.” To manage it, we need to build work environments that prevent compassion fatigue at its source—with realistic staffing, access to mental health resources, time for recovery, and leadership that models empathy.

Secondary Traumatic Stress: When Exposure Leaves a Mark

Hearing about, witnessing, or supporting patients through traumatic events can trigger symptoms similar to post-traumatic stress disorder in nurses—this is known as secondary traumatic stress (STS).

Vicarious trauma and STS may sound the same, but there’s a difference. Vicarious trauma happens slowly over time with repeated exposure, whereas STS tends to come on suddenly. STS can cause sleep problems, emotional numbing, irritability, avoidance behaviors, and even lead to physical health issues. Left unaddressed, it affects not only the nurse’s well-being but also patient safety and quality of care.

Calling it out means recognizing STS as a predictable consequence of trauma-exposed work, not an individual weakness. To manage it, organizations must offer real protections, including timely counseling, peer support systems, and a culture that normalizes seeking help.

These Stressors Are Manageable—But Only With Intentional Effort 

A resilient nursing workforce doesn’t happen by chance—it starts with leadership that actively acknowledges and addresses the challenges inherent in patient care. When employers take meaningful steps to manage these stressors, they’re not just supporting their nurses—they’re strengthening their entire organization. A workplace that prioritizes nurse well-being leads to better retention, higher job satisfaction, and ultimately, better patient care. Investing in well-being isn’t just the right thing to do—it’s a strategic imperative for the future of healthcare.

Learn more about the manageable stressors framework on the newly updated RN Well-Being Project website.