When Caring Hurts: The Buffering Role of Social Support in Emergency Department Nurses’ Coping With Secondary Traumatic Stress

BACKGROUND: Emergency department nurses routinely operate in fast-paced and emotionally charged environments, where constant exposure to trauma places them at significant risk for developing secondary traumatic stress. Robust coping mechanisms and supportive social networks serve as critical buffers against these psychological effects. AIM: This study explored how coping strategies and social support interact to influence secondary traumatic stress among emergency department nurses in Taiwan, emphasizing the mediating function of social support. METHODS: A cross-sectional design was applied between June and August 2024, enrolling 305 emergency department nurses from two tertiary medical centers. Standardized questionnaires were used to measure secondary traumatic stress, coping styles, and perceived support from supervisors, peers, and family. Descriptive and inferential analyses-including independent-sample t-tests, Pearson correlations, and stepwise multiple regression-were conducted to examine relationships among study variables. Mediation effects were examined with the PROCESS macro (5000 bootstrap resamples). RESULTS: Almost all respondents (96.1%) experienced at least mild or higher levels of secondary traumatic stress, and 63.3% reported moderate-to-severe levels. Avoidant coping emerged as the strongest predictor. Mediation analyses further demonstrated that supervisor support partially mediated the association between avoidant coping and secondary traumatic stress, whereas family support significantly mediated the relationship between emotion-focused coping and secondary traumatic stress. CONCLUSION: Secondary traumatic stress is widespread among emergency department nurses. Avoidant coping heightens susceptibility, whereas supportive supervision and family involvement can mitigate adverse effects. IMPLICATIONS: Nurse leaders should develop programs that cultivate adaptive coping and enhance both organizational and family-based support to strengthen resilience and improve care quality.