There is a part of nursing we do not talk about. Not in school. Not in orientation. Not even with each other most of the time. It is the part where you learn to function in environments where violence, whether real or threatened, becomes part of the job. And over time, you start to notice something: You are not reacting to the stress the way you used to, and you are not entirely sure when that changed.

I have worked in psychiatric nursing for nearly two decades. I have been threatened, put in unsafe situations, and was once part of a workplace lockdown after a former patient made credible threats of a shooting on our unit. This was not vague or impulsive talk. The patient had a known history of making similar threats. After discharge, he was later found with a shotgun in his vehicle when apprehended. He had previously brought a firearm to his workplace and threatened people there before he was ever admitted to us. That day, law enforcement flooded the campus. Everything stopped. And then eventually, everything resumed. Like it always does.

The hidden violence within nursing environments

I have also seen things that are harder to explain away. Violence or aggression not just from patients, but between staff. A nurse manager’s windshield shattered in the parking lot. A coworker nearly run down by another employee’s car after a dispute. A physical altercation in a clinical space where safety should be a given. Multiple instances of slashed tires in the employee parking lot. These are not stories we tell publicly. But they happen. And they stay with you in a way you do not fully process at the time.

We often talk about “nurses eating their young.” But that phrase misses something deeper. When you work long enough in high-stress environments, especially where safety is never guaranteed, something shifts. People become more guarded. More reactive. Less patient. Not because they are bad people. Because they are operating in a system that keeps them in a constant state of tension, with no real place to put it.

The silent toll of cumulative stress

No one walks around diagnosing themselves. Not seriously. But you notice things. You scan rooms without thinking about it. You are aware of exits automatically. Your body tightens when voices escalate, even when it has nothing to do with you. You go home after a shift, and it takes time to come down, not physically, but mentally. And you do not always talk about it. Not because it does not affect you, but because it has become part of what the job expects you to carry. Because in nursing, there is an expectation: You handle it. You move on. You come back for your next shift.

Preparing the next generation of nurses

My nephew is about to enter this profession. He will graduate soon, pass his boards, and likely start working as a nurse this summer. I have thought a lot about what I would want him to know. Not to scare him. Not to discourage him. But to be honest. Because nursing still matters. It is still meaningful work. It still changes lives. But there are parts of it you only understand once you have lived it. New nurses deserve more than encouragement. They deserve preparation.

They should know how to:

• advocate for their safety
• recognize unhealthy environments
• set boundaries early
• support each other instead of turning on each other

Because the job is already hard enough. We should not be adding to it ourselves.

There is also a broader conversation that needs to happen about longevity in roles like this. When you spend years, sometimes decades, working in environments where the risk of violence is real, cumulative stress matters. It adds up. And it should be recognized, not just emotionally, but structurally, in how we support and retain experienced nurses.

I do not want to scare the next generation of nurses. But I do not want to mislead them either. Because the truth is: The hardest parts of this job are not always clinical. Sometimes it is what you carry with you after the shift ends, and bring back with you the next day. And sometimes it is realizing that the people beside you should feel like your support system, not another source of stress.

Adam J. Wickett is a psychiatric nurse.