School Nursing

The Relentless School Nurse: ACEs Impact Nurses More Than We Realized

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“We just did a survey of our staff in our outpatient clinics that included knowledge and attitudes about ACEs and trauma-informed care.  The survey included a personal ACE score (anonymous).  Nurses had the highest average score, by far, at 4.  I don’t see much in the literature about ACE scores of nurses in the community.  Anyone have references on this?” –

I ran across this message on  and not only did it catch my attention, but it also made me want to dig deeper. Could it be true that nurses have a higher ACEs score than other healthcare professionals? It seemed true in this small survey, but was this a representation of a trend? If it was, the implications in nursing practice could be tremendous and concerning.

What I found was that there is a grand canyon gap in research. The minimal studies that do exist confirm that nurses self report a higher ACEs score than the general population. Is there a link between high ACEs and compassion fatigue? Does this impact health outcomes for our patients/students/families? What are the implications for nursing education programs? What are we missing and why have we not studied this important component of wellness for nurses?

Perhaps the lack of research into Nurses and ACEs speaks to the culture of nursing that has existed for decades and decades that we must put the needs of all others before ourselves. This unspoken rule, one of the darker secrets of nursing practice reinforces the precept that nurses function at all cost to ourselves. We continue to tolerate intolerable working conditions, unrealistic patient ratios and the inability to stop and pause after an adverse outcome occurs at work. We come to work sick, often letting our own health needs take a backseat to every other responsibility on our overflowing plates.

Does this sound familiar? Would you be willing and/or interested in understanding your own ACE score? What connections could we draw between our own high ACEs and the propensity for job dissatisfaction or burnout? One of the reasons that this resonates with me is that I am one of the nurses with high ACEs. I am also one of the nurses who has faced compassion fatigue, but I never connected the dots until I read the article included in this blog post. It makes sense to me now, but it also makes me want to understand more and take action to buoy my resilience.

To quote my good friend and colleague, Cissy White, “I am not a screen queen.” I am not so sure that the number really matters, but it is important to acknowledge that childhood adversity impacts us as adults. It seems from the scant research available, including anecdotal evidence, that some people with high ACEs are drawn to the “helping professions.”

Karen Clemmer, one of the strongest voices about ACEs and nursing, shared this insight on in response to Martina Jelly’s message posted at the beginning of this blog:

I think you are on to something! There is a dearth of articles focused on nurses or other “helping professionals”.

During an ACEs presentation to 150 “helping professionals” we conducted an ACEs screening (anonymous) and found participant’s scores were higher in 9 of the 10 categories when compared to the original study. Additionally, 1:3 reported that they experienced childhood sexual abuse – there seemed to be a recognition that it is not them, it is us.

Another group of 125 “helping professionals” had an average ACE score of 7. Together we agreed to do a Resilience screening and the results were reassuring. They scored high in each category for sources of positive support. When they reflected back they thought this provided a buffer to the ACEs they experienced. Them seemed to be inspired to apply this understanding when working with their at-risk populations.

Attached and linked below are a few articles on the subject:

Title – Adverse Childhood Experiences in Medical Students: Implications for Wellness. N=98 To read more click HERE

Title – Nursing students who were exposed to more Adverse Childhood Experiences have higher rates of burnout and depression. N=200 To read more click HERE

Title – Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs. N=967

Title – Prevalence of adverse childhood experiences (ACE) among child service providers Approximately 70% reported at least one, 54% reported two or more, nearly 16% reported four or more. To read more, click HERE

Some of the steps I have taken since reading this information was to reach out to Shirley Girouard, PhD, RN, FAAN,  the nurse researcher who authored the article: ACEs Implications for Nurses, Nursing Education, listed in the references section. I asked if she had continued to study this important issue and will report back when she responds.  I also shared the information with The Future of Nursing 2020-2030 because the implications on nursing practice are important for the new study now underway.

I am wondering if national nursing conferences would consider administering ACEs screenings (voluntary participation) to gather large data sets & to see if the current findings are confirmed. In addition to ACEs screenings, Resiliency screening tools can also be administered to counter-balance the potentially distressing information revealed in an ACEs screening. Food for thought and ideas to share. Please comment and let me know what next steps you would find helpful or interesting in addressing this important topic.


ACEs Implications for Nurses, Nursing Education, and Nursing Practice

ACE Scores in Nursing

Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs

What’s Your ACE Score? (and, at the end, What’s Your Resilience Score?)


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