Given the complexity and, at times, life-or-death nature of their jobs, nurses and other health care workers need to function at the highest possible level. Yet various factors can compromise a nurse’s ability to do their job, including a lack of appropriate resources and on-the-job stress.
Nurses are subject to multiple stressors on a daily basis, including difficult patient care situations and lengthy shifts. Combined, these stressors can negatively impact their mental health. Mental health struggles can lead to poor job performance, which in turn can contribute to decreased patient satisfaction, poor patient outcomes and even, potentially, increased mortality rates.
While the issue of mental health for nurses has always been important, it took on greater urgency during the COVID-19 pandemic. The pandemic has taken a tremendous and ongoing toll on the mental health of nurses and other front-line health care providers. A survey of more than 1,100 health care workers by Mental Health America at the height of the pandemic revealed a substantial increase in reports of various mental health concerns, with 86% reporting feelings of anxiety and 76% saying they were exhausted and burned out.
Nurses’ mental health concerns will continue to be a critical issue even as the pandemic subsides. Health care organizations can support nursing staff by creating a culture that values and promotes good mental health. Additionally, numerous resources and strategies exist to help nurses cope with the challenges of the profession, including peer support groups and self-care strategies.
Examining the Link Between Mental Health and Nursing
Nursing is both physically and psychologically demanding. Nurses may face countless sources of stress in a given shift, all of which can impact their mental health, including:
- Heavy workloads — A nationwide nursing shortage — due in part to an increased demand for health care services and a wave of nurse retirements — has forced some hospitals and health systems to function with skeleton crews, leading to heavier workloads for existing nursing staff.
- Long shifts — Due to staff shortages and the need to provide round-the-clock patient care, 10- to 12-hour shifts, including overnight shifts, are not unusual for nurses. These shifts may disrupt natural sleep patterns and leave nurses feeling fatigued.
- Health and safety concerns — Inadequate staffing and insufficient resources, such as the lack of personal protective equipment (PPE) seen during the COVID-19 pandemic, put nurses’ personal health and safety at risk.
- Patient mortality — The death of a patient is one of the most difficult aspects of a nurse’s job and can exact a significant mental and emotional toll.
- Workplace bullying — As in other professions, nurses may experience workplace bullying, either from patients or co-workers. A hostile work environment can also impair mental health.
Importance of Nurse Mental Health
The stressors mentioned above can lead to a host of mental health issues, including anxiety and depression. Poor mental health is also a major factor contributing to burnout — defined as emotional and physical exhaustion, detachment and a sense of ineffectiveness — among health care workers.
Nurses’ mental health and nursing care are connected — if the former is diminished, the quality of the latter usually suffers. Numerous studies have demonstrated a clear link between nurses’ mental health and the quality of the patient care they provide. A 2020 report in the American Journal of Health Promotion revealed that nurses with poor mental and physical health were 26% to 71% more likely to report making medical errors, with depression ranking as the leading cause of such errors. Poor mental health among health care workers also is associated with increased odds of being involved in a medical malpractice lawsuit.
In addition to having an impact on patient care, the mental health struggles of nurses can lead to increased turnover and absenteeism, exacerbating staffing shortages and decreases in patient satisfaction.
Nurse turnover exacts a significant financial cost as well. According to NSI Nursing Solution’s 2021 National Health Care Retention & RN Staffing Report, the average hospital loses between $3.6 million and $6.5 million each year as a result of turnover in its nursing staff.
Impact of COVID-19 on Nurses’ Mental Health
Because nurses have been on the front lines of the fight against COVID-19, the pandemic has been especially hard on them. Their experiences during the pandemic have underscored the importance of addressing nurses’ mental health concerns.
Numerous surveys indicate nurses have experienced increased levels of stress, anxiety and exhaustion since the arrival of the pandemic. A recent survey of nearly 10,000 nurses conducted by the American Nurses Foundation (ANF) found the following results:
- Reported feeling stressed: 75%
- Reported feeling overwhelmed: 62%
- Reported feeling anxious: 58%
These numbers have climbed steadily since the ANF first began surveying nurses about their mental health and wellness in the summer of 2020. Additionally, 34% of nurses in the most recent ANF survey reported that they were “not emotionally healthy.”
Staffing shortages, a lack of vital resources like PPE and concerns over infection and the risk to their families have been among the largest contributors to nurses’ mental health struggles during the pandemic. Recognizing the strain the pandemic has placed on nurses, many organizations have begun prioritizing the mental health of nursing staff and have shifted from a strategy of intervention to one more focused on mental health promotion and stress prevention.
Providing Mental Health Support for Nurses
Health care organizations have a clear responsibility to promote and provide mental health support for nurses. Besides the benefits to patient care, providing nurses with mental health support provides numerous other potential benefits, including:
- More engaged and efficient nursing staff
- Decreased turnover rates
- Cost savings from reducing the amount of time nurses take off for mental health issues
- Improved patient satisfaction
While health care organizations have increasingly focused on addressing nurses’ mental health concerns, some nurses still feel that a stigma exists around the issue. The ANF survey revealed that 36% of nurses experience some sort of stigma with seeking mental health support, including 8% who said they experience stigma from their colleagues. These concerns were most prevalent among younger nurses (age 34 and under).
According to the survey, 68% of nurses haven’t sought mental health support since the start of the pandemic. Among this majority, 45% said they didn’t need professional assistance, with a significant percentage citing alternative reasons, including not having enough time to seek support (20%), concerns over cost (5%) and fear of retribution from their employer (1%).
Strategies for Improving Nurses’ Mental Health
Health care organizations can support nurses’ mental health in a number of ways, from limiting shift lengths to improving access to professional services. Some of the more effective measures for improving nurses’ mental health include:
Destigmatizing Mental Health Struggles
As evidenced by the results of the ANF survey, the stigma around mental health issues and seeking mental health support persists, which can prevent nurses from getting the help they need. Health care organizations can help to reduce the stigma by normalizing conversations about mental health and ensuring staff are informed about the resources available to them.
Establishing a Culture of Wellness
Organizations can employ several strategies to establish a workplace culture that prioritizes nurses’ mental health, including:
- Promoting evidence-based interventions like mindfulness and relaxation techniques
- Developing policies that prioritize staff well-being, which could involve mandatory breaks, providing adequate parental and sick leave, and limits on shift length
- Appointing a chief wellness officer (CWO) to spearhead efforts to build a wellness culture and provide a voice for the mental health concerns of clinical staff
Addressing Staffing Issues
In addition to limiting shift lengths and providing time for breaks, health care organizations can support the mental health of nurses by ensuring appropriate staffing levels and working around staff shortages. This may involve increasing the use of teletherapy, which has the dual benefit of providing patients with easier access to medical services while reducing the burden on health care workers.
Providing Access to Mental Health Screenings
Nurses and other health care workers should also have access to free and confidential mental health screenings, along with other support programs. These programs can help organizations identify signs of mental health struggles among staff early, preventing burnout and other issues.
Mental Health Resources for Health Care Workers
Because nurses and other health care professionals encounter stressors daily, they need to find ways to cope. Fortunately, there are many mental health resources for health care workers. These include peer-to-peer support groups, free and confidential hotlines, and countless online resources.
When to Seek Help
Because stress often comes with the job, health care workers may find it difficult to know when they should seek help. Symptoms of excessive stress include:
- Physical symptoms — rapid heart rate, muscle tension, headaches, difficulty breathing
- Sleep disturbances — nightmares, trouble falling or staying asleep
- Emotional responses — anger, irritability, guilt
- Difficulty thinking clearly — confusion, trouble concentrating or remembering instructions
Individuals struggling with more pronounced mental health issues may experience prolonged depression, social withdrawal or an inability to cope with daily life. They may also experience burnout or compassion fatigue, which can lead to a lack of empathy for patients. In such instances, professional mental health assistance may be necessary.
Health care professionals experiencing any of the above symptoms or signs of mental health struggles may want to seek out support.
Mental Health Resources
Many mental health resources are designed specifically for nurses and other health care workers. These include:
- Therapy Aid provides access to pro bono and low-cost short-term therapy for essential workers, including health care professionals, teachers, EMTs and others.
- The Frontline Therapy Network, launched at the onset of the pandemic, provides free therapy to medical personnel, first responders and veterans, including up to six free therapy/teletherapy sessions.
- NurseGroups brings together nurses in free and confidential videoconference groups to process the mental health impacts of the pandemic.
- PeerRxMed is another free peer-to-peer service that connects health care professionals with their peers, offering support, encouragement and skill-building.
In addition to these services, the American Nurses Foundation’s Well-Being Initiative — a partnership formed by several nurse advocacy groups — provides information and access to tools and resources for improving the mental health of nurses including:
- The Moodfit app allows individuals to track various metrics related to their sleep, nutrition and exercise and to monitor their physical and mental well-being. Nurses have access to the premium version of the app at no cost thanks to a grant from the American Nurses Foundation.
- The Happy App Warm Line provides nurses with free 24/7 access to a “support giver,” who they can talk to about self-care, recovery and resilience.
- The “A Nursing State of Mind” podcast, produced by the Association of periOperative Registered Nurses (AORN), is hosted by two veteran nurses who discuss coping mechanisms and address topics like work-life balance and self-care.
The American Nurses Association’s Healthy Nurse, Healthy Nation initiative provides additional resources to support nurses’ mental and physical health and well-being, with a focus on five areas: physical activity, nutrition, rest, quality of life and safety.
Self-Care Tips for Nurses
Self-care is another valuable tool nurses can use to help preserve and improve their mental health. Nurses can adopt a number of self-care strategies and techniques to manage stress and keep themselves mentally (and physically) fit.
Engaging in social activities and prioritizing relationships is one of the most effective ways to cope with stress. Spending time with family and friends was the most commonly cited method for improving mental health and well-being in the American Nurses Foundation survey, with 65% of respondents saying it helped them.
Even when face-to-face interactions aren’t possible — due to social distancing guidelines or simply because of geographic distance — connecting with others via phone or social media can help improve mental health.
Mindfulness and Meditation
Mindfulness techniques, like meditation and breathing exercises, help individuals focus on the present moment and become more aware of their thoughts and feelings. Both are proven methods for reducing stress and anxiety,
Exercise is frequently cited as a stress reliever. Cardio-focused workouts like running or walking, weightlifting, pilates, yoga or tai chi all are effective methods for working off job-related stress and boosting endorphins, which helps improve mood.
Nursing is a physically demanding profession that often requires nurses to spend upwards of 10 to 12 hours on their feet, making it difficult to find the time and energy for exercise. But incorporating physical activity into their personal routine on days off is critical, even if it’s something as simple as cleaning the house.
Eating healthy is another important self-care tip. Stress can lead to over- and undereating, as well as to eating foods that aren’t conducive to optimal physical and mental health,
Getting enough sleep is an essential self-care strategy. Chronic stress can disrupt sleep patterns, which ultimately affects job performance. Adequate sleep helps restore both physical and mental health.
Healthy sleep habits like limiting alcohol consumption, avoiding screen time at least an hour before bedtime, and going to bed at the same time each night and waking up at the same time each morning can help improve sleep.
Other Self-Care Tips
Many other self-care tips and tricks are conducive to mental health. Respondents to the American Nurses Foundation’s mental health and wellness survey mentioned spending time in nature, practicing gratitude, journaling and engaging in leisure or entertainment (e.g., reading, listening to music) as effective methods for improving their well-being.
Prioritizing Nurses’ Mental Health
The mental health of the nursing workforce is of paramount importance, impacting everything from job satisfaction and performance to retention and, ultimately, patient outcomes. Nurses who are able to manage stress and anxiety are better equipped to provide optimal patient care, while those struggling with their mental health are more prone to commit errors and compromise patient safety.
Long shifts, staff shortages and a lack of resources all put a strain on nurses’ mental health, so it’s critical for health care organizations to support nursing staff. Actions aimed at destigmatizing mental health issues include promoting a workplace culture that prioritizes mental health and providing access to mental health resources. Peer support groups and self-care strategies can further protect and improve nurses’ mental health and enable them to perform at the highest level.
The nurse leaders of tomorrow will be instrumental in establishing workplace cultures that promote mental health. Learn how the University of North Dakota’s online Master of Science in Nursing program can help you develop the skills to become a nurse leader.
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American Association of Colleges of Nursing, Nursing Shortage
The American Institute of Stress, 42 Worrying Workplace Stress Statistics
American Journal of Health Promotion, “Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review”
American Nurse, “Promoting Nurse Mental Health”
American Nurses Association, Healthy Nurse, Healthy Nation
American Nurses Association, Mental Health and Wellness Survey 3
American Nurses Association, Nurses’ Guide to Mental Health Support Services
American Nurses Association, Well-Being Initiative
American Nurses Foundation, “Pulse of the Nation’s Nurses Survey Series: Mental Health and Wellness”
Business Insider, “Nurses Reveal the 11 Hardest Parts of Their Job, from the Death of Patients to Not Having Time to Pee During a Shift”
Forbes, “It’s Not Just a Shortage of Nurses but of Training and Understanding”
Frontiers in Public Health, “Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority”
The Hastings Center Report, “COVID-19: Ethical Challenges for Nurses”
Healthy Nurse, Healthy Nation, “Stress Reduction Tactics Every Nurse Should Try”
Mental Health America, The Mental Health of Healthcare Workers in COVID-19
National Alliance on Mental Illness, Health Care Professionals
NSI Nursing Solutions, 2021 NSI National Health Care Retention & RN Staffing Report
U.S. Bureau of Labor Statistics, Charts of the Largest Occupations in Each Area, May 2020