Nurse Mental Health Guide: Statistics, Initiatives, and Resources

The Importance of Mental Health in Nursing

Nurses are the backbone of the medical profession. Whether you’re an LPN, RN, or APRN, you are an indispensable part of the team. You know how to handle high-stress situations. You make critical decisions on a daily basis. You heal patients, comfort frightened families, and handle complex systems with grace & skill.

That’s the ideal. But the modern world and a global pandemic have conspired to make nursing an increasingly difficult profession.

• Understaffing, bureaucratic overload, extended working hours, increased liability, and toxic workplace environments have become a huge drain on mental health.
• Burnout, depression, and anxiety are rising fast in medical workplaces.
• And doctors and nurses aren’t being screened for mental health risks in the same way as patients.

If you’re struggling with your mental health or worried about the stigma of speaking up, remember:

• Heroes aren’t needed in healthcare environments; humans are.
• Caregivers must be cared for in order to take care of others.
• Working with the sick requires a healthy mind and healthy body.
• Sleep, nutrition, exercise, social support, and self-care come first.

Skim through the guide or skip to the list of mental health resources. It includes details on helplines, peer-to-peer support groups, free therapy sessions, and more.

Mental health is a major area of concern in nursing circles. In a landmark 2021 study on Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority, the authors outline many of the long-term issues and make the call for immediate change.

Nursing Suicide

That’s because nurses are literally dying on the job.

• In 2020, Davidson et al. published A Longitudinal Analysis of Nurse Suicide in the United States (2005-2016) with Recommendations for Action. The authors of this UC San Diego study found that female & male nurse suicide rates from 2005 to 2016 were significantly higher than the general population.
• In 2021, a U-M study on the Association of U.S. Nurse and Physician Occupation with Risk of Suicide confirmed these findings. The U-M authors found that female nurses were roughly twice as likely to die by suicide than the general female population. Tellingly, nurses were 70% more likely to die by suicide than female physicians.

Chronic Issues

Suicide is the worst-case scenario. But nurses are dealing with mental health struggles that affect every aspect of their daily lives.

• In 2018, Melnyk et al. published A National Study Links Nurses’ Physical and Mental Health to Medical Errors and Perceived Worksite Wellness. This cross-sectional survey of 1,790 nurses across the U.S. found that over half of the nurses reported experiencing poor mental & physical health, and approximately one-third reported depression. Depression was the leading predictor of self-reported medical errors.
• Melnyk and her colleagues followed up this study with another in 2021 on Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors. Unsurprisingly, nurses in poor physical and mental health reported significantly more medical errors than nurses in better health.

Keep in mind, too, that this is a global issue. International nurses have been working in poorly funded medical systems for years. They’ve been grappling with the SARS outbreak in Hong Kong, the 2013-2016 Ebola epidemic in West Africa, the 2015 MERS oubreak in the Republic of Korea, and more. In the 21st century, nurses face crises on multiple fronts.

How Has COVID-19 Affected Nurses Mental Health?

The arrival of the pandemic has added a steady stream of gasoline to the fires of existing problems. Suddenly:

1. Nurses who were already dealing with unrealistic workloads and tough rotation schedules were being asked to step up into high-risk frontline positions for an unknown length of time. Sleep became a thing of the past.
2. Patients flooded into the system, overwhelming the usual channels of triaging and care management. Misled by false public health information, families grew hostile and belligerent.
3. Due to poor planning and confusion, many healthcare institutions were short on personal protective equipment. The crisis exposed gaps in training and staffing. Nurses were being shoved into situations where they felt vulnerable and underprepared. In a number of cases, healthcare workers died on the job.
4. Those that did survive couldn’t—or didn’t want to—go home. Many nurses are caregivers of children and elderly parents. The risk of infecting loved ones became a constant & overriding worry.

In consequence, the mental health of nurses has taken a severe hit.

• Inequities: Female healthcare workers and nurses of color have borne the brunt of the crisis. See the 2021 article on gender, race, and health workers in the Lancet for more on the data.
• Trauma: Nurses and frontline workers have experienced a rise in trauma-related stress, with a prevalence ranging from 7.4% to 35%. See the 2020 impact review in Frontiers in Psychology for details.
• Chronic Conditions: Depression, anxiety, and PTSD have all spiked during COVID-19. See the 2021 systematic review & meta-analysis in PLoS ONE for proof.
• Moral Injury: Because they had to prioritize patients & available resources, nurses must now live with the idea of moral injury—the ambivalence & guilt of not being able to save everyone. See the 2022 article on managing mental health challenges in BMJ for further explanation.

As a result of this sustained pressure, nurses are experiencing a) Post-Traumatic Stress Disorder; and b) burnout.

• PTSD: Post-Traumatic Stress Disorder affects people who are exposed to potentially traumatic episodes. Symptoms can include intrusive memories & nightmares; avoidance of thinking or talking about the events; negative changes in thinking & mood (e.g. being emotionally numb or detached); and changes in physical & emotional reactions (e.g. being easily startled or hyper-alert, troubles with concentration, etc.).
• Burnout: Burnout is the result of chronic workplace stress. Symptoms can include being constantly tired or exhausted; feeling alienated and mentally distant from one’s job; and finding it difficult to concentrate, handle job responsibilities, or get excited about one’s work.

Nurses increasingly feel exhausted, underappreciated, and at risk of making errors. And they’re responding by stepping away.

• Hospitals have been experiencing labor shortages throughout COVID-19, with nursing staffing being an area of key concern.
• In a 2021 study on COVID-Related Stress and Work Intentions, published in Mayo Clinic Proceedings, 2 in 5 nurses said that they were moderately likely (or higher) to leave their current practice. The statistics are just as bad in the UK, especially in NHS hospital settings.

If healthcare institutions don’t prioritize the mental health of their nurses and doctors, they won’t have anyone left to care for patients.

The old ways of dealing with mental health in nursing are obviously not working. Relying on nurses to be “heroes” or deal with psychological challenges on their own is not only unrealistic, it’s dangerous. Nurses spend all of their time caring for others. They need people to step in.

Basic Changes

In the wake of the pandemic, many healthcare providers leapt to offer support hotlines, mindfulness courses, and crisis counseling. But these are short-term solutions to deeply rooted problems. In reality, institutions like hospitals and clinics can begin to improve the mental health of employees by tackling fundamentals such as:

• Safety in the Workplace: e.g. improving access to personal protective equipment; implementing better training procedures; protecting nurses from patient & family violence; instituting non-punitive responses to medical errors; using virtual tools to reduce the risk of exposure; etc.
• Reasonable Working Conditions: e.g. offering better pay & benefit packages that include professional counseling; implementing shorter shifts that leave time for family, sleep, and recharging; addressing toxic workplace issues immediately; fostering a sense of pride & self-worth amongst all staff; improving healthy cafeteria food; recruiting more staff; etc.
• Clear Communication & Staff Support: e.g. being open about mental health at all levels; involving staff in local solutions; providing useful mental health resources; always leaving the management door for questions & concerns; helping with self-care planning; etc.

Social Support Networks

Social support is a critical component in mental health for nurses. Multiple studies have shown that family & friends are the most important stress coping mechanism for healthcare workers. Although independent help from counselors, therapists, and other professionals can be utilized, there’s still a stigma attached to asking for it in a healthcare workplace. In reality, nurses turn to their social networks first.

To support this network, employers must plan for sensible working hours and time off. Supervisors can also actively foster peer support groups and buddy teams. These types of in-house groups can have their pros & cons, but they do provide an outlet for nurses who want to talk to someone who understands all of the ground-level issues.

Reflective Rounds

Healthcare institutions are seeing some success with reflective rounds (e.g. Schwartz Rounds, Balint groups, etc.). Although they’re similar in structure to traditional patient rounds, reflective rounds/practice groups are intended for staff. And they’re often facilitated by clinical psychologists or consultants.

Staff members are invited to share their personal experiences & stories on a pre-selected subject (e.g. working the night shift) and other participants are able to respond. In addition to reducing the risk of burnout, reflective rounds may also improve communication & collaboration across disciplines.

Training & Intervention Programs

Institutions are also beginning to offer mental health programs that are designed to provide nurses with resilience training. Examples of these independent interventions include:

• OSU: MINDBODYSTRONG: An evidence-based, orientation program led by trained facilitator that provides a workbook-based, 7-session cognitive behavior therapy program for new nurses and other clinicians.
• WHO: Self-Help Plus (SH+): A group-based, 5-session stress management intervention course that’s designed to teach stress management skills.
• Osmosis Nursing Resilience Course: An interactive e-learning course on mental health training that’s designed to help participants cope with stressors in & outside of a nursing environment.

Nursing schools have their part to play in these efforts. RNs and APRNs who have been exposed to therapy and are trained in resilience & self-care strategies are going to be better prepared for the work that lies ahead.

Helplines

• Frontline Responder Services Helpline: 1-866-676-7500
• NAMI HelpLine: 1-800-950-6264
• National Suicide Prevention Lifeline: 1-800-273-8255 (24 hours a day)
• Nurse2Nurse Peer Support Helpline: 1-844-687-7301
• SAMHSA Disaster Distress Helpline: 1-800-985-5990
• SAMHSA National Helpline: 1-800-662-4357

Peer-to-Peer Programs

• Disaster Response Assets Network: Free online peer support groups for frontline responders and healthcare professionals; held on a weekly basis via Zoom chat.
• Nurse Groups: Free & confidential videoconference groups for nurses who wish to connect and process issues related to COVID-19.
• Online Frontline Assistance Program: A list of online support groups for emergency responders & healthcare workers, organized by the American Academy of Experts in Traumatic Stress (AAETS).
• PeerRxMed: Free peer-to-peer program for physicians and healthcare professionals. Arrange for regular weekly, monthly, and quarterly check-ins with a PeerRx partner.

Free Therapy Sessions

• Covid Calm: Free mini-workshops for healthcare professionals that tackle stress management—request a group session.
• Frontline Therapy Network: Free therapy/teletherapy sessions for first responders, medical personnel, and veterans.
• The Emotional PPE Project: A free service that connects healthcare professionals with licensed mental health professionals who can help. No insurance required.
• Therapy Aid Coalition: Free online therapy sessions for U.S. essential workers, including frontline healthcare professionals.

Mobile Apps

• CrewCare: Resilience-focused app for first responders and healthcare professionals.
• Heroes Health: Free mobile app that helps healthcare professionals and first responders monitor their mental health and gain access to mental health resources.

Screenings & Referrals

• American Nurses Association (ANA): Nurse Suicide Prevention/Resilience Webpages: For nurses who need immediate help or those who are dealing with the aftermath of a co-worker suicide.
• Pandemic Crisis Services Response Coalition: Help for Helpers: Free crisis counseling, links to helplines, and useful articles.
• UC San Diego: Healer Education Assessment and Referral (HEAR): An independent service that provides healthcare providers with confidential screenings and personalized referrals to mental health services.

Tools & Resources

• American Holistic Nurses Association (AHNA): Stress Management Resources: Holistic self-care strategies for nurses.
• American Psychiatric Nurses Association (APNA): COVID Resources: Resources that support better mental health for healthcare professionals and their patients.
• Healthy Nurse, Healthy Nation™ Grand Challenge: A friendly competition with individuals & partner organizations to improve nursing health. Sponsored by ANA Enterprise.
• National Academy of Medicine (NAM): Clinician Resources: Info on how to support the health and well-being of clinicians during public health emergencies, including the COVID-19 response.
• National Alliance on Mental Illness (NAMI): Healthcare Professionals: Advice and resources.
• Schwartz Center: COVID-19 Resources for Healthcare Professionals: Videos, articles, tips, and weekly webinars for healthcare workers.
• Well-Being Initiative: Free tools, podcasts & apps to support the mental health and resilience of nurses. Created by the American Nurses Foundation (ANF).