Mental Health For Nurses

Mental health is a state of mental well-being that enables us to cope with the stresses of our lives, realize our abilities, learn, work, and contribute to our family and community (World Health Organization [WHO], 2022). Mental health is an integral part of our overall personal health and is just as important as our physical health. Good mental health is required for us to make decisions every day, build and foster healthy relationships, and continuously adapt to and shape the world we exist in (WHO, 2025). Mental health is crucial to a happy, healthy life.

Mental illness or illnesses are health conditions that involve a change in behavior, thinking, and emotions in an individual (American Psychological Association [APA], 2022). Mental illness is associated with a level of distress that impairs one’s ability to function in social, family, or work-life activities (APA, 2022).

Mental illness is absolutely nothing to be ashamed of, as it is a specified medical condition, just like hyperlipidemia or irritable bowel syndrome. Mental illness is widespread. According to the American Psychiatric Association (APA), in any given year, nearly 20% of American adults experience some form of mental illness (APA, 2022). Mental illness can affect anyone, regardless of gender, income, social status, age, race, ethnicity, religion, sexual orientation, or cultural background (APA, 2022). Many treatment options are available to help people successfully manage mental illnesses to function happily and fully in their everyday lives (APA, 2022).

Burnout is a condition or syndrome characterized by intense emotional, mental, and physical exhaustion due to sustained exposure to high levels of stress (WHO, 2019). It has been classified as a workplace or occupational phenomenon that is the result of chronic, toxic stress and is characterized by these three dimensions (WHO, 2019):

1. A feeling of exhaustion.
2. A strong feeling of negativity related to one’s job or increased mental distancing from one’s job.
3. Overall reduced job efficacy.

Although ‘burnout’ is not a diagnosable medical condition, it has been included in the 11th revision of the International Classification of Diseases (ICD-11) (WHO, 2019).

Burnout can manifest itself in many ways, including the following (Kakacek, 2023):

• Feeling physically drained
• Feeling emotionally depleted
• Digestive issues
• Body aches and pains
• Having trouble concentrating or making decisions
• Inability to fall or stay asleep
• Sleeping too much
• Mentally checking out at work
• Increased use of drugs or alcohol
• Regular tardiness or absences from work
• Withdrawal from social activities 
• Resistance to changes at work/within your unit
• Lack of enjoyment in a job you once loved
• Thoughts and feelings about wanting to quit your job
• Thoughts about leaving the nursing profession altogether

How severe is the issue of nurse burnout? According to the 2023 State of Nursing Report by Nurse.org, 41% of nurses felt they needed better working conditions to prevent or mitigate burnout (Nurse.org, 2023). This report also found that over 100,000 nurses have left the nursing profession in just the last two years (Nurse.org, 2023). In addition, 610,388 nurses reported that they intended to leave the nursing profession by 2027 (Nurse.org, 2023).

Burnout is the result of exposure to long-standing suffering due to a variety of workplace factors (Kakacek, 2023). These factors could include a lack of autonomy or control over personal job and job performance, a lack of unit staffing resulting in excessive workload, inadequate pay, lack of supervisory or managerial support, mental exhaustion due to long working hours and consecutive shifts, or even feeling micromanaged (Kakacek, 2023).

The signs and symptoms of burnout have many similarities with the signs and symptoms of depression. What makes them different? Burnout is experienced in one’s workplace (Chen & Meier, 2021; WHO, 2019). Depression, on the other hand, is a state of psychological suffering that is diagnostically characterized by at least two weeks of a set list of criteria, such as issues sleeping, increased or decreased appetite, that generally includes persistent sadness and a lack of interest or pleasure derived from things one once derived interest or happiness from (Chen & Meier, 2021). Depression is not solely linked to one’s workplace, though a nurse can experience depression and not burnout, or both depression and burnout together. Research has concluded that there might be an association between burnout and depression among nurses; however, it could not establish a causal relationship between the two conditions (Chen & Meier, 2021). They believe that the overlapping symptoms could cause depression, be misdiagnosed, or be missed altogether. This could result in a possible delay in appropriate treatment and an increase in suicidal risk. Still, they also believe that more extensive studies are needed to test the association and learn more about these conditions among nurses specifically (Chen & Meier, 2021). The one conclusion that most concerned researchers was that the results found that as nurses age, the burnout-depression correlation risk increases (Chen & Meier, 2021). They concluded that this may be due to the accumulated work experiences over the career length of the nurse (Chen & Meier, 2021). This, of course, depends on how the nurse is treated and cared for in the event of diagnosis and what measures are taken for prevention.

Now that we have gone over what burnout is and the magnitude of the problem that surrounds it, let’s talk about the dangers of it.

Burnout can have many negative consequences for both nurses and their patients. For nurses, these consequences can include (Kakacek, 2023):

• Increased risk of errors, turnover, missed shifts, and mental health problems such as depression and anxiety.
• Decreased mood, overall career satisfaction, and physical health.

For nurses who are experiencing burnout, their patients can experience the following (Kakacek, 2023):

• Increased risk of complications and length of hospital stay.
• Decreased quality of care and overall care satisfaction.

Burnout can be thought to be very similar to compassion fatigue, but the two are different. We will discuss compassion fatigue next.

Compassion fatigue is the physical, psychological, and mental impact of caring for others through their own experiences of traumatic stress (APA, 2022; WebMD, 2024). Compassion fatigue is thought to be a form of burnout that occurs as a result of a specific experience, whereas burnout is cumulative fatigue over a longer time (APA, 2022; Loera et al., 2022; WebMD, 2024).

Examples of compassion fatigue triggers include (APA, 2022; Loera et al., 2022; WebMD, 2024):

• Being verbally or physically threatened while providing care
• Delivering care under excessive demands (workload, time, etc.)
• The environment in which you are providing care is dangerous
• Being exposed to a traumatic sight or sound while working

Compassion fatigue occurs when triggers or experiences like these affect your mood and thoughts outside the workplace (APA, 2022; WebMD, 2024). When employed in a profession that works so intimately with patients, it is expected to experience this feeling from time to time; however, when these thoughts and feelings start to become overwhelming, they are at the level of compassion fatigue and require attention (APA, 2022; WebMD, 2024).

Here are the signs to watch out for (APA, 2022; WebMD, 2024):

• Drastic shifts in mood
• Becoming more irritable than normal
• Dramatic withdrawal from friends and family
• Heightened level of anxiety
• Depressive feelings/physical symptoms
• Difficulty concentrating
• Insomnia

Moral distress is an emotional state that a nurse experiences due to a situation in which they feel they are taking an action that goes against what they think is ethically correct (Healthy Nurse Healthy Nation, 2022).

Nearly all nurses have experienced moral distress at least once in their careers, but not many nurses have a name for what they are experiencing. It often occurs due to a policy or procedure preventing nurses from doing what they feel is right. When this happens, they experience an ethical dilemma (Healthy Nurse Healthy Nation, 2022). Feeling an ethical dilemma in the workplace and feeling like what we are doing is wrong makes us nurses feel anxious, frustrated, powerless, and often depressed (Healthy Nurse Healthy Nation, 2022).

All nurses can experience some level of moral distress. Still, those at a higher risk are those in high-risk units, including emergency rooms, operating rooms, and intensive care units (ICU) (Healthy Nurse Healthy Nation, 2022).

Specific examples of events that could cause moral distress are:

• A neonatal intensive care unit (NICU) nurse is asked to give a vaccination to an extremely low birthweight infant. Still, it could technically wait until the infant is older and more stable. The physician is unwilling to postpone vaccination because they feel it is not necessary to wait.
• A pediatric nurse practitioner (PNP) suggests a course of treatment for a child, but the child’s family cannot afford the medication and chooses not to fill the prescription.
• A cardiovascular intensive care unit nurse is taking care of a patient who is dying and wants to allow the whole family to visit. Hospital policy is to only allow two family members at a time in the room, and the nurse is concerned the patient does not have enough time left for all the family to answer in pairs of two.

Any of these situations, including others that you have personally been involved in, have the potential to make you very uncomfortable in weighing the thoughts of “this is hospital policy” and “this is what they want me to do” with the views of “this is against what I think” or “this is against what I believe in.” These thoughts elicit feelings of discomfort, which can manifest in the following physical symptoms (Healthy Nurse Healthy Nation, 2022):

• Headaches
• Abdominal pain
• Nausea
• Insomnia
• Nightmares

Once nurses realize what moral distress is and what situations elicit these feelings, the quicker we can identify them in the future and the more equipped we will be to overcome them. 

Managing moral distress necessitates the development of (Healthy Nurse Healthy Nation, 2022):

• Moral courage, which is cultivating the strength to speak up, even though there could be repercussions.

AND

• Moral resilience, which is our ability to restore our integrity after experiencing moral distress.

When medical errors occur, the “first victim” is easily identified as the patient and their family members (Vanhaecht et al., 2022). The less known and understood victims, the “second victim,” is that of the healthcare professional involved in that medical error (Vanhaecht et al., 2022).

The second victim phenomenon, or second victim syndrome, is when a healthcare professional is involved in an adverse patient event, injury, or error and subsequently is negatively impacted by their involvement (Vanhaecht et al., 2022).

Second victims often feel personally responsible for the unexpected, unintended event; they feel as if the blame is all on them, believing they are a failure, and may feel like they are not good at their job as healthcare professionals (Vanhaecht et al., 2022). Nurses who experience this phenomenon could have been involved in administering the wrong medication, giving the wrong dose of medicine, overlooking a sign of deterioration in their patient, or missing a physical sign in their assessment. The value of determining the existence of a second victim phenomenon is that we are now more aware that we, as nurses, can also be harmed in these medical error situations (Vanhaecht et al., 2022). With more awareness comes a better understanding that the nurse needs help and support as well.

Knowledge of this phenomenon can also help nurses recognize that they are not alone in their feelings after being involved in an adverse event. This should validate their feelings, thoughts, and emotions, allowing them to cope (Vanhaecht et al., 2022). Most adverse medical events and errors can be directly related to a systemic or organizational flaw or failure beyond the actual impact or influence of the individual healthcare worker (Vanhaecht et al., 2022). Organizations should apply this knowledge to drive change and prevent errors in the future.

Suppose you or one of your colleagues has been involved in an adverse patient event. In that case, you know that following an event comes a root cause analysis, possibly a nurse write-up, or maybe a meeting with your educator or nurse manager to discuss a plan to prevent errors in the future. In some cases, errors such as these can result in formal complaints, lawsuits, and board of nursing involvement. Of course, any of these sequelae would have a tremendous impact on the practicing nurse. But what is less discussed is the mental health impact that the nurse endures as the second victim. It is not meant to eliminate blame, reduce responsibility, or devalue the experience of the first victim.  Instead, this phenomenon aims to raise awareness that all healthcare workers, including nurses, are human beings who make mistakes and that they experience the guilt and shame associated with these mistakes (Vanhaecht et al., 2022). With the evidence of the existence of this phenomenon, research has aimed to empower healthcare organizations to recognize this concept, furthering research and training to support patient safety initiatives, improve care, and acknowledge that the healthcare workers involved require their support to recover and continue working with patients with their mental health in check (Vanhaecht et al., 2022).

If you are involved in a future error, it is crucial to speak up immediately and let someone know. Although you might have concerns about what might happen to you, our job is to protect our patients. You can be instrumental in helping to identify and improve a broken system within your organization by stepping up and acknowledging the mistake. By doing so, we all can continue to improve patient care and outcomes. Do not forget, though, that the guilt and fear you feel post-event are real, valid, and normal. Talk to someone you trust, question your organization as to how they can assist you in moving forward and preventing these errors in the future, and reach out to a professional if you need any additional help.

Bullying, incivility, and workplace violence are some of the biggest problems within the nursing profession. Each one of these is a form of abuse in the workplace. It is no secret that nurses are at a high risk of violence in the workplace (American Nurses Association [ANA], n.d.-a). According to the Press Ganey Survey Report of 2021 (ANA, n.d.-a):

• Two nurses are assaulted every hour in acute care
• 25% of nurses experience some form of assault
• 20-60% of incidents are never reported, meaning we do not hear about most of them
• 13% of days called off from work are due to workplace violence

Bullying in nursing is defined as repetitive, harmful actions done to embarrass or cause distress to a nurse (ANA, n.d.-a). This can include verbal attacks, intimidation, and degradation (ANA, 2025). Actions of bullying can have a significant negative impact on nurses who are bullied, including lasting psychological and physical effects (ANA, 2025). In many cases of nurse-to-nurse bullying, there is an abuse or misuse of power that can generate feelings of defenselessness and undermine the individual’s dignity. It could be from the top down in the form of the employer against an employee or even the employee against the employer (ANA, 2025).  It can even be horizontal, with two nurses on the same level.

Incivility is disrespectful actions towards a nurse (ANA, n.d.-a). This can include name-calling, using a condescending tone, expressing criticism of an individual in a public way, spreading rumors, or even refusing to assist a colleague when asked for help (ANA, 2025). These actions impact the dignity of the nurse and disregard the professional standard of basic. Incivility can often be a precursor to bullying and workplace violence (ANA, 2025).

Workplace violence (WPV) is defined as any threat or act of physical, sexual, or psychological violence, intimidation, or harassment that comes from either patients, patients’ families, or other hospital personnel (ANA, n.d.-a). Workplace violence can be perpetrated by an employee of the organization or, often, a patient (ANA, 2025). Examples of workplace violence include written or verbal threats, physical or verbal assault, assault with a weapon, verbal or physical harassment, or homicide. Workplace violence can lead to temporary or even permanent injury, emotional suffering, and sometimes, even death (ANA, 2025).

Any of these acts of generalized aggression is unacceptable and has no place in the workplace, much less in a place of healing for patients. These major issues can have severe effects on the well-being of nurses, as well as impact their ability to care for their patients effectively (ANA, n.d.-a). We know that these events contribute to the development of psychological conditions, including anxiety and depression, and can significantly decrease the nurse’s job satisfaction.

What other potential detrimental effects do incivility, bullying, and workplace violence have on the nursing profession? These can include (ANA, 2025):

• Decreased career satisfaction
• Decreased personal health
• Decreased commitment to job
• Decreased self-worth
• Decreased self-confidence
• Physical symptoms, including headaches, abdominal issues, issues sleeping
• Increased rate of psychological complaints of stress, anxiety, depression
• Risk of post-traumatic stress disorder (PTSD)
• Nurse turnover in a particular unit
• Decreased productivity in the unit
• Avoidance of work/increased call-outs
• Cost to employers
• Cost to nurse victims
• Leaving the job/unit/hospital
• Leaving the nursing profession altogether

What can WE do? First, we must educate ourselves on these events, what they are, what they look like, and that they are not okay. These are not things that “come with the territory” that we are supposed to dismiss as “part of the job.” We must also educate ourselves on maintaining a safety culture in our workplace (ANA, n.d.-a). Both bedside staff and leadership must work together to ensure nurses stay safe.

To mitigate these issues in the nursing field, the ANA, as a form of primary prevention, recommends that nurses commit to accepting responsibility for their words and actions, promote healthy interpersonal work relationships with one another, be cognizant of how we communicate with others so as not to outwardly and intentionally offend anyone, demonstrate respect for others, advocate for incivility and bullying identification and prevention, and aspire to continuously uphold our professional code of ethics (ANA, 2025). As secondary prevention, the ANA recommends that when a nurse experiences incivility and bullying, they either respond directly or seek out guidance through their appropriate chain of command. For nurses who witness incivility or bullying, they are encouraged to approach the perpetrator to help them recognize that what they are doing or saying is wrong, and then approach the victim to offer support. The witness can then encourage the victim to report that behavior to their employer (ANA, 2025).

In the event of workplace violence, we need to (ANA, n.d.-a):

• Initiate safety protocols specific to your workplace
• Stay alert
• Keep an eye out for warning signs of escalating behavior
• Try to de-escalate behavior, if in any way possible
• Utilize any physical barrier for your protection when indicated
• Use self-defense when it is appropriate
• Report the event immediately

The ANA also shares the following acronym that we can use when reporting these incidents (ANA, n.d.-a):

• S = Situation = Explain the situation
• T = Type = Give the type of workplace violence, whether it be verbal, physical, or weapons involved
• O = Observers = Provide a list of any witnesses you had
• P = People = Provide a list of anyone present for the event

• W = When/Where = Define when and where the event occurred
• P = Preceding factor = Explain what led up to the event occurring
• V = Verify = Specifically describe any injuries that were sustained, including emotional, physical, or verbal threats that were made

The ANA developed a position statement for incivility, bullying, and workplace violence, stating that if workplace violence is witnessed but then not acknowledged and reported, the individual who witnessed the event is only perpetuating the violence further (ANA, 2025).

The effects of the COVID-19 pandemic on the nursing profession were felt immediately and will continue to be felt in some way for many years. It exposed underlying systemic and organizational issues, and it generated new problems in the training, education, hiring, and retention of nursing staff. Nurses were under stress both at home with their families and at work, facing major surges in patient volumes, increases in patient acuity, end-of-life situations, hospital policies that we disagreed with but had to enforce, keeping families apart from each other, and equipment and personal protective equipment (PPE) shortages. Nurses suffered a moral injury and secondary trauma as a result (Chan et al., 2021). For many nurses, leaving the bedside or their position as a nurse was necessary to prioritize their mental health.

Chances are that either you or one of your colleagues has suffered from imposter syndrome at some point in your career. Imposter syndrome, although not specific to the nursing field, is the enduring lack of ability to believe that your success has been deserved or legitimately achieved (Pate, 2023; Peng et al., 2022). You get stuck in this mental headspace where you believe that you do not deserve the job or position you have and that you are not good enough to do the job effectively. Research has found that the prevalence rate of imposter syndrome among over 14,000 participants varied widely from 9 to 82%, depending largely on the screening tool and timeframe assessed in each study (Bravata et al., 2019).

Both men and women, adolescents to seasoned professionals in all career fields, can suffer from imposter syndrome. Typically, it is caused or exacerbated when a professional moves from a role in which they were highly experienced and felt confident to a new position (Pate, 2023). Change can be challenging for everyone, and sometimes, change can trigger feelings of self-doubt and discomfort that can morph into imposter syndrome.

Who is at the most risk? These individuals can include (Pate, 2023):

• Women
• Ethnic minorities
• Members of the LGBTQIA+ community
• Racial minorities

What exactly does imposter syndrome look like? Well, nurses who feel they might not be good enough for the job they have often try to overcompensate, sometimes without even knowing, by taking a deep dive into their new role, spending lots of time studying, showing up to work early to read everything there is about their patients, getting to know their management and doing everything they can to look good, offering to take extra shifts, and even taking on more challenging patients. To them, if they keep putting themselves in these situations, maybe they will eventually feel more skilled and more deserving of the role they serve. In other cases, such as a new nurse manager or someone in upper leadership, they might work extra hours, stay late most days, try to multitask to get more done each day, and attempt to continuously impress their superior to feel more validated in their position.

These might sound like relatively positive things, but they are not sustainable long-term. Behaving like this will ultimately lead to burnout or other mental health issues like anxiety or depression. It is already stressful to believe that you are undeserving of what you have and have somehow not earned the right to be where you are in your career. It is another thing trying to overcompensate for these feelings by absolutely exhausting your mind and body, constantly striving for perfection, not tolerating less than perfection from yourself, and beating yourself up when you do not meet the unrealistic expectations you have set for yourself, to try to prove to others that you do deserve it. Some nurses go the opposite direction, and instead of requiring perfection of themselves, they end up coping by procrastinating or neglecting their duties because their anxiety ultimately paralyzes them. The fact is, you do deserve where you are, and you deserve the opportunities that have been afforded to you. You have worked so hard to get where you are, and it is normal to question things when something works out so well for you. Please take a deep breath, know that you are worthy, that this feeling will fade, and continue doing your best without overdoing it or overexerting yourself.

The nursing shortage has achieved crisis levels, with 81.3% of hospitals in the United States reporting nurse position vacancy rates higher than 10% (Relias, 2022). The nursing shortage impacts all areas where nurses are employed and all levels within healthcare institutions. The ANA drafted a letter in September 2021 to urge the U.S. Department of Health and Human Services (HHS) to declare the current shortage a national crisis. Significant changes must be made to mitigate this deficiency. Without adequate action, the nursing shortage will have a substantial impact on the future of healthcare.

History

The nursing field has experienced numerous periods of nursing professional shortages. One of the more substantial troughs in the number of skilled nurses in the workforce was in 2000-2001. At that time, according to the U.S. Bureau of Labor Statistics, more than one million new nurses were estimated to be needed to join the workforce by 2010 (American Academy of Colleges of Nursing [AACN], 2002). The factors impacting this shortage included decreased enrollment in nursing programs, faculty shortages, an aging workforce, a high nurse turnover rate, and increased job dissatisfaction (AACN, 2002).

Scope of the Problem

Although over twenty years ago, the factors contributing to the current nursing shortage crisis are similar. While the number of new graduate nurses entering the workforce over the past decade has been climbing, these numbers cannot keep up with the loss of nurses (Buerhaus, 2021). The COVID-19 pandemic caused many reasons for perpetuating the pre-existing nursing shortage. With the surge of critical care-requiring patients came the need for emergency training of nurses to work in ICUs, floating of nurses to areas outside of their specialty, sometimes with little to no training, mandatory or forced retirement of experienced nurses who were high costs for hospital systems to employ, and nurses falling ill with COVID-19 due to community and workplace exposure. After such a sustained period in disaster mode, nurses were experiencing heightened mental health problems and extreme burnout, and many have chosen to leave the bedside or the profession altogether. From a study of more than 5,000 nurses surveyed during the pandemic, 11% indicated they intended to leave their nursing position (Raso et al., 2021). To replace and bolster the existing nursing workforce, most major hospital systems have been recruiting travel nurses to fill in the gaps. While this action was justified, this temporary staff were offered substantial bonuses and significantly higher pay than the established staff nurses. That, in turn, has contributed to more full- and part-time staff leaving their long-term nursing positions to pursue temporary assignments to secure higher pay for themselves or leave the profession altogether. This has only further contributed to the nursing shortage crisis.

Effect on Practicing Nurses

Safe staffing is not just a preference of those of us working at the bedside, but a staunch necessity. Without adequate staff numbers, units often are forced to run understaffed. As a result, nurses often work longer hours under even more stressful conditions. These stressful conditions, including understaffing, contribute significantly to nurse exhaustion, potential injury, job dissatisfaction, compassion fatigue, and eventual burnout (Haddad et al., 2023). The consequence of these suffered plights is nurses leaving that unit, that organization, specialty, and nursing altogether.

Effects on the Future of Healthcare

Without enough nurses to care for patients, what does the future of nursing look like? In 2029, the entire Baby Boomer generation will be within retirement age (Haddad et al., 2023). As a result, the United States will experience a 73% increase in Americans over 65 (Haddad et al., 2023). Patients admitted to inpatient hospital settings are older, sicker, and require more services than ever before. Who will take care of them if there is not adequate staff? The truth is that the United States is in a difficult place. The good news, however, is that much can be done to mitigate this nursing shortage crisis.

All units, floors, and positions within nursing have their pros and cons as well! Some nurses prefer to be constantly on the go, while others do not like that vibe as much. Some of us want to work with adults, while others are genuinely energized by working with children and babies! We all have our units and specialties of choice, which is a beautiful thing! The truth is that every specialty area in which nurses work has its challenges, challenges that will be subjective and dependent on the individual nurse. Although we have a choice in where we work, nurses generally continue to prefer specific environments. Keep in mind that the unit we choose to work in does have an impact on our quality of life and overall mental well-being. It is, therefore, essential to check in with yourself regularly to ensure you are caring for your body and mind well, debriefing and talking about situations that are affecting you (and others) more than usual, and sleeping and eating healthily. If, at any point, you feel as if your unit is no longer for you, maybe there is another unit of the same specialty that could serve you better, maybe within another organization. Or maybe looking at another type of unit or subspecialty. We are all needed somewhere. You can be a nurse in so many areas you might never even have thought about!

We have discussed many contributing factors to nurse burnout. So, what exactly can we do to prevent it? Many preventative measures require organization, unit, management, and leadership involvement. If you are a nurse working within management or administration, take a moment to consider the following things that you could do to help decrease the chances that your nurses will experience burnout.

Nursing leadership must (Nejati et al., 2016; Sachdeva, 2022):

1. Listen to the nurses:
   • Leadership needs to acknowledge and address the concerns of its nurses. Nurses need to be able to share their thoughts, opinions, and problems with their charge staff and management; they need to be comfortable enough to come forward when they need to talk. There needs to be an environment conducive to opening up and sharing thoughts and feelings with superiors. This can be accomplished by the leadership remaining open-minded, having an open-door policy, encouraging nurses to engage whenever they need to talk, and ensuring privacy in their conversations. Nursing leadership can learn about the concerns their staff have by allowing open dialogue in staff meetings. Staff meetings on both day and night shifts allow both shifts to be heard. When nurses feel listened to, they believe that their thoughts matter, and when they feel that those thoughts matter, they will be more willing to step forward and speak up about future issues requiring managerial weigh-in. It is also beneficial for management to go directly to the nurses and check in with them to see how they are doing, asking if there is anything that can be done to support them.
2. Prioritize the physical and mental well-being of nurses:
   • Nurse well-being can be supported by openly discussing its importance in the pre-shift huddle. Maybe the organization has a gym, offers workout classes, or hosts a wellness program. These are great things to bring up before shifts to advertise them to the nurses and encourage them to participate, with the ultimate goal of taking some time to prioritize their minds and bodies. Hosting unit potlucks, parties, birthdays, and retirement parties can celebrate the staff while prioritizing taking a break. These are simple ideas to care for the physical and mental health of the nurses you oversee. And, no, I am not just talking about one of those pizza parties we all joke about as not being a substitute for another form of appreciation! It’s not the pizza; everyone loves pizza, but pizza, because the unit is short-staffed, will not fix that.
3. Help nurses prevent overworking:
   • It is vital to encourage nurses to take their breaks. We have all been there when we purposefully held our bladders or ate a late lunch because we were prioritizing patient care or we had a hectic assignment. But it is not good practice to not take breaks. Some units and hospital systems have implemented mandatory breaks. Even short breaks, once every few hours, can do wonders for our minds and bodies. Working in leadership, you can check in with nurses during their shifts and ask if they have taken a break, gone to the restroom, drank some water, or stopped to take their lunch or dinner break. You also have the ability and the opportunity to offer temporary coverage or patient care assistance while they are off the floor for a few moments. While we cannot force anyone to do anything, a simple reminder sometimes is what we need, especially on those shifts when we have just forgotten to care for ourselves. Sometimes, just the reminder can make a nurse feel more valued, but it could also be the fact that you asked that makes a nurse feel cared for.
4. Allow for flexible scheduling:
   • Nurses love their jobs and caring for patients, but they love their free time and personal life, too. Utilizing scheduling software that allows nurses to put in their schedule per unit requirements and then easily swap shifts with other nurses as they see fit can contribute to more staff satisfaction in a nurse’s schedule to allow for a better work-life balance. It might also help to offer a weekend differential that encourages nurses to work more weekend days and nights, which we all know can be challenging. It will also help you fill your weekend shifts.
   • But what can YOU do to prevent burnout in yourself? We all know the importance of community. As nursing students, we learned how valuable our clinical group was to us. We spent most of our time with them instead of our family members. We learned to survive and thrive together by studying in groups, carpooling to clinical, and helping each other on the floor in the hospital with our patient care tasks. Those classmates became like family because we shared late nights, tears, and life-altering experiences right next to each other.
   • The same can be said for the colleagues you have now. You work side by side, daily, with a common goal and passion for the same subspecialty of patients. Staying involved with your work colleagues as much as you care to, sharing your successes and struggles, reaching out to a coworker you feel might be having a hard time, and celebrating the good stuff like birthdays, career milestones, positive patient or family comments, weddings, and new babies can help create a sense of community and family with the people you work with. Nursing units can help their nurses accomplish this by fostering a sense of belonging and teamwork immediately after hire, beginning on day one. Work environments like this are nurturing, sharing both successes and failures, allowing nurses to feel comfortable in venting their thoughts and feelings, and moving away from bottling them up and keeping them to themselves. This can be so important in preventing burnout.

As mentioned before, it is normal in our line of work to be affected from time to time by specific patient experiences, experiences that hold a special place in our hearts or are something we have stuck in our minds at the time. However, when an incident or patient encounter leaves us in a mind fog that has begun to affect our functioning in our jobs or our personal lives, this experience of compassion fatigue requires attention and action.

With the mental anguish that can be experienced, physical stress and symptoms of that stress are prevalent (APA, 2025; WebMD, 2024). Generally, the first recommendation is to prioritize self-care. Prioritizing yourself, your mind, and your body, and taking care of what you need physically, such as when you catch a cold and are advised to rest and hydrate, your focus needs to shift toward healing and recovery.

You need to know how common compassion fatigue is in our field. It is also essential for you to share with others how normal it is. Because it is not widely normalized, many of us hesitate to ask for help when it is needed. The more normalized it is, the more willing we all can be to talk about our struggles and accept help. If you might be experiencing this, it is a good idea to reach out to your primary care provider (PCP). They might ultimately refer you to therapy or psychiatry services that specifically specialize in trauma (APA, 2025; WebMD, 2024).

As nurses, we often struggle with prioritizing ourselves. We are well known for skipping breaks and holding our bladders for hours so that we can attend to our patients and make sure everyone else has what they need. We are a profession that constantly puts others' needs ahead of ours. While we have all been there and have excellent reasons for why we do what we do, we need to remember that we must care for ourselves to best care for others.

My favorite analogy to share, which outlines the importance of self-care, is taken directly from our flight attendants. Just like their pre-flight instructions to put on our masks before helping someone else put on theirs, we cannot be effective long-term in our careers or personal lives without caring for our needs. It is important to note here that eating or showering is not considered self-care. These are regular physical needs that we should work to meet. Self-care ideas can start with (National Institute of Mental Health [NIH], 2024):

• Exercise
• Healthy, regular meals
• Drinking water
• Sleeping enough (7-9 consecutive hours within 24 hours)
• Taking our daily medications

Self-care that goes beyond our basic human needs includes (Johnston, 2025; NIH, 2024):

• Meditation
• Journaling your thoughts and feelings
• Practicing gratitude to remind yourself what you are grateful for
• Encourage more positive self-talk and discourage toxic negative self-talk
• Reach out to family and friends for support if you need it
• Set goals and priorities for yourself that include when you will say “no”
• Reading a good book or magazine
• Going to the movies
• Going out to dinner
• Spending some time on YouTube or scrolling on social media, watching funny videos
• Lying down and looking at the stars
• Taking a walk on the beach
• Taking a nap
• Binge-watching your favorite show
• Engaging in a craft
• Sitting on your porch alone, without your phone
• Taking a bubble bath, with calm music and candles
• Practicing some yoga poses
• Cooking your favorite meal
• Going for a drive without an actual destination
• Sitting in a coffee shop and enjoying your favorite caffeinated beverage
• Stretching your body
• Going to watch the sun rise or set
• Remove people you follow on social media who do not bring you joy
• Unplug for the rest of your day and enjoy “me” time

Every day, we show love and compassion to our patients and their families. We went into nursing specifically to do this because of who we are. We offer endless compassion to everyone, regardless of their past and who they are. Should we not be able to gift this same level of compassion to ourselves?

The next time you listen to a friend, family member, or colleague vent, reflect on the advice that you left them with. Did you maybe tell them things like “It’s not your fault,” “Don’t be so hard on yourself; you are doing the best you can,” or even “It’s okay if you need to call in to work; it might be what is best for you right now”? Sometimes, we excel at giving others advice, understanding their human thoughts and emotions, and validating their life experiences, but we struggle to do the same for ourselves. It can take some time to improve, but it is possible with practice! Other than offering yourself the understanding that you do others, you can also (Leora et al., 2022):

1. Pay attention to your feelings and emotions. If something feels off, acknowledge that feeling, investigate what might be causing it, accept the emotions that have been elicited, take a few deep breaths, give yourself a break if needed, and then re-enter your responsibilities and tasks. Do this before proceeding to your next work task.
2. Give yourself a break. When you are tired, overworked, and feel like your energy is running out, take one moment to care for yourself. Place your hand on your chest, close your eyes, take a deep breath, and tell yourself that you are doing the absolute best that you can. Sometimes, turning off that inner critic is exactly what you need to center yourself and your mind to power through the rest of your shift.

Interestingly, showing ourselves some self-compassion can also be a way to treat or prevent compassion fatigue.

Above, we discussed the existence of moral distress, what it looks like, what types of situations cause it, and why we experience it. But now that we know what moral distress looks like, how can we deal with it?

The American Association of Critical-Care Nurses (AACN) is well-versed in this issue. It even has a framework for dealing with morally distressing situations (Healthy Nurse Healthy Nation, 2022). Let’s look at the four A’s of this framework (AACN, 2004).

The whole point of the 4 A’s from the AACN is to give you a memorable tool to use the next time you find yourself in a situation causing you moral distress. Let’s put this framework together better with an example!

Let’s say, for example, that you are a nurse in the pediatric intensive care unit (PICU). Due to recent respiratory disease outbreaks, visitation rules have been strictly eliminated. One of your patients is a 4-day-old twin baby girl, “B”. Due to the strict cessation of current visitation, Olivia’s first-time parents are being told they are not allowed to visit their newborn baby girl since the mom has been discharged. You are taking care of Olivia for the fourth night in a row, and this situation is wearing on you.

Olivia experienced an episode of belly pain that evening. While rocking Olivia, you ASK yourself if what you are experiencing is morally distressing to you. You AFFIRM that you are experiencing moral distress. You then ASSESS your ability to do something about how you are feeling. Discussing your thoughts with your immediate superior, your charge nurse, is the best action. You believe specific considerations must be made for this family’s unique situation. You also think that this family’s case might be similar to others during this challenging time of strict rules and that the current policy needs to be reviewed. You decide to ACT following Olivia’s midnight care.

You reach out to your charge nurse to discuss your concerns. Your charge nurse agrees that this is not a good situation and that there needs to be some adjustments made to the unit visitation policy to mitigate these issues and to allow for some exceptions. She asks you if you have considered a solution to these issues.

You make a recommendation to allow mom to visit daily while wearing a mask and a hospital gown so that she can do some skin-to-skin with Olivia and breastfeed her for at least one feeding. You also recommend that Olivia’s twin sister, Penelope, be allowed to join her mom so that mom can work on the psychomotor tasks of breastfeeding her twins to be more prepared for when they are all home together for the first time. By allowing this, the mom can visit, bond, breastfeed, and receive in-person parent teaching, Olivia’s twin can be around her sister, and Olivia can receive the bonding and breastmilk that is best for her. Ultimately, this could likely allow her to be discharged sooner. As for the dad, you recommend using the unit’s video phone call feature. This will allow the dad to see his baby daily via virtual technology, ideally while mom is present. The charge nurse agrees that these ideas are reasonable and takes them to the unit’s nurse manager.

The nurse manager discusses these concerns and potential solutions with hospital leadership. Hospital leadership acknowledges several similar situations arising in other units concerning visitation. They recognize that some exceptions need to be made due to the adverse sequelae that can result if the strict, no-visitation rule remains. After weighing the pros and cons, the hospital administration agrees. Leadership works on adapting the current policies and procedures to reflect a list of exceptions to share with every unit!

What we might identify and bring forward regarding situations that elicit moral distress might not always necessitate action or yield results. But it is always worth the effort to try!

What can you do to address imposter syndrome? Here is a list of things you can do if you are experiencing it (Nurseio, 2022; Pate, 2023):

• Acknowledge your accomplishments resulting from the hard work you have put into your career. Remember, it is not the result of luck.
• Acknowledge that your life experiences and expertise are extensive and valuable. You have grown so much and come so far!
• Recognize where you are now and what “younger you” would think about what you have been through to get where you are today. Chances are that you could serve as a fantastic mentor or role model for someone else, just the way you are right now!
• Try your best not to compare yourself to others. Focus on your accomplishments.
• Celebrate every success, even the small ones! Keep a file or binder of each of your triumphs (certifications, awards, nice emails, patient/family comments) so you can look at them when you are questioning your abilities to remind yourself how awesome you are!
• Be patient with yourself. What you are feeling is normal. Practice some self-compassion, as we have discussed.
• Talk to someone you trust, another nurse, an old manager, an old “work mom,” someone you can lean on and share how you feel. Chances are, they will tell you that you are not alone because you are not!
• Accept any positive comments and feedback you receive! You deserve it. Try not to brush it off or reduce what you have done. You are allowed to be proud of yourself. Hearing and truly feeling these positive comments helps to rebuild your confidence.
• Identify an individual to serve as your mentor. Sometimes, we are fortunate in a new or established role to have a specific individual who is predetermined as a mentor. But maybe you click better with another person who might be an excellent sounding board for you. Having a mentor in nursing is invaluable.
• Do not expect perfection from yourself. You do the best you can to fulfill the obligations of your role. You do not have to change the whole unit in one day to be considered a success.

If you are continuing to be stuck in this headspace and it is wearing on you, consider reaching out to a therapist sooner rather than later. Most are well-versed in this issue (or have perhaps even experienced it themselves) and would be happy to help you through this. Generally, cognitive-behavioral therapy (CBT) can be beneficial in validating your thoughts, directly addressing your fear of failure, and changing the mental narrative you have with yourself to change your overall thinking and break out of that rut (Bravata et al., 2019).

Although there is still a stigma around the terms “therapy” and “counseling,” all forms of therapy can be highly beneficial. Whether someone wants to work on uncovering a childhood trauma they have not quite healed from, determine why they have trouble forming or sustaining healthy relationships, talk through some significant issues around a family member, or work on coping mechanisms for current and future problems, therapy can be an invaluable tool.

As nurses, especially those in the field of mental health nursing, we have the opportunity to share the benefits of therapy, encourage others to seek it out when needed, and help reduce some of the negative stigma.

Some people feel that seeking out therapy services means they are incapable of handling their problems on their own. Others might think they are “crazy” or that therapy should be a last resort. These things could not be further from the truth! As I mentioned at the start of this section, therapy can be beneficial for virtually every person. The type of therapy, the professional providing therapy, and the frequency and length of treatment periods are all dependent on the individual, their current situation, and their therapy goals.

Therapy is not a one-size-fits-all, and there is not just one type of therapy professional. There are dozens of different types of therapy and professionals capable of providing this service.

Types of Therapy Professionals

Trained therapy professionals could include (APA, 2017a; Open Counseling, 2021):

• Psychologists (Degrees: MA, PhD, PsyD, EdD)
• Psychiatrists (Degrees: MD or DO)
• Social Workers (Degrees: MSW, LCSW)
• Psychiatric/Mental Health Nurse Practitioners (Degrees: MSN or DNP)
• Licensed Professional Clinical Counselors
• Licensed Marriage and Family Therapists
• Pastoral Counselors

Each of these professionals has had a different level of education and has a different approach to providing therapy. Some will be educated and experienced in certain types of treatments or have certain types of therapy that they are best at or prefer providing. Some therapists specialize in certain age groups, specifically children, adolescents, or older adults (APA, 2017a). The therapist's credentials will indicate what degree the therapist earned, and licenses will indicate that the therapist has passed specific examinations administered by the state (APA, 2017a).

In general, psychologists attend graduate school in psychology. If the psychologist has a doctorate, this indicates that they have completed four to six years of didactic coursework, followed by one to two years of supervised direct patient therapy work (APA, 2017a).

Psychiatrists attend medical school and then undergo residency training, specifically in psychiatry (APA, 2017a). Psychiatrists can provide both therapy and prescribe medications if needed.

Social workers typically undergo two years of graduate-level training, followed by two to three years of supervised clinical work with patients (APA, 2017a).

Psychiatric/mental health nurse practitioners (PMHNPs) attend undergraduate nursing school with clinicals, followed by graduate nursing school with intensive clinicals involving psychiatric patients across the lifespan. Some nurse practitioners go to graduate nursing school initially for another specialty, such as family practice or pediatric primary care, and then decide to specialize further in psychiatry/mental health care. When they choose to do this, they attend a one to two-year psychiatric/mental health nurse practitioner post-master certificate program to gain didactic knowledge and clinical training with psychiatric patients across the lifespan. They can then take a national board examination to become certified as a psychiatric/mental health nurse practitioner. PMHNPs are educated and certified to provide medication management with psychotropics, but they can also be trained to provide therapy services.

Types of Therapy

What types of therapy are available? There are dozens of types of therapy approaches. A list of some of the top, most popular, and evidence-based therapies available includes (Psychology Today, 2023):

• CBT
• Dialectical behavioral therapy (DBT)
• Eye movement desensitization and reprocessing
• Humanistic therapy
• Interpersonal psychotherapy
• Motivational interviewing
• Psychoanalytic therapy
• Psychodynamic therapy
• Rational emotive behavior therapy
• Solution-focused brief therapy

As mentioned, this list is not all-inclusive. We will spend just a few minutes discussing a couple of these types of therapy to give you an idea of why there are different types and indications for use.

As a nurse, I am sure you have heard of CBT. CBT is evidence-based and one of the most widely used forms of therapy (Psychology Today, 2022). It is a form of psychotherapy that works on identifying negative or maladaptive thoughts, bringing awareness to those thoughts, learning to challenge them, and ultimately working to change thinking patterns to be more realistic, positive, and adaptive to life situations (Psychology Today, 2022). Some of us struggle with cognitive distortions like all-or-nothing thinking, where we see all good or all bad without any gray area, or catastrophizing, where we assume that the worst possible thing will always happen (Psychology Today, 2022). CBT can help change those thought processes! CBT is the evidence-based treatment recommendation for anxiety and depression.

DBT is another relatively well-known type of therapy. This therapy focuses on educating the individual and providing specific skills for managing intense emotions and healthier social relationships (Psychology Today, n.d.-a). It is also often used in situations of chronic suicidal ideation (Psychology Today, n.d.-a). It is the treatment of choice for many personality disorders, such as borderline personality disorder (Psychology Today, n.d.-a). It is also often used for those who are struggling with anxiety, depression, bipolar disorder, substance use, bulimia, and binge-eating disorder (Psychology Today, n.d.-a).

EMDR is an interesting therapy technique! It involves recalling a specific traumatic experience and recounting its details while following side-to-side eye movements demonstrated by the therapist (Psychology Today, n.d.-b). It is said that the lateral movements of the eyes, along with talking about the specific traumatic experience, are thought to work to reduce the emotional charge of the memory so that the traumatic experience can be stripped of its power to trigger anxiety and avoidance symptoms (Psychology Today, n.d.-b). EMDR was initially developed to treat PTSD, but it has also been found to be beneficial in treating anxiety disorders, including panic and phobias, depression, dissociative disorders, obsessive-compulsive disorders, personality disorders, and eating disorders (Psychology Today, n.d.-b).

As you can see, there are many forms of therapy for many different types of mental health conditions. There is something out there for everyone. Even couples or marriage therapy could be beneficial for relationships.

If you are interested in looking at the other therapies available, you can use the link here. When you click on each kind of therapy, you can see a description of the treatment, when it is indicated, how it works, what to expect, and what to look for in a specific therapist.

It is important to note that therapy can be initiated at any time as long as you have a goal in mind. You do not have to wait until the crisis point before seeking professional help. It is an even better idea to start working with a therapist when you initially begin struggling or are having trouble getting past something traumatic or challenging in your life so that you can have someone help you through times, to be accessible in case it escalates to the level of a crisis, or to be available to you in the event of emergencies, and to help prevent a crisis; having that person assist you in processing emotions, identifying triggers, and helping you to adapt your thinking to healthier thought patterns.

EAP Services

Depending on where you work, you might have access to therapy services you did not know you had! Take a moment to check your employee benefits for an Employee Assistance Program (EAP). Maybe you knew about access to this service but assumed it was a financial savings program or other service assistance, such as childcare. An EAP program is generally a service that provides the staff with access to assessment, short-term counseling, referral, and management, sometimes even coaching, for mental health reasons (HHS, 2023). In most cases, nurses are allotted a set number of therapy/counseling sessions per year that can be used free of charge. Some hospital systems allocate 4-6 sessions every year. Not only are you entitled to this benefit, but you are also allowed to pick and choose from a list of therapists available in your area.

Some nurses become concerned that if their workplace knew they were suffering from a mental health condition, they might be discriminated against or fired. These programs ensure that services are kept confidential, except when the individual is at risk of harm to themselves or others (HHS, 2023). Additionally, most of these programs offer 24-hour, seven-day-a-week access to mental health professionals (HHS, 2023).

The goal of the EAP access benefit is an investment in staff that allows employees to work through challenges with professionals for free to live happier, healthier lives (HHS, 2023). Often, EAP services can be extended to family members.

How Do I Find a Therapist?

The mental health crisis is a real thing that we, as a country and a society in general, are dealing with. It is no secret that we are severely lacking in having enough mental health professionals for everyone requiring access. With that being said, it can be a challenge to find someone accepting new patients/clients. But it is certainly not impossible! Given the opportunities for in-person and online teletherapy options, there are many opportunities to meet with a professional for therapy.

Feel free to talk to your PCP, as they often have their list of therapists, psychiatrists, and PMHNPs they refer directly to.

One excellent online resource for locating psychiatry services is PsychologyToday.com. This website can help you find a therapist, psychiatrist, treatment center, or support groups in your area.

When visiting the this link, select one of the professionals above in the left dropdown box under “Find a Therapist.” You can search specifically for the type of mental health professional you seek. Then, input your zip code. The next page will list all those professionals within a variable distance from your zip code. You can click on any professional listed and see everything you need to know! PsychologyToday.com provides you with:

• A professional biography
• Contact information (email, phone number, office location)
• Links to their websites
• Insurances they accept, or if they are self-pay
• Types of therapy they specialize in
• Mental health conditions they have expertise in
• Types of appointments offered: in-person, online, or both
• Qualifications

For anxiety disorders, research has shown that psychotherapy is more effective than medication and that adding medication does not substantially improve outcomes from therapy alone (APA, 2017b). However, according to research on the treatment of depression, it has been found that a combination of both psychotherapy and psychotropic therapy performs significantly better for improving function and quality of life when compared to each treatment (Kamenov et al., 2017). If psychotherapy needs more momentum to get you where you want, need, and deserve to be, the option of psychotropic medications can be excellent!

Just like there is a stigma about therapy, psychotropic medications also receive their share of shame. For some, medication works to potentiate and increase the levels of neurotransmitters.  Although not for everyone, many patients do so well on these medications that they experience mental health struggles when not taking them.

Much like children, adults may struggle with symptoms of attention deficit hyperactivity disorder (ADHD) and require the help of stimulants to increase their focus and motivation and decrease their impulses; mental health conditions such as anxiety and depression could very well be treated effectively by selective serotonin reuptake inhibitors (SSRIs).

SSRIs are antidepressants that block the reuptake and recycling of serotonin, which allows more serotonin to be available in the brain (Cleveland Clinic, 2022). Low serotonin levels are implicated in several mental health disorders, including (Cleveland Clinic, 2022):

• Anxiety
• Depression
• Suicidal thoughts/behavior
• Panic disorders
• Phobias
• PTSD

What does serotonin do? Serotonin within your brain helps regulate your mood (Cleveland Clinic, 2022). It’s our “feel good” neurotransmitter! At normal levels, we can focus better, be more emotionally stable, and overall happier and calmer. Serotonin also plays a role in the quality of our sleep, digestion, wound healing, bone health, and sexual health (Cleveland Clinic, 2022).

So, what causes lower levels of serotonin? Sometimes, our body is not producing enough, and other times, it is not using it effectively, or our serotonin receptors are not working like they are supposed to (Cleveland Clinic, 2022).

How can we increase serotonin levels to improve our mood and support other bodily functions? You can certainly try to get more sunlight, get more exercise, work on lowering your stress levels, and even eat foods like salmon, eggs, pineapples, cheese, and nuts (Cleveland Clinic, 2022). There is also the option of SSRIs, which are the first-line psychotropic treatment for depression and several other mental health disorders. SSRIs like paroxetine, fluoxetine, and sertraline are relatively well-tolerated and, after a period of generally 4-6 weeks, have been shown to increase the serotonin levels enough for people to notice a difference in their overall mood and a decrease in their symptoms (Cleveland Clinic, 2022). Other serotonin-potentiating medications can also include serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, which also works to increase levels of norepinephrine, the neurotransmitter that plays a role in attention, motivation, emotions, and memory storage (Endocrine Society, 2022). Low levels of norepinephrine are also implicated in several mental health conditions, including depression, anxiety, PTSD, and substance use (Endocrine Society, 2022). Several other second-line and third-line options for treatment are available for these mental health conditions that have been mentioned, as well as many others that have not been.

As we have previously discussed regarding the nursing shortage, nursing staffing ratios have much to do with the concerns that nurses have while working on the floor. In some unfortunate cases, nurses are assigned challenging patient assignments, often with more patients than are commonly allotted to a nurse on that unit or even with a combination of too many high-acuity patients paired together. We have all worked at least one shift where we felt we were spread too thin. These shifts leave us feeling overwhelmed, unsupported, and frustrated that we cannot provide the optimal level of care we usually offer because of the assignment situation we were stuck with. Every once in a while, you decide it is permissible because you are doing someone a favor, you want to be a team player, or because the staffing situation is so dire that everyone else is in the same boat. However, with what we know about burnout and compassion fatigue, this is not sustainable long-term. In addition, because of what working short-staffed and experiencing high levels of stress in the workplace can do to your body, you must consider that your patient assignment might also be contributing to a deterioration of your mental health. You have rights when evaluating the patient assignment you have been given (ANA, 2009).

According to the ANA position statement, Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment of 2009, nurses have the professional, ethical, and moral right to accept, reject, or even object in writing to any assignment that they feel would place themselves or their patients at serious risk of harm (ANA, 2009). This safeguard statement is grounded and defended by the ANA’s Code of Ethics for Nurses, the ANA’s Nursing: Scope and Standards of Practice, and state regulations that oversee nursing practice (ANA, 2009).

Before accepting a patient assignment, the ANA wants you to ask yourself these types of questions (ANA, n.d.-b):

1. What is expected of me with this assignment?
2. What are the characteristics (stability, complexity, insight, resources available)?
3. Do I have the expertise required to care for these patients?
4. Do I have the experience and knowledge to manage these patients?
5. Are these patients’ rooms physically close together or in different halls or different units?
6. Is this assignment a temporary thing? Will it be a one-time ask, or will help be available?
7. Is this assignment the result of an ongoing staffing issue?

When Should I Refuse an Assignment?

Although identifying an unsafe assignment will come with more nursing experience, sometimes even our intuition will tell us what we can and cannot, or should not, subject ourselves to. An inappropriate or unsafe assignment might look like (Nurse.org, 2022):

• Too many patients/high patient-to-staff ratio
• Inappropriate/unfair distribution of patient acuity
• Inadequate training has been provided for the patients assigned
• Lack of needed supplies or assistance 

How Do I Refuse a Patient Assignment? 

Consider the following points (ANA, 2009; Nurse.org, 2022):

1. It is your responsibility to know your rights and responsibilities, depending on the state where you work as a nurse. Your state’s Nurse Practice Act is the law that defines what you can and cannot do as a nurse and your scope of practice.
2. Do not initiate a nurse-patient relationship until you have decided to accept the assignment. This can create issues and risk of nurse abandonment, depending on your state, in which a nurse-patient relationship was made, and THEN the assignment was refused. Viewing a patient’s chart, talking to the patient, taking orders from a physician, or administering any patient care to that patient would be considered establishing a nurse-patient relationship.
3. Read your facility's policies and nursing rights to ensure you understand what your facility expects of you and what you can do according to their policies.
4. Write down on paper or email your leadership team to include all of the information regarding the assignment situation to provide thorough documentation of what was being asked of you and why you are refusing the assignment. This documentation of the situation is necessary to provide you with some defense in the event of possible workplace discipline. Keep copies of everything for your records. Follow the appropriate chain of command in your institution to communicate your refusal of your assignment.
5. Because we all have a feeling of guilt for not accepting an assignment because of what it will do to the unit, our colleagues, and the patients, you can help suggest possible solutions. You can suggest what could change for you to be comfortable accepting the assignment. You could also make suggestions like calling in another nurse to serve as a resource, re-arranging the patient assignment to redistribute acuity better among all nurses on the unit, working to obtain a sitter for confused patients you are worried about, or even allocating the patients in a different way to speak to everyone’s certifications and expertise.

Although these are hard conversations, by refusing unsafe patient assignments, you are advocating for both yourself and your patients. When we stand up for ourselves, we are listening to our needs as well and working to keep our mental health in check.

Maybe you have been on the fence for a while, considering working in other areas of nursing. You are not alone. Sometimes, this is a temporary feeling, like when you are having a good day or night shift, you are working alongside your favorite coworkers, and you genuinely feel like you made a good impact on the patients you took care of that shift. Then you realize you could never picture yourself working in another unit! Sometimes, this has been a feeling that keeps bubbling up inside you, but you just have not wanted to investigate other options. It is okay to consider other workplaces, organizations, units, specialties, and roles that might be better for your mental health! Maybe you are now working within your third specialty since graduation. It took a little while to find a job you love, and now you finally feel like this is where you belong. We all have somewhere that aligns with our priorities, allows for a work/life balance that we are happy with, and is good for our physical, emotional, and mental well-being. Let’s go over some options you have to consider!

New Bedside Unit

Maybe you thrive in medical/surgical environments, but your current unit has an environment that feels toxic to you personally. Perhaps you are happy working in the NICU, but you now want to care for slightly lower acuity babies. Simply looking into another hospital system or organization is all you need to find a unit that might be a better fit for you.

Residency Program

What about if you have spent the last five years working labor and delivery with the mothers, but you are now considering a slight focus switch to the NICU for the babies? Or what if you have ten years of experience working in the adult neurological ICU? Still, you are interested in applying what you know and learning about the brave new world of the pediatric ICU. Many hospital systems offer excellent residency and internship opportunities. While more common among new graduate nurses, and some are specific to new graduate nurses, experienced nurses can sometimes have an advantage in these programs as they bring real-life nursing experiences and skills to apply to their new specialty. Every bit of knowledge you bring to the table, even if not in the nursing field, can benefit you and your new workplace somehow!

Many residency/internships are highly organized programs that are complete with 3-12 months spent with a preceptor, live lecture classes, certification classes, additional specialty training, evidence-based practice projects, and a formal completion/graduation. These thorough programs provide you with the tools and resources you need to learn about your new specialty and come out proficient and ready to practice at the bedside among your colleagues. These programs generally include pay during the whole program and a full-time position in the same unit upon completion. Several have a mentoring component so you can feel guided and supported throughout the program. These programs include residency/internships for NICU, PICU, pediatric cardiac intensive care, adult intensive care, adult cardiac intensive care, and psychiatric nursing. There are even many residencies available at the nurse practitioner level as well!

Virtual/Work From Home Positions

There are so many virtual/work-from-home nursing opportunities out there! Working from home has benefits, like not having to commute, eating your lunch or dinner right in your kitchen, and allowing for a better work/life balance overall! While this list is not all-inclusive, here are some examples to consider (Nurse.org, 2025):

• Telehealth visits with patients: Using video technology to assist a provider in seeing patients virtually.
• Telephone triage: Providing triage, dependent on specialty, over the phone to patients and families.
• Case management: Working in a specific specialty you have bedside experience in, coordinating care for patients, and managing their specialty care.
• Legal nurse consulting: Reviewing charts for legal-related companies and providing your professional nursing expertise, given the legal situations.
• Freelance nurse writing: Utilizing your professional nursing experiences and writing talents to write educational materials for blogs, websites, or various companies.
• Utilization review nursing: Work with patients, families, healthcare staff, and insurance companies to ensure appropriate services are provided and adequately covered.

Further Education

Maybe you want to change your role within your organization or unit. Depending on your location and the unit, you may be able to have a simple conversation with your charge nurse or nurse manager about what you need to do to start advancing within your unit. Maybe this will mean looking into your BSN! Perhaps you have the desire to help patients at the provider level. In this case, take some time to look into your options for obtaining your master's or doctoral degree in nursing. You could go into so many different specialties as a nurse practitioner. You could do primary care, acute care, adults, pediatrics, family, neonates, or even psychiatry/mental health! If you are already a nurse practitioner who is no longer feeling fulfilled where you are, consider a post-master's graduate nursing certificate program to bridge you to another specialty!

You might even want to give back and teach the next generation of graduate nurses. You may be interested in working in clinical education. You might be interested in additional coursework allowing you to teach in the academic or clinical setting as a nurse educator or nursing faculty. There are numerous positions for nursing adjunct faculty, often in the clinical setting. You could have the opportunity to directly apply what you have learned, working at the bedside and conveying all those years of learning and skills, working with student nurses.

Unique Nursing Positions

There are so many unique nursing positions in areas you might have never even thought about. To give you a bit of an idea of what else is out there, here is an exciting list of possible opportunities for nursing employment (Great Value Colleges, 2023):

• Wound care nursing
• Diabetes nurse educator
• Nursing informaticist
• Infection control nurse
• Nurse health coach
• Nurse navigator
• Occupational health nurse
• Research nurse
• Forensic nurse
• Holistic nurse
• Cruise ship nurse
• Oil rig nurse
• Nurse esthetician
• Medical script nurse
• Theme park nurse
• Nurse auditor
• Public health nurse

If you want additional ideas, try making a profile on LinkedIn.com, setting up an email notification for any jobs containing the word “nurse,” and see what you get emailed to you! New positions and workplaces that require nurses come up all the time!