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Mental Health For Nurses

2 Contact Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Sunday, November 30, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


≥ 92% of participants will know how to assess and care for their own mental health as nurses.


After completing this continuing education course, the participant will be able to:

  1. Define the mental health terminology specific to the experience of nurses.
  2. Describe the cited issues within the nursing field and their impact on nurses.
  3. List the mental health risk factors and protective factors.
  4. Explain how nurses can best care for their mental health.
  5. Indicate which coping tools and resources nurses can use to manage, treat, and prioritize their mental health.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Mental Health For Nurses
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Alyssa King (DNP, APRN, CPNP-PC, PMHNP-BC, CLC, CNE)


Welcome nurses! This continuing education course is about you and each of your fellow nurses. Go ahead and take this opportunity to take a deep breath and focus on yourself, your profession, what makes “you” you, and the importance of making an everyday effort to care for your mental health.

This course will attempt to cover as much as possible to equip you with the knowledge of how our beloved profession can potentially negatively impact us and what we can do to mitigate those effects. This course will cover crucial mental health terminology, including “burnout” and “compassion fatigue,” the researched impact on nurses’ mental health of numerous situations within the nursing field, and most importantly, what we can do to best take care of ourselves so that we can take the best care of our patients.


Let’s take a few moments to discuss some of the essential terms related to our mental health. Several of these terms you have likely heard of before.

Mental Health

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, 2022). Mental health is crucial to a happy, healthy life.

Mental Illness

Is ‘mental health’ and ‘mental illness’ the same thing? These terms are often used interchangeably, but they mean different things.

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). It does not discriminate. Mental illness can affect anyone, regardless of gender, income, social status, age, race, ethnicity, religion, sexual orientation, or cultural background (APA, 2022). Mental illness is very treatable! 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). The World Health Organization, WHO, is in the process of developing evidence-based guidelines on mental well-being in the workplace to prevent burnout from occurring (WHO, 2019).

Burnout can manifest itself in many ways. What might this look like? Signs and symptoms could include (Kakacek, 2023):

  • Feeling physically drained
  • Feeling emotionally depleted
  • Digestive issues
  • Body aches and pains
  • Having trouble concentrating or making decisions
  • Inability of falling or staying 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

Being able to recognize the signs and symptoms of burnout in ourselves, or even in our colleagues, is so important. If we recognize signs of burnout in our coworkers, we can offer support and assistance if needed. It is possible that, even as you are reading this, you might realize that you, yourself, are experiencing burnout. It is going to be okay! Nursing burnout is a very significant but also a prevalent issue within our industry. We will discuss how common this issue is and what we can do about it.

How severe of an issue is nurse burnout? According to’s State of Nursing Report of 2023, 41% of nurses felt they needed better working conditions to prevent or mitigate burnout (, 2023a). This report also found that over 100,000 nurses have left the nursing profession in just the last two years (, 2023a). In addition, 610,388 nurses reported that they intended to leave the nursing profession by 2027 (, 2023a). Why? Nurses named stress and burnout as top contributing factors for wanting to leave (, 2023a).

What exactly is contributing to burnout? Burnout is not a phenomenon that is suffered after a singular adverse event. 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, 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).

When you reviewed the signs and symptoms of burnout, did they remind you of a similar psychological condition? The signs and symptoms of burnout have many similarities with the signs and symptoms of depression. They are very similar, but, as of the most current research, they are not the same thing.

What makes them different? Burnout is experienced in one’s workplace (WHO, 2019; Chen & Meier, 2021). 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. A systematic review and meta-analysis conducted by Chen and Meier (2021) set out to clarify the distinctiveness of burnout as a separate entity from depression. They hypothesized and reviewed whether burnout was possibly even a predisposition to depression in nurses (Chen & Meier, 2021). Although their study concluded that there might be an association between burnout and depression among nurses, 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 need to be conducted to test the association and learn more about these conditions among nurses specifically (Chen & Meier, 2021). The one conclusion that most concerned Chen and Meier (2021) was that the study’s results found that as nurses age, the burnout-depression correlation risk increases (Chen & Meier, 2021). They concluded in this analysis 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

Compassion fatigue is the physical, psychological, and mental impact of caring for others through their own experiences of traumatic stress (APA, 2020; WebMD, 2022). 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, 2020; WebMD, 2022; Loera et al., 2022).

Examples of compassion fatigue triggers include (APA, 2020; WebMD, 2022; Loera et al., 2022):

  • 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, 2020; WebMD, 2022). 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, 2020; WebMD, 2022).

Here are the signs to watch out for (APA, 2020; WebMD, 2022):

  • 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

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 (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 due to physician order and unit protocols. Still, it could technically wait until the infant is older and more stable. The physician is not willing to put off 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 (CVICU) 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.


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

Second Victim Phenomenon

Medical errors are events that we try so hard to prevent but, unfortunately, are an inevitable part of the medical field. Errors that are due to system flaws and failures are particularly frustrating. Within the nursing field and the entire medical community, there is a need to continuously work to improve patient safety.

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). It is a concept that was initially discussed back in 2000 by Dr. Albert Wu (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, they feel like they are a failure, and they can feel like they are not good at what they do 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 realize that they are not alone in how they feel after being involved in an adverse event. This should validate their feelings, thoughts, and emotions and allow 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 take this knowledge and employ it to generate change to avoid 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 like these in the future. In some cases, depending on many factors, 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 that of 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 is intended to bring awareness that all healthcare workers, nurses included, are human beings who do make mistakes and that they do feel the guilt and shame of the mistakes that they make (Vanhaecht et al., 2022). With the evidence of the existence of this phenomenon, Vanhaecht et al. (2022) 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 in adverse events require their supports to recover and continue working with patients with their mental health in check (Vanhaecht et al., 2022).

If you have been involved in adverse patient events, know that you are a human being, and human beings make mistakes. As mentioned above, the majority of errors are a result of a problem within the system or within the organization in which we work. 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 as a result of stepping up and identifying 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.

Issues in Nursing & Their Impact on Nurses

As mentioned above, the wonderful nursing field has many pros, benefits, and positives! But, like any other field, nursing also has its negatives. Each of these difficulties that come up in nursing can have a negative impact on practicing nurses. We will now take a look at some of the possible negatives and the respective impacts that they may have.

Bullying, Incivility, & Workplace Violence

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 ever 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, 2015). Actions of bullying can have a significant negative impact on nurses who are bullied, including lasting psychological and physical effects (ANA, 2015). 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 (ANA, 2015). The fact is anyone can be a bully. It could be from the top down in the form of the employer against an employee or even the employee against the employer (ANA, 2015).  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, 2015). These actions impact the dignity of the nurse and disregard the professional standard of basic respect (ANA, 2015). Incivility can often be a precursor to bullying and workplace violence (ANA, 2015).

Workplace violence (WPV) is defined as any threat or act of physical, sexual, or psychological violence, intimidation, or harassment that comes from either patients, patient’s 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, 2015). Examples of workplace violence include written or verbal threats, physical or verbal assault, assault with a weapon, verbal or physical harassment, or homicide (ANA, 2015). Workplace violence can lead to temporary or even permanent injury, emotional suffering, and sometimes, even death (ANA, 2015).

Frequently, the focus on patient safety prevails over nurse safety when, in fact, keeping the patient AND the nurse safe should be the priority (ANA, 2015). It is an unfortunate truth that most of us, at some point in our careers, have been subjected to some form of workplace violence, generally directly from our patients. It angers us that workplace violence has somehow become normalized and become “part of the job.” It is not. We need to change this culture and this line of thinking.

Any of these acts of generalized aggression are unacceptable and have 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 abilities to take care of 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, 2015):

  • 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, 2015). 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 in their unit (ANA, 2015). For nurses who witness incivility or bullying, they are encouraged to either approach the perpetrator to help them identify that what they are doing or saying is wrong and then approach the victim to offer them support (ANA, 2015). The witness can then encourage the victim to report that behavior to their employer (ANA, 2015).

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 American Nurses Association (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 (ANA, 2015). It was written to echo the perspective of the ANA on these significant issues and to bring attention to the fact that both employers and nurses, in all practice areas, even academia, have a legal, moral, and ethical responsibility to do their part in maintaining a healthy and a safe work environment for everyone (ANA, 2015). It states 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, 2015). This position statement also indicates that there should be zero tolerance for violence of any kind in the workplace.


We are all well aware of the way COVID-19 impacted the world we live in. I am willing to bet that most of us worked as nurses or were in nursing school during the peak of the global pandemic. COVID-19 had a significant impact on the field of nursing in that it changed everything that we did for an extended period. It affected how we worked, how we cared for patients, how many patients we had, if we were floated to new units to assist with COVID-19 patients, how we dressed and undressed for our shifts, how we sanitized our equipment, how we cleaned our nursing stations, and how we filled our supply rooms. It affected everything, every part of our roles as nurses, especially if you worked in an acute care setting caring for COVID-19 patients. For those in nursing school, it affected how you learned, how you attended class, how you took your exams, and how you fulfilled your clinical requirements. There was nothing that it did not impact.

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. With the level of stress, nurses were under both at home with their families and at work with major surges in patient volumes, increases in patient acuity, end-of-life situations rampant, hospital policies that we disagreed with but had to enforce, keeping families apart from each other, 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.

Every single human being was affected by the COVID-19 pandemic, but the nursing workforce was thrust into the spotlight right from the very beginning. What we went through as a profession was one of the most life-changing events probably in our lifetimes. While many of us hurt and suffered for those couple of years, we also have learned so much about adapting and solving new problems with new, creative ideas. We are surely not going to forget what we went through and will likely carry along the traumatic things we did and saw during this time. Yet we persevered, we did our jobs, and we saved lives. You should be incredibly proud of the role you played during the pandemic. We, as a profession, made it to today because of all of you and your service.

Imposter Syndrome

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 enough. A systematic review conducted by Bravata et al. (2019) 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). It is something that you might have dealt with, but you did not know this phenomenon had a name!

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

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

In the nursing field, we learn so much more once we get out of school and begin working. It is quite common to graduate from nursing school, pass the NCLEX, and still feel like you have not learned everything you need to know to succeed. That is true! You have not learned everything. But every other nurse is in the same situation after they graduate. For some, not feeling genuinely ready to be off on their own can contribute to feeling unworthy and unprepared for the real nursing world. For some new graduate nurses or those desiring to switch units or specialties, a nurse residency/internship can help ease them from novice to experienced nurse. With a formal program specifically constructed and built to provide one-on-one preceptors, classes, and even new certifications, all while getting paid, nurses will often have a direct line to a full-time position after completing the program. Sometimes, however, the nurse can still feel the weight of imposter syndrome, even after the residency/internship.

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 the position they inhabit.

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 for them. 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.

Nursing Shortage

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 American Nurses Association (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.


The nursing field has seen many periods in which a shortage of nursing professionals existed. 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 1 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 intensive care units (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 was 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 of being understaffed contribute significantly to nurse exhaustion, potential injury, job dissatisfaction, compassion fatigue, and eventual burnout (Haddad et al., 2022). 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., 2022). As a result, the United States will experience a 73% increase in Americans over 65 (Haddad et al., 2022). 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.

Nurse Practice Settings

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! Nurses who prefer the environment of intensive care units (ICUs) all have their reasons. Whether it be the desire to care for a smaller, higher acuity group of patients, having a passion for a specific population of patients like premature and sick neonates, or finding great satisfaction in titrating high-risk medications, nurses who work in intensive care units have a unique level of responsibility different from those who work on medical/surgical floors. However, working on these units does have its negatives.

The intensive care unit environment has been regarded as a high-stress setting (Ni et al., 2023). Nurses generally have a heavy workload and must employ a high level of skills, abilities, and critical thinking. Their patients are critically ill, often with life-threatening conditions, exposing nurses to secondary trauma from routinely providing resuscitation, high-risk medications, emergency interventions, and minute-by-minute close monitoring (Ni et al., 2023). Many studies have examined how nursing environments can affect the mental health of the nurses working in them. In these studies, nurses in ICU settings are more likely to experience physical and psychological exhaustion, affecting their overall quality of life and capacity to provide care (Ni et al., 2023; Mohammadi et al., 2017). It has also been determined that the work environment for nurses is one of the most important external factors that affect and can lead to nurse burnout (Ni et al., 2023).

Emergency room (ER) settings carry a lot of the same weight. ERs are characterized by many of the same high-acuity patients, life-saving measures, and emergency responses. Therefore, emergency room nurses are also accustomed to working in very high-stress conditions in which they are enduring great psychological stress (Jiaru et al., 2023). One systematic review and meta-analysis of 21 different studies revealed that the stress level of emergency room nurses necessitates nursing managers to regularly pay active attention to the mental and physical conditions of their nurses and take action to assist nurses in relieving stress and improving their mental and physical health. This manuscript explained that this must be done to reduce the emergency department nurse turnover rate (Jiaru et al., 2023).

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. Some of us are passionate about pediatrics, while others have difficulty seeing children in pain. Some of us have a love for oncology, while others struggle to care for children and adults with cancer. Some of us receive great satisfaction from serving as correctional forensic nurses. In contrast, others might feel they are not strong enough to work with individuals in prisons or detention centers. 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 will talk about that more in a bit.

Mental Health Statistics of Healthcare Workers

The National Institute for Occupational Safety and Health (NIOSH) and Center for Disease Control and Prevention (CDC) continue to advocate and bring attention to improving healthcare workers mental health (CDC, 2022). These organizations aggregated and reviewed recent data and numerous surveys from the time during COVID-19 and the months that followed that found (CDC, 2022):

  • 22% of healthcare workers reported depression, anxiety, and post-traumatic stress disorder (PTSD)
  • 93% of healthcare workers were experiencing high stress
  • 82% of healthcare workers were physically and emotionally exhausted
  • 45% of nurses were not getting the emotional support they need
  • 32% of nurses had plans to leave the nursing profession within the next year
  • Nurses, especially those working on the frontline and younger, were experiencing more severe levels of psychological symptoms compared to others

Another extensive literature review was conducted by Li et al. as part of the International Centre for Evidence in Disability and the London School of Hygiene & Tropical Medicine in the United Kingdom (2021). This literature review was presented as a systematic review and meta-analysis. It included data on the prevalence of anxiety, moderate depression, and PTSD among 65 studies during the COVID-19 pandemic (Li et al., 2021). Among these, 65 studies included over 97,000 healthcare workers within 21 countries (Li et al., 2021). Their results concluded the following percentages of prevalence (Li et al., 2021):

  • Depression: 21.7%
  • Anxiety: 22.1%
  • PTSD: 21.5%

All of this statistical data was collected and analyzed knowing that healthcare workers, namely nurses, are particularly at risk for mental health issues, including anxiety, depression, and PTSD, given their work environments, long work hours, intense physical, emotional, and psychological labor, and their exposure to death, disease, and violence, especially during the height of the pandemic (Li et al., 2021). The overarching goal is that of a call to action that additional action must be taken to mitigate these risks and bring further attention to healthcare workers (Li et al., 2021). Although we are outside the critical period of the pandemic, nurse mental health remains a significant concern.

Nurse Suicide

Suicide has become one of the leading causes of death for people aged 10 to 64 in the United States (CDC, 2023b). Suicide, or death that is caused by injury to oneself with an intent to end life affects all cultures, countries, genders, and ages in the world (CDC, 2023b). A suicide attempt is defined as intentional harm to oneself without a result of death (CDC, 2023b).

According to a study by Davis et al. (2021), nurses are 18% more likely to die by suicide. This study also concluded that nurses who are female are twice as likely to die by suicide than when compared to the general population (Davis et al., 2021; Lee & Friese, 2021). In addition, this study concluded that female nurses are 70% more likely to die by suicide than female physicians (Davis et al., 2021). It is clear that the rate of suicide among nurses exceeds that of the general population (Davis et al., 2021). With this in mind, it is essential that initiatives, both at the national and organizational levels, are prioritized to promote nurse well-being (Davis et al., 2021). The result of this study could also help to insinuate the need for routine assessment of nurse well-being in the workplace, which could also allow for referral and intervention if needed.

What are some warning signs and symptoms to watch out for? An excellent mnemonic to help you remember the signs and symptoms for a thorough suicide assessment is "IS PATH WARM(Juhnke et al., 2007):

  • I = Ideation = Any suicide ideation? Mentioning killing oneself?
  • S = Substance abuse = Excessive chronic or recent alcohol/drug use?

  • P = Purposelessness = Lack of purpose verbalized?
  • A = Anger = Feelings or anger? Desired revenge?
  • T = Trapped = Feelings of being trapped? No other way out?
  • H = Hopelessness = Feelings of hopelessness? No future?

  • W = Withdrawal = Desire to withdraw from others? Already withdrawn?
  • A = Anxiety = Anxiety, agitation, unable to sleep? Unable to relax?
  • R = Recklessness = Engaging in reckless behaviors?
  • M = Mood change = Dramatic mood shifts?

Many of the definitions and workplace issues we have discussed thus far have the potential to contribute to an increased risk for suicide in nurses. There is a need for multi-level intervention to include policy and procedural changes and practice changes within workplace settings (Lee & Friese, 2021). Nurses must also be proactive in taking care of themselves and prioritizing their own physical, mental, emotional, and spiritual wellness (Lee & Friese, 2021).

Suicidal ideation is thoughts of harming oneself with an intent to end life (CDC, 2023b). It is important to note that suicidal ideation can present itself as either active or passive (Salt Lake Behavioral Health, 2022):

  • Active suicidal thoughts are thoughts that include a plan for ending life and the loss of motivation to continue living.
    • An example of active suicidal ideation includes comments like, “It would be simple to end my life by __________” with a specific means of ending life described.
  • Passive suicidal ideation includes a loss of motivation to continue living but does not include a specific plan of how to end life.
    • Examples of passive suicidal ideation can include comments such as, “I wish I could go to bed and just not wake up again” or “I wish I would just get in a car accident so it could all be over.” 

Actions to be taken if you or someone you know is experiencing active suicide ideation are to immediately call the National Suicide Lifeline number, call a trusted friend or family member, or report directly to the nearest emergency room or psychiatric hospital. So much can be done to help you, your colleagues, your family members, or your friend who is experiencing active suicidal ideation. A safety plan will be developed to help protect the individual, a support system will be organized, psychiatric services will be initiated to intervene for excellent support, and the person will be kept safe.

Passive suicidal ideation is also very much a severe mental health concern that should be taken seriously. However, treatment in an acute care setting is not immediately recommended. It is recommended that anyone who is experiencing passive suicidal ideation be seen by a mental health professional as soon as possible (Salt Lake Behavioral Health, 2022). If the individual verbalizes that they do not feel safe themselves or if they answer you that they cannot commit to staying safe for the next 24 hours when you ask them that question, it is recommended that that person is immediately referred to the nearest emergency room or psychiatric hospital for evaluation and potential hospitalization (Salt Lake Behavioral Health, 2022).

The National Suicide Lifeline number was updated in July 2022 as a shorter, easier-to-remember number. For you or anyone you know in crisis or experiencing suicidal ideation, people utilize the following number for support:

24/7 Suicide and Crisis Lifeline:

Call or Text "988"

This line connects you directly with a trained crisis counselor who is trained and ready to help you.

Mental Health Risk Factors

The field of nursing is both wonderful and rewarding. But, as we have discussed, it includes a myriad of factors that could potentially increase the risk of mental health issues. Some of these workplace risk factors include (American Mental Wellness Association, n.d.; American Foundation for Suicide Prevention [AFSP], 2019; CDC, 2023c; Davidson et al., 2020):

  • Workplace violence
  • Long shifts
  • Consecutive shifts
  • High work environment stress
  • Repetitive trauma-exposing experiences (death, suffering, etc.)
  • Isolating assignments (physically, day vs. night shift)
  • Non-supportive charge nurses or leadership
  • Access to controlled substances
  • Negative unit/floor morale

Personal risk factors that can negatively impact a nurse’s mental health outside of the workplace can include (American Mental Wellness Association, n.d.; AFSP, 2019; CDC, 2023c; Davidson et al., 2020):

  • High stress in personal life (relationship problems, child custody issues, etc.)
  • Chronic pain
  • Chronic medical condition (cancer, diabetes, etc.)
  • Prior history of adverse childhood experiences (ACEs) or trauma in adulthood
  • Criminal/legal problems
  • Financial problems
  • Substance use
  • Pre-existing or new anxiety, depression, or bipolar disorder
  • Family history of mental health issues
  • Personal history of Traumatic Brain Injury (TBI)
  • Lack of self-care (poor nutrition, lack of sleep, etc.)
  • Lack of work-life balance
  • Feelings of loneliness and isolation from others
  • Feeling unsupported or unprepared for the role
  • Lack of access to support services

Mental Health Protective Factors

We all have some level of protective factors that are working FOR us to prevent the development or nurturing of a mental health issue.

The workplace protective factors can include (American Mental Wellness Association, n.d.; AFSP, 2019; CDC, 2023a; CDC, 2023c; Davidson et al., 2020):

  • Great unit/floor morale
  • Coworkers who assist and care for each other
  • Management/leadership who listens to the floor staff
  • Showing appreciation for staff
  • Resources for self-care (massage chairs, wellness rooms, nap abilities)
  • Focus on taking care of the nurse as well
  • Fair and convenient scheduling
  • Zero tolerance for workplace violence and follow-through in these events
  • Investment in retaining staff

Personal protective factors can include (American Mental Wellness Association, n.d.; AFSP, 2019; CDC, 2023c; Davidson et al., 2020):

  • Healthy diet, exercise, development
  • Optimism
  • Good support system
  • Self-regulation of emotions (effective coping)
  • Overall positive self-regard
  • Good peer relationships/friendships
  • Participation in extracurricular activities
  • Access to support services
  • Utilization of psychiatry/counseling services
  • Financial security
  • Set of moral beliefs
  • Problem-solving skills
  • Religious beliefs
  • Feeling connected to the community, school, or other social places
  • Strong cultural identity

The Nursing Profession

Like you, the majority of the nurses reading this course right now probably dreamed about being a nurse for quite some time. Are there any families that do not have at least one parent, grandparent, aunt, uncle, or child who is a nurse? Whether you wanted to be a nurse since you were a child, decided in college, had a significant event in your life in which a nurse impacted you, leaving you wanting to pursue nursing, or wanted to become a nurse like a friend or family member you idolize, we all have our stories which brought us into nursing.

Most of us have had dreams of saving lives and helping people that inspired our career path. Many of us go into nursing pursuing a specific subset of patients like pediatrics, obstetrics, or psychiatry. We want to help. We want to be there for these people during the worst day/days of their lives. We want to make a difference.

I am sure you did your homework before applying to school. You interviewed a few nurses about their jobs, possibly shadowed one to get an idea of what a day in life looked like, and probably even did a quick internet search about the pros of being a nurse.

Having gotten to where we are in our careers, we all know what these pros generally are. Depending on your workplace environment, acute care, or outpatient, the pros differ a bit. Typically, nurses have 10-12 hour work days, which could mean shorter work weeks, pay can be pretty good depending on your location and experience level, you have the option to work during the week or weekends or days or nights, the very-real nursing shortage means that there are so many jobs out there, there are so many specialties you could work in, schedules can be flexible, there are many opportunities for advancement and working within leadership, work clothing is simple and comfy, and we have a daily opportunity to make an impact on a patient and their family (Indeed Editorial Team, 2023). I am sure you can think of even more advantages!

We worked extremely hard to get into a nursing program. We all saw days of highs and lows in nursing school. Maybe you have even experienced multiple nursing programs. These programs were not for the faint of heart. Nevertheless, you pursued, you persisted, and you succeeded!

Maybe you read about some of the cons of the profession as well. Or perhaps you discovered some of them in nursing school. Maybe you listened to your preceptor and her colleagues and heard them discuss some issues in your clinical settings. Or perhaps it took until you were working as a nurse yourself to realize some disadvantages. We all know that every career field has its positives and negatives. Both should be discussed and normalized so everyone understands what they might have in store and be prepared to mitigate the things they are unwilling to deal with.

What are the cons of nursing? These are you probably aware of, too! They can bother some people more and others less. These include longer shifts, required weekends and holidays, life-or-death stress, physical requirements, exposure to possible communicable diseases and illnesses, and challenging daily situations (Indeed Editorial Team, 2023). I am confident you could come up with a few others.

Nursing has challenges that we all know were not mentioned in this list. Nurses struggle with working short-staffed, being assigned unsafe patient assignments, experiencing nurse-to-nurse bullying/incivility, being a victim of patient violence, and being subjected to abuse from physicians or other members of the healthcare team. All of these major issues have the potential to be mitigated by nursing organizations, nursing management/leadership teams, and nurses themselves. These issues need to continue to be brought up and discussed, and solutions determined to minimize the adverse sequelae that result from these situations. There are, unfortunately, no easy answers, but there are things that can be done. Although those things are outside of the focus of this course and will not be discussed specifically, what we will discuss are these individual issues, how they impact, harm, and affect the mental health of nurses, and what you can do to protect yourself and your license.

How to Care for Our Mental Health as Nurses

Burnout Prevention

We have discussed many contributing factors of nurse burnout. So, what exactly can we do to prevent it? Of course, certain aspects may be beyond the control of a specific healthcare organization or management team, but overall, there are possible proactive measures that can be taken to prevent nurse burnout (Kakacek, 2023;, 2022b).

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

  • Listen to the nurses: 

Leadership needs to acknowledge and address the concerns of their 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.

  • 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 substitution 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.

  • 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 worked to make breaks mandatory. 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 of 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 like you care.

  • 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 help, too, to offer a weekend differential that might encourage nurses to want to work more weekend days and nights, which we all know can be challenging to do. 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 students in nursing school, 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.

Treating Compassion Fatigue

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.

What can be done to treat compassion fatigue? With the mental anguish that can be experienced, physical stress and symptoms of that stress are prevalent (APA, 2020; WebMD, 2022). Generally, the first recommendation made is to ramp up self-care. Prioritizing yourself, your mind, and your body, and taking care of what you need physically, like when you catch a cold and are told to rest and hydrate, your focus needs to shift toward working on healing and getting better.

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, 2020; WebMD, 2022).

Prioritizing Self-Care

As nurses, we are not great at 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 reasoning for why we do what we do, we do need to remember that we need to care for ourselves to best care for others.

My favorite analogy to share that 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], 2022):

  • 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 (National Institute of Mental Health [NIH], 2022; Johnston, 2023):

  • 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
  • Laying 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

Giving Self-Compassion

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?

Day in and day out, we work very hard, we are demanding of our mind and body, and we are striving continuously for perfection in how we do our jobs as nurses. It is important that we also remember that we are human. Showing ourselves some “self-love” and compassion at the end of a long workday/night or even a long stretch of back-to-back shifts is essential to caring for our mental health. What exactly does that look like? Well, it depends on the person! This could be simply offering yourself the same level of understanding that you offer others.

Imagine treating yourself like you treat a patient or a family member. Would you expect someone else to “bounce back” after losing a loved one? Or watching their child in pain? You would not! You would acknowledge the weight of these issues and the emotional toll that would result. Okay, what about you or other nurses? Would you expect a “bounce back” after providing end-of-life care for a long-term patient? What about after being present when a patient is given a terminal diagnosis? The answer should still be “no”. We are allowed to be sad, hurt, and frustrated. We can take a moment or whatever time is needed to mourn, vent, and collect ourselves. Remembering, again, that we are human beings with human feelings that require reflection and debriefing in times of high stress and trauma is the key to understanding the importance of self-compassion.

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 are just excellent at giving others advice, understanding their human thoughts and emotions, and validating their life experiences, but we are unable 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):

  • Pay attention to your feelings and emotions. If something feels off, acknowledge that feeling, get to the bottom of what might be making you feel the way you do, accept these emotions that have been elicited, take a few deep breaths, give yourself a break if you need it, and then re-enter your responsibilities and tasks. Do this before you move on to your next work task.
  • 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 enough, showing ourselves some self-compassion can also be a way to treat or prevent compassion fatigue!

Mitigating Moral Distress

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? And is there anything we can do in these situations?

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 (American Association of Critical Care Nurses [AACN], 2004).

Table 1: The 4 A’s to Rise Above Moral Distress (Adapted from AACN, 2004)
ASKAm I experiencing distress or suffering in some way about a work/patient situation?
AFFIRMYes, I’m in distress considering this work/patient situation. I need to address this.”
ASSESSWhat am I able to do to address this distress? What am I able to do to mitigate this situation?”
ACTThe time is now. I am going to take action to mitigate this current situation. This is what I am going to do to reduce my distress, make it known to others, and implement changes to reduce the risk of situations just like this causing moral distress to my colleagues.”

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. The idea is that first, you will acknowledge that you are experiencing moral distress; second, you will check in with yourself and make a decision that something must be done; third, you will consider what can be done to solve the level of distress that you are feeling, and then finally, you will speak up, be it with your charge nurse or your nurse manager (minding your clinical ladder level of escalation per your organization or facility), to discuss the issue, share your view and concerns, and work to change current policy and procedures, if needed, to accommodate situations such as these.

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) in April 2020. Due to COVID-19, visitation rules have been strictly eliminated. One of your patients is a 4-day-old twin “B” baby girl. Sweet little Olivia was admitted to the PICU for some feeding intolerance that her twin sister was not experiencing. 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. You feel guilty for being involved in keeping mom and dad from their newborn, the twin sister from her twin; you worry about mom’s ability to bond with Olivia; you are concerned that the lack of bonding will affect mom’s breastmilk production; you are also concerned that Olivia’s ability to bond and breastfeed will impact her development. You are frustrated that you cannot provide the patient/family teaching that you need to teach these new parents how to care for their newborn because they cannot be there in person.

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 need 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 to 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!

As a nurse, you can create change. Speak up, stand up for what you think is right, and continue to advocate for yourself and your patients- always.

What about in times of genuinely ethical situations? This could include continuing care to sustain life when it is not in the best interest of the patient, or maybe against their wishes, or taking care of an infant in a severe amount of pain but not fully medicating due to family wishes. Situations like these, especially when longer-term, can affect the entire healthcare team, namely all of the unit nurses who are assigned to that patient. In these cases, if your unit has an ethics committee, these issues are best addressed by them. If the issues have not yet been brought to the ethics committee’s attention, you can discuss them with your team to bring them forward for review. Ethics committees are valuable because they are composed of individuals with experience and expertise in weighing ethical dilemmas. They are particularly poised to discuss your case in question and advise how to or how not to proceed.

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!

Overcoming Imposter Syndrome

What can you do to address imposter syndrome? Here is a list of things you can do if you are experiencing it (Pate, 2023; Nurseio, 2021):

  • 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 you have 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 like we have talked about!
  • 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 very fortunate in a new or established role to have a specific individual who is predetermined as somewhat of 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. You have time!

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 maybe 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). It is doable. We will talk a little more about therapists and the value of therapists in just a bit!


Although there is still a stigma around the terms “therapy” and “counseling,” all forms of therapy can be highly beneficial to LITERALLY EVERYONE YOU KNOW. 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 to help that individual to accomplish absolutely anything they want to!

As nurses, especially those of you who work within 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 eliminate 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 right at the start of this section, therapy can be helpful for literally every single person. Everyone, regardless of age, gender, background, and level of mental wellness! The type of therapy, the professional who provides therapy, and the frequency and length of treatment periods of therapy are all going to be dependent on the person, their current situation, and their therapy goals.

Therapy is not a one-size-fits-all-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

What types of professionals could I go to for therapy services? Trained therapy professionals could include (Open Counseling, 2021; APA, 2017a):

  • 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 can prescribe medications if needed.

Social workers generally have two years of graduate-level training, which is then followed up 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 also can be trained to be able to provide therapy services.

Types of Therapy

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

  • Cognitive Behavioral Therapy (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. This list was just 10 of the 74 types of therapy available, according to

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 Cognitive Behavioral Therapy or 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 your 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.

Dialectical Behavioral Therapy, or 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).

Eye Movement Desensitization and Reprocessing, or EMDR, is an interesting therapy technique! It involves recalling a specific traumatic experience and recounting the details of it 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 indications 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 this link. 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 right now 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 (U.S. Department of Health and Human Services [HHS], 2023). In most cases, the nurse is 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). In addition, most of these programs boast 24-hour-a-day, seven-days-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 to manage their life’s challenges with professionals for free to live happier, healthier lives (HHS, 2023). Many times, the EAP services can be extended to family members! Sometimes, the nurse is allotted six sessions a year, as is each family member! This is a benefit you will want to utilize!

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 This website can assist you in finding either a therapist, psychiatrist, treatment center or even support groups in your area!

When visiting 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, simply input your zip code. The next page will list all those professionals within a variable distance from your zip code. You can click any professional listed and see everything you need to know! 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

A great feature is the listing of specific therapies each professional offers. As we discussed, there are many different types of therapy. Therapies like CBT or DBT require additional training and certification, depending on the level and educational preparation of the professional. Suppose you are specifically looking for a psychologist who specializes in EMDR. In that case, you can adjust the search criteria at the top of the page to search for therapists who provide that specific type of therapy!

It is also important to note that not all therapists or therapy professionals will be aligned with you and your goals. Sometimes, a particular therapist might not “click” well with you, and you might not feel as if therapy with them will work or is working. That is okay! It does not mean that therapy is not for you. It simply means that that therapist might not be a good fit for you. We can pick and choose who provides our primary care or specialty care.  Similarly, you can “interview” for a therapist that will work best for you. Some people identify best with therapists who have a strong religious background that guides their suggestions and advice. Others would prefer a female or male therapist. It is entirely up to you! There is nothing wrong with starting with one therapist, realizing that the therapist-client relationship is not benefiting you in the way you need, and working to terminate that relationship to find another therapist.

It is also good to note that many therapists work specifically with nurses all the time! These are often affiliated with providing the EAP services we recently discussed in the last section. Sometimes, it does help to talk with someone who has an idea of what you go through every day at work!

Psychotropic Medications

For anxiety disorders, research has shown that psychotherapy is more effective than medication and that adding in 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 a bit 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).

Why 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
  • Post-Traumatic Stress Disorder (PTSD)

What does serotonin do? Serotonin within your brain helps regulate your mood (Cleveland Clinic, 2022). It’s our “feel good” neurotransmitter (Cleveland Clinic, 2022)! At normal levels, we can focus better, be more emotionally stable, and overall happier and calmer (Cleveland Clinic, 2022). 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 so that our mood can improve and our body can have it for 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 is the first-line psychotropic treatment for depression and several other mental health disorders (Cleveland Clinic, 2022). 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 treatment for these mental health conditions that have been mentioned, as well as many others that have not been.

There is absolutely nothing wrong with considering or taking psychotherapeutic medications to improve your mental health. Just like people with diabetes require insulin, some mental health conditions do not improve with therapy or alternative methods alone; they require medications. Just because you start taking medicine to improve your mental health, your mood, and your quality of life, it does not mean that you will need to take it forever, but maybe you will want to! It is possible that the SSRI could help you get through a rough time, bedside burnout that turned into a crippling depression that bled over and has affected your work and your life outside of work. Then, after a year of treatment and symptom remission, under the guidance of your prescribing mental health professional, you can begin weaning off the SSRI. You have autonomy in how you care for your body and your mind. If you, or someone you know, is struggling with symptoms of a mental health disorder, consider psychotropics as a viable option and discuss your options with your prescribing mental health professional.

Safe Patient Assignments

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 (, 2022a):

  • Too many patients/high patients-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 (, 2022a; ANA, 2009):

  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 as 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.

A New Nursing Position

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. That is FANTASTIC! We all have somewhere we 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 SO 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 pediatric ICU. Many hospital systems have excellent residency/internship opportunities available to you!  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 (, 2023b):

  • 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 where you are and which unit, you might be able to have a simple conversation with your charge nurse or nurse manager about what you might need to do to start climbing the ranks 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. Maybe you might have an interest in working in clinical education. Perhaps you have trained so many new nurses, and you love it! You might be interested in additional coursework allowing you to teach in the academic or clinical setting as a nurse educator or nursing faculty! Just as there is a bedside nursing shortage, there is a need for 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 yourself working at the bedside and convey all those years of learning and skills working with student nurses. It can be such a rewarding role to have!

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, 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! It is worth a little digging!

The Next Generation of Nurses

Think back to your nursing school experience. You probably had an excellent learning experience in the didactic, clinical, and lab/simulation settings. You likely enjoyed experiencing all your patient skill firsts alongside your best clinical group comrades. You maybe even created a few core memories right at the beginning of your career that you will never forget. But you also probably had some truly humbling experiences that showed you how much you did not know about nursing. Remember those post-clinical day crash naps where you would wake up four hours later, not knowing what day it was? Those hardcore naps were the result of being so mentally focused while in clinical all day and having to absorb as much as humanly possible. That paired with running around on your feet all day providing patient care. We have all been there.

The next time you are training a brand-new graduate nurse on their orientation or an experienced nurse who is new to your unit, try to remember again what it felt like being a student nurse, questioning anything and everything, and lacking the confidence that you once felt like you had. These new and newly transferred nurses are our future, and we must be part of the solution. We can bring them in, mentor them, provide them with advice and support, use our experience to guide them, and take them under our nurse’s wing. “Eating our young” needs to be a thing of the past. We have all been affected by some level of nurse-to-nurse bullying. Let’s keep working to change this narrative. Be the nurse you needed when you were a new nurse. What is best for each nursing workplace is an environment conducive to learning that welcomes questions and respects every nurse, both seasoned and novice. A safe, non-toxic workplace is good for every nurse’s mental health.

Mental Health Coping Tools & Resources

The goal of this course is primarily to provide you with tips and resources for how to both prevent negative outcomes and manage your mental health. Although we have already discussed many ways to mitigate specific issues, such as burnout and compassion fatigue, we will now review some general mental health resources.

We know that mental health is health. It is just as important as going to our PCP yearly to get a yearly physical or basic bloodwork to ensure our labs are within normal limits. To care for our physical health, we understand the importance of drinking enough water, eating a balanced diet, getting adequate exercise, and prioritizing enough restful sleep. While all of these things can also help our mental health, here is a detailed list of ways to take care of and improve your mental health (Swiner, 2023; Croke, 2021; CDC, 2023a):

  1. Breathwork:
    • Breathing can be a cleansing and comforting thing that we can do anywhere! Try it right now! Please close your eyes, take a deep breath, hold it, and then let it go. There are so many different ways to do some breathwork. Box breathing, or square breathing, is a powerful breathing technique that includes breathing in for 4 seconds, holding for 4 seconds, exhaling for 4 seconds, and then holding against for 4 seconds. In this way, imagine drawing a square, with each side being 4 seconds! The best thing about breathing exercises is that you can do them everywhere, and no one else could even be aware you are doing them! Bring some nice deep breaths into times when you are stressed or overwhelmed when you need a few moments to gather yourself alone in the supply room, or even take a second to take a few good deep breaths each time before you access patient medications in the Pyxis or before walking into a patient’s room! It really can help center you, bring you into the here and now, and decrease your current stress level!
  2. Talking/sharing with colleagues:
    • Other nurses can understand what we are going through and can truly empathize with how we are feeling. Sharing our thoughts and feelings with those we can trust can be helpful and healing for us as nurses. Having the opportunity to vent and share experiences, talk and laugh about the crazy situations we can find ourselves in, and even cry with those we work with, used to work with, or even went to nursing school with can be so cathartic. We are all in this together. You are not alone in what you have seen and what you must do every day.
  3. Quality time with family and friends:
    • Although our families and friends, unless they are also nurses, do not always understand what we are talking about or what we have been through, having a chance to unload the events of what happened during your workday to a loved one can be therapeutic. Plus, we all have to admit sometimes it's really fun to be the one telling all the gross nursing stories at the dinner table!
  4. Leisure/hobby activities:
    • We all need something fun to engage in. Whether you have a lifelong hobby like dancing or singing or if you need to go out and find a brand new, inspiring hobby, find something that you can do to spend your time doing something you love. Some of our hobbies, like soccer or running, can be great forms of exercise as well; WIN WIN! Having something fun to enjoy outside of nursing activities can help us better understand or even find ourselves. We all are beautiful, intricate, fascinating humans with boundless talents to share with the world!
  5. Spending time in nature:
    • Fresh air has long been a recommendation to help us feel better overall, mentally and physically (Mental Health Foundation, 2021). According to research conducted by the Mental Health Foundation (2021) during COVID-19, newer evidence has shown that having a “connectedness” with nature, or a good quality connection, can have a positive impact on our well-being, help us to be happier, and increase our feeling that life is worthwhile. Nature can help us generate numerous positive emotions, too, such as joy, creativity, and calmness (Mental Health Foundation, 2021). Connectedness with nature has also been associated with lower depression and anxiety levels (Mental Health Foundation, 2021).
    • How can we develop connectedness with nature? This can be done by taking a moment to truly appreciate the song of a bird, the bark of a tree, the smell of a flower, or even the feeling of soil and grass beneath our feet. Maybe you have heard the terms “earthing” or “grounding”? These terms are meant to describe the action of standing or walking barefoot in the sand at the beach, the grass in the park, the soil in a forest, or even in your yard (Schwartz, 2022). The goal is to walk barefoot while paying close attention to how your feet feel in the natural elements on the ground (Schwartz, 2022). The benefits of going barefoot are that it physically feels good, it elicits a sensory experience with different textures and temperatures, it allows us to center our minds and bodies in the present, and it helps to decrease stress (Schwartz, 2022).
    • It has been shown that we benefit best from nature spaces that are high quality (Mental Health Foundation, 2021). What typically makes a natural area more high quality is a wide variety of plants and wildlife (Mental Health Foundation, 2021). Essential characteristics include lots of green being found in trees, grass, and plants, nice calm, quiet, and serene areas, and nature spaces that are clean, without the mess and litter from the human impact (Mental Health Foundation, 2021).
  6. Mindfulness:
    • You have probably heard of mindfulness! A solution to nurses’ work stress, personal health, and position retention is mindfulness or formal programs like mindfulness-based stress reduction (MBSR) (Penque, 2019). Mindfulness is being checked in and focused on the present moment. Formal nursing MBSR programs that include a few hours a week for a couple of months working with a professional trained in mindfulness techniques have been shown to decrease stress and burnout (Penque, 2019).
    • An easier way to immediately immerse yourself in a mindful experience is the Five Senses Exercise (Balance, 2023). Think 54321. Give it a try! Here are the steps you can take (Balance, 2023):
      • First, you find a quiet, comfortable space to sit or lie down for a few minutes (Balance, 2023).
      • Then, close your eyes and take a few deep breaths.
      • Open your eyes and take a look around you.
      • Find five things you can see. Examine their colors, textures, and shapes.
      • Then, find four things you can touch.
      • Touch each of those four items, noticing how they feel, picking them up if small enough, and noticing their weight.
      • Next, listen to three things around you. Make a mental note of what they sound like and where they are coming from.
      • Then, find two things you can smell. Maybe a candle or a fresh flower. Close your eyes as you smell them, noting how the scents make you feel and if they bring back any comforting memories.
      • Finally, look around for one thing you can taste. If you cannot actively taste something in the room you are in, note what taste might still linger in your mouth, like toothpaste or that coffee you recently finished.
    • Mindfulness activities help to bring us into the “now” in our current environment and can be done anytime and anywhere. When you find yourself tense or stressed, try this exercise. With practice, it can reduce your anxiety, interrupt and reroute negative thought patterns, and promote feelings of calmness (Balance, 2023).
  7. Massages/spa days:
    • Every one of us needs a break. Sometimes, those breaks are quick little walks around or off the unit to get fresh air and nature exposure. Other times, we could benefit from a mental health day that includes some mental and, most importantly, physically relaxing activities.
    • When we stress, it is not just carried in our minds; it is felt in our bodies as well. Right now, sitting exactly where you are, notice where your shoulders are. Are you able to drop them down and relax them? What about your jaw? Is it clenched? We wear so much of our stress and anxiety in our neck, shoulders, jaw, and back. Getting a massage can be beneficial to release some of that pent-up stress and decrease inflammation in your body (Mehrabian et al., 2022; Redmint, 2023). Massages can include essential oils. Aromatherapy has been shown to reduce symptoms of stress and promote relaxation (Mehrabian et al., 2022; Redmint, 2023).
    • Any spa day activity, including massages, facials, pedicures, manicures, saunas, or hot tubs, can assist you in relaxing and rejuvenating both physically and mentally (Redmint, 2023). Spa day activities help to release endorphins to promote relaxation and happiness, improve your mood, improve the quality of your sleep, improve your circulation, decrease overall stress levels, reduce muscle tension, and reduce symptoms of anxiety and depression (Mehrabian et al., 2022; Redmint, 2023).
  8. Travel:
    • Taking a break, interrupting your same old daily routine, and exploring the world around you can benefit your mental health. Psychologists learned so much from the pandemic when we were all shut down inside our homes, unable to go anywhere except for work. One recent study conducted by researchers at University College London’s Centre for Transport Studies in the United Kingdom showed that people who travel away from their immediate home life surroundings experience better overall health than those who do not (Anciaes & Metcalfe, 2023). Even if lack of money is a reason why you cannot travel, a quick hour or two long drive outside of your immediate area. Explore a state park or drive along a scenic parkway to get you out of your everyday scenery and allow you to see some new things! Our country and world have much to see, do, eat, drink, touch, explore, and experience! Travel, even to places not very far from home, has been shown to reduce stress, increase creativity, promote resiliency, and surge productivity when returning from trips (Mental Health Association in Delaware, 2022). There is something about hiking to the top of an overlook in a national park that clears your mind and inspires you in all areas, including your career!
  9. Stop negative self-talk loop:
    • We all have that voice in our heads. That voice is to blame for pressing snooze another four times before getting up. That voice is also what tells you to get yourself to the gym after you have made a personal commitment to better physical health. Sometimes, though, that voice in your head is not so nice and does not have your best interest in mind, ironically. We can be mean to ourselves when we get stuck in a negative self-talk loop. That critical inner voice we have can be known to constantly chime in to elicit feelings of fear, doubt, blame, or even judgment (Headspace, n.d.). When we are having a rough night at work, we might have missed a medication time window, we forgot to clock in for our shift, or maybe we made a mistake and contaminated our blood cultures; it is expected, to a point, for some of us to experience thoughts like “you’re the worst, you can’t get anything right” or “you’re not good enough for this job.” While some of that can also be a touch of imposter syndrome, this kind of self-talk can be damaging to our egos and overall mental health.
    • It is important to remember that we can, sometimes, be our own worst enemies. It is more important to remember that just changing the way we talk to ourselves can improve the way we feel and our outlook on life. Positive self-talk can help promote a positive psychological state, whereas negative self-talk is associated with emotional ill-being (Kim et al., 2021).
    • How can I stop the negative self-talk? So, unfortunately, we cannot just stop our thoughts. We all know this when your mind is racing after a busy shift where you barely sat down, and your mind is still going, going, and going while you are trying to fall asleep. Some simple medication can assist us in retraining our minds to stop immediately believing every single negative thought that is popping up (Headspace, n.d.). We are not talking about having to reroute every single thought to be positive because the whole “positive vibes only” thing can only contribute to this headspace of toxic positivity where we must always be happy (Headspace, n.d.). That is not real. We can have feelings and thoughts that are outside of happiness. We are complicated human beings with complex emotions. What we do mean here is when you find yourself caught up in negative self-talk, pause and ask yourself, “If a friend or family member shared this view with me, how would I respond to them?” (Headspace, n.d.). Most likely, we would offer sympathy and speak to them more gently with understanding and patient validation for what they are doing and who they are as a person (Headspace, n.d.). Use this example to remind yourself to be kind and accept yourself for who you are. Some negative self-talk can motivate us to make changes to improve ourselves (Headspace, n.d.). But repetitive negative self-talk can make us feel like another person is working against us, only that other person is yourself.
    • Remember, we are all doing the best we can. Give yourself grace. Give yourself the same love and understanding that you give your coworkers and your patients!
  10. Resilience training:
    • Resilience is the unique ability to be able to adapt to being exposed to situations that are stressful or traumatic (The Resiliency Solution, n.d.). It includes our ability to overcome adversity, return to baseline functioning, continue functioning moving forward, and continue to grow and adapt to our experiences (Zhai et al., 2021; The Resiliency Solution, n.d.).
    • What exactly is resilience in nursing? Day in and day out, we are exposed to life-altering and often traumatizing situations that put us at risk for many mental health issues, like the ones we have talked about thus far, such as anxiety, depression, and burnout (Zhai et al., 2021; The Resiliency Solution, n.d.). As nurses, we are asked to be able to cope with these high levels of stress and pressure and be able to somehow quickly “bounce back” every day (The Resiliency Solution, n.d.). Resiliency is necessary for nurses because of what we do every day. It is important because that same workplace stress can affect job satisfaction, lead to staff turnover, and possibly contribute to reduced quality of patient care (Zhai et al., 2021; The Resiliency Solution, n.d.). When we are better equipped and able to be resilient, we can be more productive, enjoy our work more, maintain better colleague and management relationships, and feel better outside the workplace (The Resiliency Solution, n.d.). Resilience is a protective factor that allows us to problem-solve and carry on (Yılmaz, 2017)​​​​​​​.
    • Some of us are just born more resilient. Some of us have no trouble classifying our work from our personal lives. We are not all like that, and that is okay. Some hospital systems have resilience training programs available to assist nursing staff in developing the skill of resiliency to benefit us in the workplace and our mental health outside of the workplace (Zhai et al., 2021; The Resiliency Solution, n.d.​​​​​​​). The most helpful programs are those that focus on mindfulness and value-based actions where nurses learn techniques for mindfulness, as we discussed above, and mind and body exercises to help nurses clarify their values and work through different situations (Zhai et al., 2021; The Resiliency Solution, n.d.)​​​​​​​. Resiliency training also focuses on building hardiness, maintaining a positive outlook, emotional intelligence, reflective and critical thinking, and achieving a good life balance (Henshall et al., 2023)​​​​​​​​​​​​​​. Without a formal program, things that can be done to improve our level of resiliency include (Yılmaz, 2017)​​​​​​​:
      • Improving our social network of supportive people
      • Having a balance in our lives between work and our home life
      • Finding our spiritual side and belief system
      • Engaging in enough rest and exercise that our bodies need
      • Engaging in self-care activities
      • Finding a mentor in the workplace who we trust
      • Sharing your own experiences as a mentor for someone else
      • Talking things out in the form of debriefing following significant events at work
      • Allowing ourselves to have a sense of humor, even in the workplace
      • Working on our coping skills by ourselves or with the help of a therapist

For additional information and support for you and your colleagues, please use the following resources, phone applications, and phone numbers:

  • American Association of Critical Care Nurses (AACN)’s Well-Being Initiative: This initiative is meant to specifically address the challenges that nurses face. This initiative includes free tools and resources to support the mental health of nurses: Visit Source
  • National Institute for Occupational Safety and Health (NIOSH): The NIOSH, along with the CDC, has established its initiative for healthcare workers. This initiative aims to raise awareness and educate about tools to prevent burnout and to improve overall health and well-being: Visit Source
  • Healthy Nurse Healthy Nation through the American Nurses Association: This initiative works to connect and engage nurses and organizations with a five-domain focus, including physical activity, sleep, nutrition, safety, and quality of life: Visit Source
  • Vitalizecare App: This app was created by a nurse for nurses. It provides daily check-ins, journaling, and coaching: Visit Source
  • Moodfit: You can receive free access to mental health tools to help you. These can include mood journals, breathing exercises, and CBT thought records: Visit Source
  • Substance Abuse and Mental Health Services Administration (SAMHSA): For 24/7 free and confidential treatment referral and information regarding mental and substance use disorders and recovery: Call 1-800-662-4357
  • Phone applications for breathing exercises and meditation: Headspace, Calm, Aura, and Breathe.

Case Study

Let’s take a moment to apply some of our learned here.

Nurse Beth has been a nurse for six years. She spent her first 5.5 years working bedside in the pediatric ICU (PICU) of a large hospital system. She recently made the switch to the NICU in the same hospital system. She had always loved working with kids and wanted to gain more exposure and experience working with premature infants. Her old manager did not support the move, telling her that she was leaving her old unit “high and dry,” but reluctantly provided her recommendation.

Nurse Beth has always worked on the night shift. She says it works best with her schedule so that she can sacrifice a little more sleep as she just “naps” for 1-3 hours after her last consecutive shift. Nurse Beth has an active 6-year-old daughter and a husband who works an 8 a.m. to 5 p.m. schedule as an accountant. Nurse Beth is almost off her 6-month residency with a preceptor, and she is feeling the pressure of being entirely on her own with the higher understanding, extremely premature, and very low birth weight neonates. Because of this, she has picked up two additional shifts per week to give her more exposure to these patients. She has told her husband that she does not think she is cut out for this new role. She is frustrated because she had such confidence in her job as a nurse before. Her husband notes that Nurse Beth has had a shorter temper with their daughter, is less interested in going out with him on date night like she used to do weekly, she does not want to take her daughter hiking anymore, she skips meals all the time, and he notices that her water bottle is near full following each shift when he is doing the dishes.

Nurse Beth just experienced her first full code in the NICU, where she experienced the loss of her first extremely premature neonate. Nurse Beth immediately begins to blame herself, citing her inexperience in not seeing the signs of the neonate’s deterioration. She has seen death, unfortunately, in the PICU, but this is affecting her differently. But she does not have time for this; she has so much to do and more to learn to prevent this from happening again. She goes to the restroom, washes her face off, and goes right back on the floor, asking her preceptor to tell the charge nurse that she would like the next new admission once her patient’s room is cleaned.

What are we thinking about Nurse Beth? First of all, she has some nursing-related issues in her life that are working against her. It sounds like:

  1. She is not getting enough sleep
  2. Her less-than-supportive previous manager has made her feel guilty for leaving the PICU
  3. She is experiencing a bit of imposter syndrome because she feels like she is not good enough or ready enough to come off the orientation period of her residency program in the NICU
  4. She is moodier and quicker to anger at home with her daughter
  5. She is skipping meals
  6. She is not drinking water during work
  7. She just participated in her first NICU code with an adverse outcome
  8. She is blaming the passing of the neonate entirely on herself
  9. She neglects to take care of her own needs and emotions before going back out on the floor
  10. She asks for another patient before she has the opportunity to process and grieve what she just went through

We all might have been in this mindset at some point in our careers. It sounds like her self-care is starting to decline, given the stress of her career transition. It also sounds like she is exhibiting some all-or-nothing thinking. It seems as if she thinks it is 100% her fault the neonate passed and not due to the extreme prematurity or something that even Nurse Beth’s preceptor missed. Remember, she is still with a preceptor! It also sounds like the stress she is experiencing at work and in her career transition is bleeding into her home life with her family.

What would you recommend for Nurse Beth?

One of our biggest concerns is that we want to work to prevent burnout and compassion fatigue in Nurse Beth. It sounds like she is well on her way to becoming affected by the way she is thinking and how ineffectively she is taking care of her body. So, first, we would recommend her basic human needs be cared for. We need to encourage Nurse Beth to start sleeping more each night, give herself goals for water intake each day, and prioritize at least two meals a day or even five small meals. Her basic human needs to be satisfied first to move forward from here. Next, we want to encourage Nurse Beth to re-engage in open communication with her husband, share with him what her thoughts and feelings are, and schedule time alone with him and her daughter to do something fun like they used to do all the time, like date nights or hiking!

This is also an excellent time to bring up the importance of Nurse Beth confiding in her preceptor or charge nurse about her thoughts and concerns about her abilities. Nurse Beth could benefit from a debriefing conversation with the entire medical team who were present during the patient code where she lost her first NICU patient. It could be prefaced with being a good learning experience. Still, it will also be an excellent opportunity to hear what more experienced coworkers think about what happened, what went right, what went wrong, and how each person could improve for future situations like this. In addition, jumping right into taking another patient is not the best option. Although it can keep our bodies moving and our minds busy, it is way more beneficial to us to have the time to talk about and process traumatic events like these, take a moment to ourselves to cry or vent, and check in with our personal needs we have neglected during this time of emergency.

Also, due to the number of stressors Nurse Beth has worked against her and the risk of possible mental health issues like anxiety, depression, or even burnout, it would not hurt to tell Nurse Beth that she is not alone and that it would help if she could talk to someone about what she is going through. Seeing a mental health professional could help identify mental health struggles that she is suffering with currently, identify the imposter syndrome that she is exhibiting, guide her through the rest of her orientation and her transition to being off on her own again, provide her support by way of talk therapy, and be there as a referral source if psychotropics are desired at any point.


Every one of us has a story. We all have a reason or inspiration for why we chose to become a nurse. We love what we do. The nature of our jobs and the environments in which we work can affect our mental health.

The long hours, consecutive shifts, exposure to traumatizing situations, and life and death can all take a toll on our mental health at some point. It is also important to note here that there are some things about nursing we did not know much about before working as nurses. Things like the effect of working short-staffed, the commonality of nurse-to-nurse bullying, the struggle with lack of resources or supplies from time to time, or even how our place of work would react to a global pandemic are things we learned with our experience. These are the not-so-glamorous parts of nursing that sometimes contribute to nurses leaving the bedside or leaving nursing altogether. The more these things are talked about and the more attention that is brought to these things not being just a “part of the job,” the more likely we are as nurses to come up with plans to mitigate these problems and improve nursing as a profession for ourselves and for those who follow.

In nursing school, we learned about primary and secondary prevention measures. We must do what is necessary to care for our minds just as we care for our bodies to work to prevent mental health issues and mitigate any that should arise. Caring for our mental health is vital to being able to live fully outside of work among our family and friends and in our workplace, where we have patients depending on us to be our best. For a profession that works so hard to help others, there is still so much stigma around asking for help for ourselves.

We are not robots. We have needs just like our patients do. If at any point you are experiencing at least two weeks of problems sleeping, appetite changes, difficulty focusing at work or home, sustained low mood, loss of interest in things you once loved, or an inability to perform the daily functions and responsibilities you have as a nurse, mom, dad, sister, brother, cousin, aunt, uncle, grandmother, or grandfather, please seek professional help (NIH, 2022). Please do not wait until your symptoms are overwhelming to you. Your family needs you, your patients need you, YOU need you.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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