Written by Samantha Wall, LCSW
Nursing is a high stress job. Statistics show that nurses are more likely to experience depression and anxiety than other professions. Why is that? There are many reasons why high stress leads to anxiety and depression, and I feel it is important to talk about the WHY, so we have an understanding of WHAT needs to change!
Operation Happy Nurse was created for a reason; mental health support for nurses is a need that is not being met. High stress situations, the fears of causing patients harm, a large daily workload, work–life balance, and toxic work environments are all factors that affect a person’s mental health. A study published in June 2021 found that nurses reported “heightened stress during the COVID-19 outbreak, resulting in substantially higher levels of depression and anxiety.” (Serrano, Hassalmal, Hassalmal, Dong, Neeki, 2021). This study also found that “Long-term exposure to stressful conditions weakens nurses’ resilience, resulting in an increase in anxiety levels.” (Serrano, Hassalmal, Hassalmal, Dong, Neeki, 2021). This is not new information; prolonged stress leads to increased struggles with mental health, and it’s safe to say there was heightened, prolonged stress during the pandemic. When we work in an environment where we are in a hyperarousal state (fight-or-flight) for a prolonged period of time, our brain and body grow accustomed to that level of stress. The result is either a switch to the hypo-arousal state (freeze/depressed) or a never-ending state of hyperarousal, i.e.fight-or-flight mode all the time.
As I listed above, there are many factors to the day-to-day stressful working environment for nurses. Some of the factors are not going to change, such as high stress situations, worrying about your patients, and the number of patients coming in each day. These stressors can be managed by utilizing grounding techniques, regulation strategies, self-care, and a healthy work/life balance. No two shifts are going to be the same, and it is important to utilize the skills listed above to support your mental health. It is a never-ending process of learning through experience. We need to use our resources, breaks, and time off to take care of our needs or have those routines in place to let our brain and body know we have left that stressful environment.
One topic I want to touch on, but will expand on in later blogs, is the fear of causing patients harm. This is a stress in the job that NEEDS to be processed with a therapist, supervisor, or (if appropriate and helpful) a co-worker. The worries we experience as caregivers in any capacity can affect the way we perform; we may be too cautious or talk down to ourselves after making a mistake. Again, this is a topic I will address in a separate blog, but I want to acknowledge this worry/fear/stress does not go away by distraction or through the skills I listed above. The skills I listed above help more in the moment with this specific stress.
Other important factors that contribute to the high stress environment include work/life balance and a toxic workplace culture. These factors are trickier to address and solve for the individual. Work/life balance is something I discuss in most of my blogs for good reason… When there is no balance, there is an increase in stress and other mental health struggles such as anxiety and depression. Creating a clear division can prove to be very difficult because of the stress nurses experience daily. One factor that adds to the difficulty in creating separation is how nurses schedules are set up. The way the shifts are scheduled can hinder your ability to do anything but eat and sleep on your days off because of the exhausting nature of the job… Finding time and energy to spend living your personal life can be really hard! In addition, thinking about what went wrong in the last shift or feeling constantly on call can be overwhelming and VERY hard to shut off. The ability to separate work and personal life also is affected by the toxic workplace culture. Factors that define a toxic workplace can include: bad communication, cliques, exclusion, bullying, bad leadership, unmotivated coworkers, stifled growth, rapid employee turnover, battling burnout, and chronic stress. Toxic work environments lead to stress, burnout, and disruptions in your personal life. Even with all of the skills I suggest to create separation in your work life and home life, if you work in a toxic environment, it can be really hard to decrease your stress. Boundaries can be a helpful tool when working in a toxic environment to create a level of separation, but they are not a complete solution.
This may feel discouraging to read because there are factors that are out of your control in your place of work that affect your mental health. There are more solutions!! These solutions range from personal changes you can make to big policy changes for all nurses. Nothing will ever be perfect, but there are ways we can work together to support everyone’s mental health! You can hold yourself and your friends accountable for taking care of ourselves, set healthy boundaries at work, or advocate for the needs of nurses through policy change. There are so many ways to support resilience in the workplace, and we are just touching the surface!
*The above factors are only some of the factors that affect nurses’ mental health, and there are many others that we could address. If there are any factors you feel like I missed or affect you, please comment or email so I can address them in a later blog!
Sources used: https://journals.lww.com/nursingmanagement/fulltext/2021/06000/depression_and_anxiety_prevalence_in_nursing_staff.7.aspx https://www.relias.com/blog/depression-anxiety-in-nurses