Improving the mental health of nurses | Viewpoint

Over the last few years, the issue of clinician mental health has been thrust into the national spotlight, as the public became aware of the challenges of a job where life and death scenarios are routine.

Danielle Bowie (Photo: Trusted Health)

As a former bedside nurse myself, I can attest that the emotional demands of the job can be intense at best, and all-consuming at worst. As a 24-year-old charge nurse, I had little time to process any of the things I saw on a daily basis and was expected to simply keep going.

Today, I work with the team at Trusted Health to help nurses take control over their professional lives, and also to find a way to make nursing a more sustainable career. Each year since 2020, we have released our annual Frontline Nurse Mental Health & Well-being Survey in order to gauge the well-being of our nation’s nurses, and also to advocate for solutions.

This year's survey offers some reasons for cautious optimism. Nurses’ self-reported mental health ratings continued to improve since the darkest days of the pandemic, from 5.4 in 2020 to 6.6 in 2023.

Similarly, negative outcomes associated with mental health have declined across every category over the last year. While the incidence of things like burnout and depression remains cause for concern, we saw significant drops in the occurrence of moral injury (-28%), compassion fatigue (-27%) and suicidal thoughts (-25%).

And yet, nurses don’t think that their facilities or the industry at large prioritize and offer adequate support for their mental health. Every year since the survey’s inception, 95% of respondents have said that their mental health was either not a priority for the healthcare industry or that it was a priority, but that there were inadequate measures in place to support it.

The number of nurses who are planning to leave the profession within the next year dipped slightly from last year, but still remains worryingly high. Fifty-four percent of all nurses say that they are either actively looking for a job away from the bedside or outside of nursing completely, had plans to do so within the next year or were planning to retire from the workforce entirely.

Taken together, there are some encouraging signs in this year’s survey, but we as an industry still have work to do in order to slow the tide of departures.

It’s here that the findings reveal something simple yet profound: the benefits and programs that hospitals provide have a tangible impact on nurse mental health. Nurses who rated their overall mental health as positive were two and a half times more likely to be satisfied with the level of support their hospital provides relative to those who rated their mental health as negative. Similarly, nurses who report overall negative mental health are almost twice as likely (92%) to say their hospital doesn’t offer any benefits at all.

The findings also offer insight into exactly the kind of programs that are most impactful. Peer support programs – something that helps not only with mental health, but overall unit and hospital culture – had the strongest correlation with nurse mental health. One-to-one counseling and therapy, as well as education around mindfulness, meditation or other stress reduction techniques were also shown to have a significantly positive impact.

Addressing chronic staffing shortages also needs to be at the top of hospitals’ lists. Younger nurses have made it clear that they are seeking flexibility in their careers, and removing rigid rules around scheduling in favor of options like self-scheduling, different shift lengths and the ability to work on a full-time, part-time or gig basis can have a positive impact on nurses’ work experience and well being.

Lastly, this year’s survey revealed an important but less-discussed legacy of the COVID-19 pandemic that needs to be addressed: due to a mass exodus of older and more experienced nurses from the profession in recent years, new nurses have taken on advanced responsibilities at an accelerated pace at the expense of their well-being.

In fact, of those nurses who reported that they had become a preceptor or a charge nurse one year or less into their careers, 38% reported that it had had a negative impact on their mental health. Educational and mentorship support should be baked into training for these nurses, and regular check-ins should be a core part of their experience for a minimum of six months. Moreover, these kinds of advanced responsibilities should always be voluntary, never forced upon nurses who aren’t ready or aren’t interested.

After three years of relatively dire findings, this year’s survey has me feeling hopeful. We are finally headed in the right direction, and now we have a roadmap that shows us how to continue in that direction. Now it’s incumbent upon all of us to follow that map and to continue to invest in concrete, evidence-based solutions to support our nurses.

Danielle Bowie is the chief nursing officer of Trusted Health.