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Discussion

Why We Need to Talk About Our Mental Health as Nurses

There is an elephant in the room filled with nurses. A looming presence that we choose to ignore, an ever-present force amongst us, and nobody wants to talk about it. This elephant is our mental health. As nurses, we are holistically trained. We learned in nursing school to consider the mind and spirit as well as the body when we assess our patients. So why is it that we are often hesitant to discuss our own personal mental health struggles? Why don’t we look upon ourselves with the same consideration and treat ourselves with the same kindness as we do with our patients? As depression and anxiety rates increase amongst nurses, now more than ever, it’s time to talk about our mental health.

Rates of depression and anxiety are on the rise amongst nurses, particularly in light of COVID-19. According to a recent survey performed by American Nurses Association, 40% of nurses reported feelings of depression. Although mental health struggles are increasing with COVID-19, they are not new amongst nurses. Prior to COVID-19, an Australian study of 102 nurses found depression in 32.4%, anxiety in 41.2%, and stress in 41.2%. although no one wants to talk about it, mental health issues are prevalent amongst nurses. Yet it seems like we are afraid to discuss these vulnerable aspects of ourselves. Why is that do you think?

Why We Don't Talk About Mental Health Issues

Historically, nurses have prided themselves on being strong-minded and capable. We are prone to self-sacrifice and value heroism. We fear the seemingly social stigma that is associated with mental health issues. We believe that we have to be held to a higher level of functioning, so we give our all. This, in turn, can lead to burnout which can significantly contribute to mental health issues such as anxiety and depression.

Contributing Factors To Anxiety And Depression

Stress

It’s no secret that our day-to-day jobs as nurses are filled with stress. We encounter stress every single day, and sometimes all throughout the day. Stress takes a toll on our bodies, both physically by raising cortisol levels thereby leading to chronic health conditions, and mentally by triggering anxiety and depression. Today we are dealing with an astronomical force of added stress related to COVID-19. We’ve been working longer hours, we’re shorter staffed, and we’ve had to deal with limited resources. This added stress is affecting nurses all across the world.

Burnout

Along with COVID-19, rates of burnout are on the rise amongst nurses. Burnout is often caused by prolonged stress and is characterized by emotional, mental, and physical exhaustion. A survey done on Canadian nurses found that 63.2% reported some symptoms of burnout and 29.3% reported significant levels of burnout. The study noted that “higher levels of burnout were associated with higher levels of anxiety, stress, and depression symptoms.” In this time of COVID-19 more and more nurses are being pushed to their limits and are unfortunately reaching burnout. We are exhausted. We’ve been fighting this battle for two years and sadly we don’t have an end in sight. We’re in this for the long haul. Now, more than ever, we need assistance in developing positive coping mechanisms.

Compassion Fatigue

Compassion fatigue coincides with acute mental health issues and is particularly prevalent today with COVID-19. The Merriam-Webster dictionary defines compassion fatigue as “the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.” The prolongation of the COVID-19 pandemic is pushing compassion fatigue to new heights amongst nurses. Compassion fatigue significantly contributes to burnout. It may cause increased feelings of hopelessness amongst nurses, leading many nurses to consider leaving the nursing profession altogether.

What To Do About It

Awareness of an issue is the first step to initiating change. We need to talk about mental health issues amongst nurses. We need to be aware of the prevalence of mental health issues amongst nurses so that we can address them. Let’s be compassionate to ourselves by starting the conversation.

Practicing Mindfulness and other Self-Care Habits

Self-care habits such as getting enough sleep, eating well, exercising, and practicing mindfulness are excellent lifestyle behaviors that boost mental health wellness.  These self-care behaviors are associated with improving and preventing anxiety and depression. Mindfulness is the practice of returning to the present moment and is often achieved through practicing meditation and yoga.

Support Groups

Support groups are a valuable resource for mental health wellness as they assist people in finding and maintaining community support. Support groups provide a network of like-minded individuals dealing with similar issues and offer a non-judgmental space to discuss sensitive topics. We need to promote support groups amongst nurses to increase awareness, availability, and attendance.

Mental Health Counseling/Therapy

Mental health therapy should be promoted more amongst nurses. It should be easier for nurses to find mental health counselors, and time off should be encouraged for this essential treatment. Some examples of ways to increase use amongst nurses are placing mental health fliers in the break rooms, management promoting self-care habits, and easy-to-find online resources for therapy and support groups on our intranet websites or portals.

Supportive Workplace Environments

If workplaces support holistic wellness cultures and encourage their nurses to seek available mental health resources, then nurses feel empowered to seek out mental health care without fear of social stigma.  Mental health wellness is key to building a stronger and healthier nursing workforce. If we do not promote mental health practices and support our nurses struggling with mental health issues, then rates of depression, anxiety, and stress will only continue to rise causing even more nursing staffing shortages as nurses reach compassion fatigue and burnout. It is in management’s best interest to promote healthy self-care habits and provide easy access to mental health resources.

Call To Action

If we change the story, we change the stigma, then we can change the outcome. The more we talk about mental health issues amongst nurses in a non-judgmental supportive manner, the more nurses will know about resources available to them and not feel afraid to seek out those resources for fear of stigma or shame. As seasoned nurses, it is our responsibility to support the next generation of new nurses, to set them up for success by promoting mental health wellness. It’s time to change the story, promote healthy mental health practices, and support our nurses who struggle with mental health issues.

 

References

American Nurses Association. (2021). New Mental Health and Wellness Survey Finds Depression Increasing Among Nurses.

National Library of Medicine, PubMed.Gov. (2018). Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses. 

National Library of Medicine, PubMed.Gov. (2021). Associations Between Burnout and Mental Disorder Symptoms Among Nurses in Canada. 

Merriam Webster. (2022). Compassion Fatigue. 

Psychology Today. (2022). Burnout. 

Psychology Today. (2021). 7 Simple Habits to Protect Your Mental Health.

National Institute of Mental Health. Mental Health Information. 
 

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    This was a very good article and I appreciate it.  Problem is time, we need to make time.

    I don't necessarily think the statement is true, that we don't treat or value ourselves holistically in the same way that we treat our patients.  WE DO.  Honestly, I don't think anyone cares how you feel when your butt is handed to you during a shift, they just want the job done.  By the time you've had a day off from the hella shifts you've encountered you just want to totally forget about work and enjoy your life that day or those days (for however many days you'll have) off.  If you are feeling bothered at the end of the day, when you do go into your managers office to vent, you'd better hope their phone doesn't ring.

    To me, I don't think the issue is that we are necessarily afraid to speak out against workload/burnout, r/t anxiety and depression, it's just that we don't have time.  Our minds are always thinking.  We are thinkers by the sole nature of the job, always trying to prevent a problem before it becomes a huge issue. We are jugglers (aka priority champions).  We are counselors (stopping trains in motion to have a needed discussion to ease a patient/patient's family) meanwhile falling far behind in work, with a smile. And the list goes on.

    What merriam webster calls compassion fatigue I call prioritization.  We care about our patients and ourselves, it's just we are always on go mode, (which situation is most likely to turn south first).  And when shift's over, it's over.  Most nurses I know, when we're walking out after a shift's over, we are talking about our families and what to look forward to.  Sometimes venting about your day/night, is counterproductive.  Someone can always one-up you on your way out, so we just suck it up.  Is it right?  No freaking way.

    The ideas of support fliers posted throughout the facility and mental health resources are great but does anyone ever reach out before it's too late.  I hope so, but I don't know.  We need real time conversations with people who are non judgmental who "get it".  We need safe places with some of our peers or mentors who are also fighting the good fight.  When I was young their was a buddy system in place, but in this case you would have to be matched with someone who may be a little stronger than you and can really hear you out and help with no fear of retaliation.  Nowadays, people say we don't have to be perfect while at the same time, expecting perfection...

    Nurses are buzzzzzzyyyyy.  It would be nice to have therapeutic real conversations on unrecorded lines ?that seem interested in what we encounter on a daily basis.  Sometimes actively listening and justification for our feelings are all we need.  When stressed, I typically call or go out with one of my nurse friends so we can sound off.

    Lastly, I hope none of us are ashamed.  We're human, we get stressed out, mentally exhausted, fatigued beyond measure, want to quit and yuck spit, and we shouldn't care about stigma.  This is a highly stressful professional job before and after covid, and we should be proud of the differences we make in each and every life we encounter.  I take it one shift at a time. I try to compartmentalize and deal with my feelings by knowing it's not personal, it's work.  We can and do make a difference. We matter.  I'm not going to say we're heroes or superheroes or gigantic heroes or none of that stuff.  What we are, are Leaders, making real time decisions, one situation at a time.  

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    • Author

    Thank you for your feedback. You make a really good point in saying that we need more time. As nurses, we constantly feel like we are running out of time. Adding mental health care to an already overloaded system can seem like an impossible task indeed! This can be particularly frustrating because, in order to thrive holistically, it is necessary to foster mental health. As you also pointed out, real conversations from supportive listeners help us feel heard. This echos my main point of this article, that we need to start the conversations. We have to start somewhere, and most often change starts with a conversation. In this case, feeling safe enough to initiate conversations knowing that the vulnerable things you reveal to another person will be heard, supported, and not shamed. 

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    We are socialized to take responsibility for every problem, if something goes wrong, tell the nurse. We coordinate everyone, so its easy to blame nursing, and easy for us to take the blame. It's standard after a physical assault for nurses to be asked "what could you have done differently?" So if we have trouble coping, naturally we expect to take the blame for bad coping, and we keep it quiet. There's no reason to think anything will change.

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    On 8/18/2022 at 10:10 PM, canoehead said:

    We are socialized to take responsibility for every problem, if something goes wrong, tell the nurse. We coordinate everyone, so its easy to blame nursing, and easy for us to take the blame. It's standard after a physical assault for nurses to be asked "what could you have done differently?" So if we have trouble coping, naturally we expect to take the blame for bad coping, and we keep it quiet. There's no reason to think anything will change.

    You are onto something here, and this scARES me.  For every little thing that the patient tells us no matter how insignificant it may seem, I'm still mentioning it to the doctor.  It could be totally unrelated to their CC HPI but I don't care, especially given the way society is viewing nursing.  It could be a new bald spot, ingrown toenail, or as donkey said on shrek "my eye is twitching".  Nowadays it just seems they want everything to fall on the nurse.  It seems like we are the fall guys.

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