While most nurses are eager to discuss their profession with friends, family, and colleagues, conversations surrounding depression and anxiety remain taboo despite the prevalence of these mental health conditions within the field. Self-care for nurses is perhaps not given the attention it deserves.
According to the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative, 18% of nurses exhibit symptoms of depression -- double the rate within the general population. These numbers have increased significantly during the COVID-19 pandemic. One survey found that 93% of healthcare workers were experiencing stress, 86% reported anxiety, and 75% reported feeling overwhelmed.
The survey also indicated that 38% of healthcare workers did not feel they had adequate emotional support. Unfortunately, nurses were even less likely to report having adequate emotional support (45%).
Many nurses will continue to avoid seeking the mental health support they need simply due to the stigma of being viewed as weak or inferior and admitting to needing help with their mental health.
Why are nurses prone to depression and anxiety?
Many of the factors that impact an individual's mental health, including significant stress, an odd sleep schedule, and lack of support, are a normal part of a nurse's profession. In fact, nurses often experience mental health challenges at a higher level than individuals working outside of the healthcare industry. Some of the specific causes of anxiety and depression among nurses are discussed below.
High-stress situations
From a nurse's first day on the job to their last, no two shifts are identical. Nurses are thrust into new situations daily, forced to use their knowledge to recall information quickly and often make life and death decisions. It's a never-ending process of learning through experience. For individuals in a new nursing job, the anxiety induced by these high-stress situations can be even more pronounced, especially if they are exacerbated by insufficient peer or mentor support.
Fear of causing patient harm
Even veteran nurses can find themselves feeling overwhelmed by their work. Nearly all healthcare professionals, regardless of their rank, are haunted by the fear of creating a medical error. Unfortunately, this extreme habit remains a psychological burden for many nurses who are unable to cope with the complexity of this level of high stress when the shift is over. A high level of stress moves from an abnormal, unusual event to a normal, recurring event in the brain. This becomes a central part of their daily lives, even after the scrubs come off. This creates a trigger and is unknown to the nurse when they are faced with this level of decision making.
Finding work-life balance
The difficulty of creating a clear division between work and home is a significant cause of anxiety and depression among nurses. Due to the nature of nurses' schedules, which often prevent them from doing much more than eating and sleeping on their days off, finding the time to take a step back and focus on themselves and their families can be challenging, making self-care for nurses even less likely. Nursing is a way of life for many working in the industry. Their world encompasses only nurses and nursing activities, making it very difficult to navigate outside of their roles for much-needed respite and a level set of their thoughts. Nurses simply do not deal with their self-identities and may not have the coping mechanisms needed to adequately face anxiety and depression.
Toxic workplace culture
Regardless of the industry, a toxic workplace can be detrimental to any employee. Nursing leadership is a key component of balancing work culture and creating a tolerant environment. Lateral violence among nurses is a major issue within the healthcare industry. A form of workplace bullying, lateral violence fosters feelings of failure and inadequacy and can leave nurses feeling devastated and without the support systems they need to thrive. It also heightens tensions within an already high-stress environment and is often the cause of high turnover and retention rates.
The pandemic's effect on nurses
As if nurses weren't already experiencing a highly stressful, demanding work environment, the impact of the COVID-19 pandemic has unleashed unforeseen stressors that continue to evolve. Data suggests that American healthcare workers are experiencing greater mental health impacts yet to be understood and managed.
According to a survey by the American Nurses Foundation (ANF) that netted responses from 22,215 nurses from January 19 to February 16, 2021, nurses feel "betrayed" (12%), "guilty" (11%), and "like a failure" (10%). Nurses reported more than one emotional state as the highest percentage answers exceeded 100%: exhausted (51%), overwhelmed (43%), irritable (37%), and anxious (36%). Only 1% of respondents felt suicidal, but that is still 222 nurses considering taking their own lives.
The American Psychiatric Association has discussed the likelihood of post-traumatic stress following the pandemic, recognizing the stigma around mental health preventing healthcare workers from seeking care. Healthcare workers, especially those who are directly caring for COVID-19 patients, are at a high risk of developing traumatic stress disorders due to unprecedented levels of burnout, moral injury, and compassion fatigue. These findings demonstrate the importance of prioritizing self-care for nurses.
Self-care for nurses
Self-care is paramount when it comes to dealing with anxiety, depression, and even everyday stress. But taking care of your well-being is easier said than done — especially in a profession that values endless resilience. Nurses must be encouraged to offer themselves the same grace, compassion, and attention typically reserved for others. Some helpful approaches to self-care for nurses include:
- Schedule a vacation day without obligations.
- Disconnect during your breaks with a book, music, or a quick walk.
- Book a massage or appointment just for you.
- Connect with coworkers you feel comfortable with.
- Practice meditation.
- Ask friends or family for help with housework or chores.
- Learn something new (even if taking a class isn't an option).
- Make someone laugh, find humor when you can.
- Say "no" to optional commitments you're not interested in.
- Find gratitude in the small things.
- Use EAP resources for counseling, coaching, and healthy coping tools.
Having reliable support systems in place is critical when to navigating self-care for nurses. It's important that you feel empowered to engage in a safe space to discuss your stress and mental health concerns. These efforts allow you to realize you are not alone, validating your experiences and encouraging support.
Nurses have undergone unusually high amounts of stress through the pandemic, and this should not be overlooked or forgotten. Advocate for yourself and your peers when you can, and always remember to prioritize your mental health and self-care, just as you would advise to your patients.
Learn more about important nursing topics like this one on the NurseDot Podcast.
