Stress is unavoidable in nursing, so managing it is critical. High stress levels and related mental health conditions can threaten the well-being of nurses and their patients. Psychological distress increases the likelihood of medical mistakes and contributes to staff burnout and retention challenges.
The COVID-19 pandemic has highlighted the physical dangers that nurses and other healthcare providers expose themselves to when providing life-saving care. Less visible, however, is the mental toll of the work that they do, and the real dangers of nurse stress.
If stress is left untreated, it can lead to physical ailments including high blood pressure or insomnia and mental health conditions such as depression or anxiety. Fortunately, there are a number of ways that nurses can manage stress to improve their overall health and maintain vitality in their roles. Nurse leaders and educators can also play a role in reducing stress among nurses.
The Stress of Nursing
The mental and physical challenges of nursing, even under normal conditions, are exceptional. Nurses work long hours doing physically demanding work, all while maintaining constant vigilance in making decisions and performing duties with potentially life-or-death consequences. Surrounded by sickness and death, nurses care not only for patients but also for patients’ families, providing comfort to people who are often experiencing fear, anger, or grief.
The responsibilities and challenges of nursing extend beyond these duties, however. From the physical risk of treating infectious diseases to the mental strain of providing constant emotional support, many of the most stressful aspects of nursing are the least visible.
While careers in medicine can provide great emotional rewards, the emotional labor of providing healthcare can be one of the most taxing, and overlooked, challenges of nursing. Emotional labor refers to the effort involved in managing feelings when a work role demands that some feelings be displayed while others are hidden.
For nurses, negative emotions such as fear, anxiety, or frustration are often concealed in order to project the compassion, confidence, and professionalism necessary to perform their jobs. Such dissonance between inner feelings and outer appearances can contribute significantly to mental fatigue and stress.
Disasters and Health Crises
Major life-threatening events such as multiple-vehicle crashes and wide-scale flooding can overwhelm an emergency staff. Such events can amplify the challenges and stress caused by long hours of physically and mentally taxing work and exposure to critical and life-ending injuries. These events can also result in increased emotional labor.
Resources for Disaster Nurse Stress Management
The resources below address the mental health needs of healthcare professionals during disasters.
Coping With a Disaster or Traumatic Event: The emergency preparedness and response program of the U.S. Centers for Disease Control and Prevention (CDC) provides resources for various groups, including emergency planners and responders.
Disaster Distress Helpline: Providing a constant source for crisis counseling and support, this Substance Abuse and Mental Health Services Administration (SAMHSA) helpline helps people experiencing emotional distress related to natural or human-caused disasters.
Taking Care of Your Emotional Health: The CDC provides guidance on taking care of your emotional health during and after a disaster.
Nursing Stress During a Pandemic
Often overlooked is the danger and associated stress that nurses face when working with patients with infectious diseases. During major outbreaks, such as the COVID-19 crisis that reached global pandemic status in 2020, nurses have one of the most dangerous jobs. Research shows nurses are among the workers who face the greatest risk of contracting the coronavirus due to their exposure to the disease and their physical proximity to others in the work environment.
A recent study of healthcare workers exposed to COVID-19 found high levels of mental health symptoms, including anxiety, depression, and insomnia. More than 70% reported experiencing psychological distress.
The extreme conditions of a major disease outbreak create unique stressors. In addition to the fear of disease exposure, nurses and other healthcare workers may face resource shortages — including low supplies of personal protective equipment (PPE) — and uncertain leadership and guidance. Under such conditions, nurses may experience large disparities between the knowledge of how care should be given and what is possible during a crisis. All of these factors contribute to a sense that nurses lack control, which further heightens stress.
The stressful aspects of nursing during a pandemic are not limited to the workplace. Quarantine protocols and the fear of infecting loved ones can force nurses to be separated from their families for long periods of time. Physically removed from their most essential support system, some nurses also experience feelings of guilt regarding the care of their partners and children.
Resources for Pandemic Nurse Stress Management
Information for nurses and other healthcare professionals about coping with stress during the COVID-19 pandemic are listed below.
Coping With Stress: The CDC provides guidance on coping with stress during a pandemic.
Healthcare Personnel and First Responders: How to Cope With Stress and Build Resilience During the COVID-19 Pandemic: The CDC outlines symptoms of stress and provides tips for enhancing resilience.
Reducing Stigma: This CDC guide addresses various groups, including healthcare providers, who may experience stigma during an infectious disease outbreak.
Resources to Support the Health and Well-Being of Clinicians During the COVID-19 Outbreak: The National Academy of Medicine lists resources available through the World Health Organization, U.S. government agencies, universities, and various healthcare organizations.
Taking Care of Your Behavioral Health: SAMHSA’s tip sheet describes feelings that people experience related to social distancing, quarantining, and isolation.
Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic: The CDC describes telehealth, a critical service for the general public and healthcare workers during disease outbreaks.
Recognizing Symptoms of Nurse Stress
When nurses and other healthcare professionals struggle to manage stress, the effects can manifest in many ways. Some common symptoms include:
- Irritation and anger
- Anxiety and fear
- Denial, numbness, or disbelief
- Uncertainty or nervousness
- Motivation or energy loss
- Tiredness or burnout
- Sadness and depression
- Sleeplessness and nightmares
- Appetite loss
- Concentration difficulty
- Alcohol, tobacco, or drug use
While some degree of stress is unavoidable, and some amount of negative feelings is normal and healthy, it is important that nurses take the signs of stress seriously and monitor themselves and each other. Nurse leaders also have a responsibility to identify nurses who need help managing stress. If left unchecked, stress can contribute to more serious health conditions.
Observing warning signs and unhealthy behaviors and taking action early is crucial for recovery. Left unchecked, symptoms can become disabling if they become too severe. In extreme cases, nurses can experience acute stress disorder, secondary traumatic stress, and post-traumatic stress disorder (PTSD).
Tools to Locate Nurse Stress Assistance
Behavioral Health Treatment Services Locator: This resource from SAMHSA allows users to find treatment facilities confidentially and anonymously, searching by address.
Mental Health Tools and Resources: The CDC’s resources include guidance for public health and health professionals and information for people seeking mental health treatment.
Tips for Managing Nurse Stress
The following actions can help reduce nurse stress:
- Manage your diet. Eating healthy foods — fruits and vegetables, whole grains, lean proteins — boosts energy levels and aids digestion. It can also contribute to better sleep.
- Get plenty of sleep. Stress can lead to poor sleep, which in turn can contribute to more stress. Eating healthy foods and exercising can help break the cycle.
- Exercise and stretch. Finding time to exercise can be difficult, particularly when nurses are already working long hours doing work that is physically demanding, but the benefits are substantial. Exercise releases endorphins and boosts serotonin levels, which can improve mood, appetite, and sleep cycles.
- Practice meditation, mindfulness, or yoga. Practices that quiet the mind, focus awareness, and regulate breathing can help reduce stress.
- Unwind by pursuing hobbies. Focusing on personal interests gives people something to look forward to, provides a healthy outlet for stress, and keeps the mind distracted from work-related concerns.
- Share your feelings. Venting to friends and family members about work challenges can help relieve stress. Professional, community, and faith-based organizations can also provide outlets for sharing experiences.
- Many people find that recording their thoughts and feelings helps clear their mind.
- Limit exposure to media, particularly social media. While it is important to stay informed during health crises, setting parameters for the time and duration of media consumption prevents fixation on negative events.
Team Stress Management Tips
It is helpful for nurses to understand that they are not alone, but equally important is the realization that everyone is different. While a nursing cohort may share many challenges — dangerous working environments, long hours, separation from family — individuals face vastly different situations and challenges in terms of family responsibilities, levels of support from family and friends, financial situations, and existing physical and mental health conditions.
Activities that encourage nurses to share their specific challenges can bond teams and build empathy. Other team strategies for managing stress include:
- Participating in employer-provided occupational health safety programs
- Developing a program for reporting signs of stress or mental health challenges that require interventions
- Creating a peer-support system that partners nurses for shared support and stress monitoring
Resources for Managing Nurse Stress
The resources listed below offer general information about stress relief and self-care strategies.
Combating Stress: The American Nurses Association lists content from its Healthy Nurse, Healthy Nation blog related to stress relief.
Holistic Stress Management: This resource provides self-care strategies from the American Holistic Nurses Association.
The Importance of Nurse Stress Management
It is crucial for nurses to understand the importance of self-care. For those who have dedicated their lives to helping others, it can be difficult to accept a simple truth: Their lives and health are no less precious than that of their patients. In fact, because their ability to do their jobs is dependent on their health, they have a duty to protect their own well-being.
Nurses who learn to successfully manage stress are more likely to experience the rewards of their work, including the perspective that comes from helping others during times of crisis. Many find that their work teaches them a greater tolerance for others, helps them experience more gratitude and spiritual connection, and makes them appreciate loved ones even more.
Centers for Disease Control and Prevention, Emergency Responders: Tips for Taking Care of Yourself
Verywell Mind, “The Importance of Hobbies for Stress Relief”
U.S. Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19), Helping Children Cope
U.S. Centers for Disease Control and Prevention, Information for Healthcare Professionals About Coronavirus (COVID-19)