Disclaimer: The views and opinions expressed in this article are solely those of the contributor and do not necessarily reflect the official policy or position of ANPD.
I began my career 15 years ago in the Medical Intensive Care Unit of a large academic medical center. Reflecting on my early days as a nurse, I recall feeling constantly anxious, exhausted, and on edge. I felt overwhelmed by the vast amount of knowledge I needed to master and apply, along with the significant responsibility I carried. I knew that my actions or inactions could seriously harm a patient. I remember one particularly difficult week when a physician belittled me for reporting a patient finding he deemed irrelevant, and a patient’s family member took their frustrations out on me. I started to tear up, and my preceptor took one look at me and simply said, “buck up.” And I did just that—I composed myself and continued working. I internalized the belief that as a nurse, I should suppress my emotions and needs and soldier on. My colleagues and I worked through long hours without breaks, hiding our grief over futile care and suffering patients. We had been trained to desensitize ourselves to these circumstances and neglect our own needs. This took its toll, but— “there is no crying in nursing.”
Like many in the field, my training focused on clinical competencies and protocols, often neglecting to address the psychological impacts of the job and strategies for coping with its stressors. The methods used to prepare new nurses may inadvertently reinforce the idea that they should conceal their emotions and endure hardship in silence. This can lead to the belief that acknowledging struggles or seeking help is a sign of weakness, perpetuating a cycle of suffering, suppression, and deteriorating mental health. The culture of stoicism, combined with the idealized image of nurses as entirely selfless angels, is subtly harmful. Although this perception flatters the profession, it creates anguish and identity confusion by conflicting with reality. While others exalt nurses as superheroes, they themselves frequently endure grueling working conditions, emotional distress, and exhaustion. Yet, these experiences are often denied, with many preferring to pretend they don’t exist.
The Nursing Mental Health Crisis
Nurses have long struggled with mental and emotional well-being due to the inherent stressors of their work. They experience mental health issues at a higher rate than other professions, with suicide, substance abuse, and depression rates almost twice as high (Choflet et al., 2023; Naegle et al., 2023). Studies reveal that these difficulties are a significant occupational hazard for nurses, reducing quality of life and job satisfaction, and impeding the delivery of safe, quality care (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). Tragically, the stigma surrounding mental health support perpetuates a culture of silence. Nurses suffer in solitude, fearing repercussions such as losing their license or facing professional setbacks if they seek help (Office of the Surgeon General, 2022). Because these issues have not been adequately addressed, they have resulted in a mental health crisis worsened by the COVID-19 pandemic (NASEM, 2021). This crisis threatens not just individual nurses but the entire nursing workforce. Many are leaving their positions, worsening staffing shortages and further burdening those who remain (Naegle et al., 2023; National Academy of Medicine [NAM], 2022). According to the American Nurses Association (2023), nearly 1 in 5 new registered nurses leaves the profession within their first year, with burnout and stressful working conditions cited as key factors.
Systemic Change and Genuine Support: Essential for Nurse Well-being
To address the ongoing mental health crisis in nursing, we must actively dismantle the institutional barriers undermining well-being. Specific occupational hazards in nursing are well known, and education along with safeguards are typically implemented to prevent harm. Unfortunately, systemic protections to mitigate psychological stressors have not been developed as extensively as those for other hazards, such as needlesticks or infectious diseases (Choflet et al., 2023). Instead, efforts have been focused on encouraging nurses to build resilience through self-care and mindfulness practices. These strategies place the burden of addressing the mental health consequences of nursing on individuals instead of tackling root causes. This approach is inadequate and suggests that the person, rather than the system, needs to change. It is irrelevant if we instill resilience in individuals if they enter systems that undermine their ability to thrive (NAM, 2022). Those developing the nursing workforce must recognize the scope of these issues and create education, policies, and environments that genuinely support nurse welfare. Validating the challenging experiences that nurses routinely face is an important step forward. We must also provide comprehensive education on the causes, symptoms, and treatments of occupational risks, including burnout, compassion fatigue, moral injury, secondary traumatic stress, and addiction. Moreover, we need to actively address and counteract the negative attitudes toward seeking help that persist within nursing’s culture and training. A holistic approach to professional development, incorporating emotional support, mental health education, and a cultural shift towards valuing and supporting nurse well-being, is crucial for effectively confronting these issues.
Embracing Vulnerability: Fostering Empathy and Humanity Among Nurses
I once believed that I needed to be polished and impenetrable to be a good nurse. However, I’ve learned that there is no need to reject feeling and vulnerability to be great at this job. Perfectionism and stoicism can be harmful to nurses and may also serve as barriers to quality patient care. They may widen the gap between patient and caregiver, creating a patronizing dynamic rather than a partnership. By embracing our humanity, we can more effectively perform our roles. To be human and to be there for another human exemplifies the nursing profession. Accepting our shortcomings and vulnerabilities allows us to truly empathize with others, and empathy is crucial for effective, patient-centered care. Nurses need to receive empathy and support themselves in order to offer it to others; it’s difficult to give what you do not have.
Many of us continue to demand perfection of ourselves and of each other—cultures die hard. We need to encourage nurses to embrace their own truth and not feel ashamed if it conflicts with societal expectations. While we dedicate ourselves to saving others, we must also remember to save ourselves. We need to accept that as humans, we will occasionally falter, and this should not be a source of shame. It’s essential to extend patience, compassion, and forgiveness to ourselves and to one another, especially when we fall short. It's time to create a supportive culture that enables nurses to contribute to the field with renewed dedication and capability.
Disclaimer: The views and opinions expressed in this article are solely those of the contributor and do not necessarily reflect the official policy or position of ANPD.
References
American Nurses Association. (2023, May 19). Why nurses quit and leave the profession. ANA.
Choflet, A., Rivero, C., Barnes, A., Waite-Labott, K., Lee, K. C., & Davidson, J. E. (2023). Accessibility and financial barriers in the utilization of alternative to discipline programs in the United States. OJIN: The Online Journal of Issues in Nursing, 28(1), 1-13. https://doi.org/10.3912/ojin.vol28no01man06
Naegle, M. A., Kelly, L. A., Embree, J. L., Valentine, N., Sharp, D., Grinspun, D., Hines-Martin, V. P., Crawford, C. L., & Rosa, W. E. (2023, February 1). American Academy of Nursing consensus recommendations to advance system level change for nurse well-being. Nursing Outlook, 71(2). https://doi.org/10.1016/j.outlook.2023.101917
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020-2030, Flaubert, J. L., Le Menestrel, S., Williams, D.R., & Wakefield, M. K. (Eds.). (2021). The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity. National Academies Press (US). https://doi.org/10.17226/25982
National Academy of Medicine; Action Collaborative on Clinician Well-Being and Resilience, Dzau, V. J., Kirch, D., Murthy, V., & Nasca, T. (Eds.). (2022). National Plan for Health Workforce Well-Being. National Academies Press (US). https://doi.org/10.17226/26744
Office of the Surgeon General (OSG). (2022). Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce. US Department of Health and Human Services. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
Courtney Hickey, BSN, RN
Registered Nurse, Pre/Post Special Procedures/Surgery, University of Colorado Hospital
Courtney Hickey is a baccalaureate-prepared registered nurse, with over 15 years of diverse experience. She is currently specializing in pre/post special procedures within the endoscopy lab at the University of Colorado Hospital. Throughout her career, Hickey has held various roles, including professional development coordinator/director of education, preceptor, and relief charge nurse across critical care, peri-operative, gastroenterology, and behavioral health settings.
Hickey is a member of multiple professional organizations. She serves as co-chair of the Workplace Advocacy Advisory and Networking Team (ANT), which provides guidance to the Colorado Nurses Association when determining position statements, legislative priorities, education, and other strategic initiatives. She is deeply committed to driving positive change for the nursing profession through advocacy and by cultivating supportive, inclusive practice environments.