At 22 years old, I became a charge nurse on a 27-bed step down unit at a large metropolitan hospital. The job demands were intense, and I regularly saw critically ill patients, distressed family members, and other difficult situations that I had little time, emotional bandwidth, or support to process. This experience drove me to join Trusted Health, where I work with a team to identify workforce solutions that make nursing a more sustainable career. Each year since 2020, we have published the annual Frontline Nurse Mental Health & Well-being Survey to gauge the collective health of our nursing workforce and advocate for solutions to support it.
After three years of primarily grim findings, however cautious, this year’s survey offers reason for optimism. Nurses’ self-reported mental health ratings have shown continued improvement since the darkest days of the pandemic, ascending from 5.4 in 2020 to 6.6 in 2023. Furthermore, adverse mental health outcomes have decreased across all categories over the past year. Although concerns such as burnout and depression persist, there have been notable reductions in the incidence of moral injury (-28%), compassion fatigue (-27%), and suicidal thoughts (-25%).
One dispiriting finding, however, has remained consistent since the survey’s inception: 95% of respondents 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 to support it. Given the attention paid to clinician mental health since the start of the COVID pandemic, most nurses see industry-wide efforts at improving their mental health as inadequate at best and lip service at worst.
This year, we set out to identify the exact programs and initiatives that have a positive impact on nurse mental health, bolstered by the fact that 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.
My hope is that our findings provide the blueprint for a new, evidence-based approach to supporting nurse mental health. At the core should be an overhaul of nurse staffing, better support for new grads, and peer support programs.
It’s no secret that staffing continues to be one of the biggest – if not the biggest – challenges facing the healthcare industry, and this year’s survey highlights its deleterious effect on nurse mental health: fully 80 percent of respondents said that staffing levels or staffing shortages hurt their mental health. Hospitals must eschew rigid, outdated practices in favor of alternatives such as self-scheduling, variable shift lengths, and providing full-time, part-time, or gig-based employment opportunities.
More support must be given to new grad nurses who have taken on advanced responsibilities at an accelerated pace, often at the expense of their well-being. Disturbingly, 38% of nurses who assumed the role of preceptor or charge nurse a year or less into their career reported that it had a negative impact on their mental health. Hospitals need to incorporate educational and mentorship support 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 advanced responsibilities should always be voluntary, never forced upon nurses who aren’t ready or interested.
Lastly, this year’s research highlighted the power of peer support programs on nurse mental health: nurses who report positive overall mental health are twice as likely to work at a hospital with a peer support program than those who rated their mental health as negative. Not only can these positively impact nurse well-being, but they can also improve overall unit and hospital culture.
This year’s survey gives me hope after three years of findings where reasons for optimism were hard to come by. Now, it’s incumbent upon all of us to follow the evidence toward a path forward and find substantive ways to support the nurses who do so much to support us.
- An Evidence-based Approach to Improving Nurse Mental Health - November 3, 2023