Call to Action: Nurses Battling Depression, Stress and Anxiety Need Help

Nurses battling mental health challenges on the job have suffered in silence long enough, according to Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, the nation’s first University Chief Wellness Officer at an Institution of Higher Learning and Dean of the College of Nursing at The Ohio State University (OSU) in Columbus. She is also a member of the National Academy of Medicine’s action collaborative on clinician well-being and resilience.

Melnyk says a growing body of research is uncovering the true and startling nature of mental health issues among nurses, issues that are linked to medical errors and an upswing in reported nurse suicides.

Nurses also face physical health issues and have higher rates of high blood pressure, diabetes and depression than physicians, she says, suggesting “we should be declaring this a crisis amongst our nursing population.”

Building Evidence

Melnyk believes health care systems and nurses have to recognize that the health and wellbeing of the nursing population needs immediate attention, and this must begin by systematically reviewing the evidence from studies that exist and using that evidence to inform action tactics to address the issue.

“Depression is the most significant predictor of medical errors in nursing practice,” she explains, citing findings from a 2018 national study on nursing mental health and medical errors she led—the first study of its kind to investigate the relationship between depression and other health indicators in nurses and medical errors. 

The study examined nurses’ physical and mental health, the relationship between health and medical errors, and the association between nurses’ health and perceptions of wellness support. Through this study, Melnyk and her co-investigators found:

• 32.8% of nurses reported some degree of depression,
• 51.97% reported anxiety,
• 38.7% reported stress,
• 49.7% reported having medical errors in the past five years.

Nurses who perceived that they worked in a healthcare system that supported their health and well-being had better physical and mental health outcomes than those who reported less support. They are now working to apply this methodology to nursing specialties, such as critical care nurses, to understand how specific nursing practices and care environments may further impact mental wellbeing in nurses.

Recognizing the Risks

One important first step is to screen nurses for signs of depression and anxiety in particular, as well as burnout and compassion fatigue, Melnyk recommends.

“There is a sense among nurses that they are failing if they don’t stay tough and power through challenges in their practice, but mental health issues such as depression require support to be treated successfully, not unlike a broken bone that requires medical attention,” she stresses.

One other change Melnyk feels strongly about is an end to 12-hour shifts. Her study showed that the longer shifts that nurses worked, the poorer their health and the more medical errors made. Other studies over recent years also have supported the association between 12-hour shifts and medical errors.

“I know nurses love 12-hour shifts for the time off that follows, but it actually can take two days to recover from a run of three 12-hour shifts,” she notes. “We are also seeing nurses working several 12-hour shifts per week in one job and then picking up other work on days off to make more money.”

Looking at the System

Considering the individual health risks, as well as risks to safety and quality for patients, Melnyk believes health care systems as a whole need to take a hard look at addressing nurse wellness as a cultural norm.

At OSU, Melnyk has spent the past seven years in her role as Chief Wellness Officer to instill such a culture that offers resiliency-building programs for all and a menu of options for addressing the nine dimensions of wellness, such as mindfulness, yoga, healthy eating, cognitive behavioral skills building, and financial planning that serve the varied needs of individuals.

She says the future of our new nurses depends on establishing an expectation for nursing wellness that is indoctrinated into health care culture. “If we don’t get nurses engaging in healthy behaviors now, our next generation of nurses are going to fall into these same unhealthy habits.” However, we also have to make needed improvements in multiple factors within the healthcare system that affect nurses’ well-being, including short staffing and the electronic medical record, she adds.

Find resources to identify and address clinician mental health and learn more about the National Academy of Medicine’s national collaborative on clinician well-being and resilience.

Free Resources for Members

Periop Perks: Improve your nurse/life balance by saving up to 80% on travel, retailers, nursing education, insurance programs, and much more!

AORN Career Center: Take the stress out of staying ahead in your career with expert advice and career resources, including a 90-minute career coaching session.

Guideline Essentials: Reduce stress from your workday by utilizing your easy-to-use Guideline implementation tools, including:

• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements