Portrait of sad young woman with face mask looking through the window at home, struggling with mental health during COVID-19 pandemic

Mental Health Issues in Nursing

Mental health issues in nursing

From Florence Nightingale’s Notes on Nursing to modern nursing curricula, nurse educators strive to instill the principles of compassion, empathy, respect, and understanding in their students. These are the foundational concepts of the profession. Compassion, however, is not an unlimited resource, and nurses are only human. The pandemic has shone a spotlight on the mental health issues in nursing.   

Recommended: Mental Health CE Courses for Nursing Professionals 

Mental health issues in healthcare 

Mental health issues are complex, arising from genetic and environmental factors, including those in the workplace. The World Health Organization (WHO) found that one year after the pandemic, anxiety and depression increased by 25% worldwide, and exhaustion among healthcare workers significantly triggered suicide ([WHO], 2022).  

After COVID-19, approximately 100,000 registered nurses left the workforce due to stress, burnout, and retirement. Another 610,962 report an intent to leave the profession by 2027 for similar reasons (National Council State Boards of Nursing [NCSBN], 2023).   

Burnout is described as mental and physical exhaustion, mental distancing from the job, cynicism about the job, and reduced efficacy in the workplace (ANA, 2023). 62% of nurses experience burnout, which increases in nurses under age 25.  

In addition, burnout can lead to other concerns, including insomnia, depression, post-traumatic stress disorder, and substance use.  


Nurses experiencing sleep disorders report dissatisfaction in sleep quality at least three nights per week. This may include difficulty initiating sleep, frequent awakenings, or inability to return to sleep. Early morning waking is also common. These symptoms cause significant distress in social, occupational, or behavioral areas of life. 


The common feature of all depressive disorders is the presence of sad, empty, or irritable moods that affect an individual’s ability to function (American Psychological Association [APA, 2022]).  

In addition, an individual with major depressive disorder demonstrates a depressed mood most of the day, almost daily. This includes markedly diminished interest or pleasure in virtually all activities, weight loss without trying, insomnia, fatigue, feelings of worthlessness, diminished concentration, and recurrent thoughts of death (APA, 2022).  

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911. 

Post-traumatic stress disorder 

Post-traumatic stress disorder is a complicated disorder involving thoughts, feeling, and actions evident after an individual is exposed to a traumatic event. Presentation varies, but most individuals recover after six months, while others have symptoms for up to a year or longer.  

Flashbacks, recurrent memories of the incident, distressing thoughts, and physical signs of stress are common. Avoiding thoughts or feelings related to the event, being easily startled, irritable, engaging in risky behavior, or feeling tense is also exhibited (APA, 2022).  

Individuals also display negative thoughts about themselves, exaggerated thoughts of blame, shame or guilt, social isolation, and losing interest in enjoyable activities.  

Recommended podcast: Boundaries and Burnout: Strategies for Nurses to Maintain Self 

Substance use disorder 

No one is immune from substance use disorder, but nurses present a unique challenge (NCSBN, 2018). The behaviors from this disorder have far-reaching consequences for both nurses and patients. Many nurses with SUD are unidentified and unreported and may continue to endanger patients’ lives.  

Additionally, these individuals create significant legal and ethical issues for colleagues. SUDs can arise from behaviors long before the actual abuse begins. They are rooted in cognitive, behavioral, and physiological symptoms of diagnoses that overlap, including depression, insomnia, anxiety, and others. Changes in job performance, extended absences from the unit, arriving late or leaving early, or making excessive mistakes may be noticed earlier in the disorder (NCSBN, 2018).  

Subtle changes in appearance may escalate over time. Isolation from colleagues and diminished alertness can signal problems. Medication diversion includes incorrect narcotic counts, large amounts of wastage, or ineffective pain relief reported by patients.  Most states have non-disciplinary programs designed to evaluate, monitor, and treat SUD-impaired nurses.  

Combating mental health issues in nursing 

The nursing profession desperately needs a paradigm shift, from crisis intervention at the employee level to prevention programs at the systems level. Unfortunately, stigma or fear of professional consequences continues to stand in the way of effective help for mental health conditions.  

Organizations must commit to evidence-based interventions to improve nurses’ psychological and physical health. Such interventions may look like employees’ self-care through: 

  • Teaching and promoting mindfulness strategies  
  • Staying in the moment with one’s awareness of thoughts and feelings 
  • Enhancing resiliency 
  • Building personal attributes such as forgiveness, gratitude, and compassion 
  • Practicing cognitive behavioral skills  
  • Identifying negative thoughts and replacing them with positive thinking (Melnyk et al., 2021) 

The American Nurses Association (ANA) launched the Healthy Nurse, Healthy Nation ™ in 2017. This program is designed for all nurses to improve individual cognitive, physical, and psychological well-being by partnering with organizations by engaging in programs using 6 domains: physical activity, rest nutrition, quality of life, safety, and mental health. 

This model provides a foundation for healthcare systems to reduce the number of nurses who exhibit burnout or are experiencing acute or chronic mental health disorders. Patients, families, and nurses deserve such programs in every space where nurses are employed.