Williams • Nurse Mental Health • 01 Aug 2025

Promoting Nurse Mental Health: From Crisis to Prevention

A paradigm shift from crisis intervention to mental health promotion and prevention is urgently needed. Nurses, at the forefront of healthcare, face significant challenges that contribute to high rates of burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment. The World Health Organization has identified burnout as an “occupational phenomenon” that must be addressed to maintain mental health and well-being. Without systemic interventions, individual nurses have been left to manage these challenges, resulting in a mental health crisis.

When burnout occurs, it often leads to depression, anxiety, risky substance use, physical fatigue, and workplace incivility. According to Davidson and colleagues, the prevalence of depression, anxiety, and suicide among nurses is now higher than in the general population. A 2019 study by Melnyk and colleagues, involving 1,790 nurses from 19 healthcare systems, revealed poor mental and physical health, with approximately one-third reporting depression. The study identified depression as the leading predictor of self-reported medical errors, contributing to costly job turnover and increased risks to patient care and safety.

The COVID-19 pandemic has exacerbated these issues, increasing rates of burnout, depression, anxiety, acute stress disorder, and post-traumatic stress disorder (PTSD). The lack of system-level preparation to protect nurses from COVID-19-related secondary trauma has led to tragic outcomes, including nurse and physician suicides. These outcomes underscore the urgent need for interventions to support nurses experiencing acute mental health problems and to intensify mental health promotion and prevention efforts.

Contributing Factors to Nurse Mental Health Challenges

Nurse burnout and other mental health concerns—such as compassion fatigue (a severe form of burnout involving trauma, reduced ability to sympathize, and a change in worldview), depression, anxiety, and risky substance use—are driven by multiple factors:

• High workloads and staffing shortages: Nurses often face intense job demands and inadequate staffing, leading to physical and emotional exhaustion.
• Compassion fatigue: Prolonged exposure to patient suffering can diminish nurses’ ability to empathize, exacerbating mental health challenges.
• Workplace incivility: Negative interactions with colleagues or patients contribute to stress and mental strain.
• Lack of systemic support: Insufficient mental health resources and organizational support leave nurses to manage these challenges independently.
• COVID-19 impact: The pandemic has intensified these issues, with increased exposure to trauma and inadequate protective measures contributing to acute stress and PTSD.

These factors highlight the need for comprehensive, system-level interventions to address nurse mental health proactively.

System-Level Interventions for Mental Health Promotion

To address the mental health crisis among nurses, organizations must prioritize employee self-care by providing evidence-based mental health resources and interventions. These include:

• Mindfulness: Training nurses to stay present, aware of their feelings and thoughts, to manage stress effectively.
• Sense of belonging: Fostering personal attributes such as forgiveness, gratitude, and compassion to build supportive workplace relationships.
• Sense of purpose: Helping nurses understand how their thought patterns impact emotions and behaviors, encouraging positive thinking to replace negative patterns.

Evidence-Based Programs

HEAR Program

The University of California at San Diego’s Healer Education Assessment and Referral (HEAR) program offers free, anonymous depression and suicide screenings. This evidence-based initiative successfully identifies and provides care for individuals experiencing suicidal thoughts, substance use disorders, and other mental health conditions. By integrating such screenings into healthcare settings, organizations can proactively support nurses’ mental health.

MINDBODYSTRONG Program

The MINDBODYSTRONG program, a workout-based cognitive behavioral therapy initiative, can be delivered by nurses and non-psychiatric mental health providers. A study with new nurse residents showed that those who participated in the program during orientation reported higher job satisfaction and lower burnout up to six months post-completion compared to those who did not.

National Initiatives

Several national programs support nurse mental health and well-being, aligning with the efforts of the American Nurses Association (ANA) Building Strength through Resilience Committee:

• ANA’s Healthy Nurse, Healthy Nation (www.hnhn.org): Promotes nurse well-being through resources and community engagement.
• American Nurses Foundation Well-Being Initiative: Provides tools and support to address nurse mental health.
• Joy 360 (www.joy360.com): Focuses on fostering joy and resilience in healthcare settings.
• National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience (www.nam.edu/initiatives/clinician-resilience-and-well-being): Offers strategies to improve clinician mental health.

These initiatives demonstrate nursing leadership’s commitment to prioritizing mental health. Sustainable improvements require a multi-stakeholder approach, including direct leadership from nursing professionals and indirect support from state policymakers, health professional licensing boards, and educational institutions.

State Policy Briefs

States can issue policy briefs to promote clinician mental health. For example, the Health Policy Institute of Ohio, in partnership with The Ohio State University Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, published A Call to Action: Improving Clinician Well-being and Patient Care and Safety. This brief outlines the state of clinician well-being, defines the relationship between mental health and patient care, reviews evidence-based policies and programs, and establishes recommendations for improvement.

Legislative Efforts

Legislation introduced on July 20, 2020, aims to address healthcare professionals’ mental health by:

• Providing behavioral health and well-being training programs.
• Launching campaigns to promote seeking mental health support and treatment.
• Conducting a federal study on mental health and burnout in healthcare professionals.
• Offering grants to establish and expand programs for healthcare workers caring for COVID-19 patients.

If passed, this legislation could significantly enhance mental health support for nurses and other healthcare professionals.

Building a Foundation of Prevention

Promoting nurses’ mental health and well-being is foundational to improving population health, enhancing patient outcomes, and reducing healthcare costs. As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” By prioritizing prevention through evidence-based interventions, organizations can mitigate the mental health crisis and foster a healthier, more resilient nursing workforce.

About the Authors

Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, Andreanna Pavan Hsieh, MPH, Judy Davidson, DNP, RN, MCCM, FAAN, Healy Carpenter, BSN, RN, Amanda Choflet, RN, BSN, OCN, Janie Heath, APRN-BC, FAAN, FNAP, FAANP, Marianne E. Hess, MSN, RN, CCRN-K, Peggy Lee, BSN, RN, Terri Link, MPH, BSN, CNOR, CIC, CAPF, FAPIC, Jalma Marcus, RN, BS, MS, HNP-BC, CLSE, CBP, AJT, Christine Pabico, PhD, RN, NE-BC, Kathleen Pendleton, PhD, RN, CNE, ANEF, and Lisa Sund, JD.

Publication Information

Source: American Nurse Journal, Volume 16, Number 1, January 2021.
Resources: ANA’s nurse suicide prevention resources are available at nursingworld.org/practice-policy/nurse-suicide-prevention.