Mental Health & Wellness for Nursing Students
Nursing school can be tough. Many students report periods of stress, anxiety, or depression while navigating everything from admissions to the NCLEX. Learn how to manage these challenges yourself, and how to get help should your self-care efforts fall short.
Attending nursing school can be an incredibly rewarding and worthwhile experience. However, it also often comes with a high amount of mental stress. From trying to choose the nursing program that’s right for you and navigating the admissions process to getting good grades both in clinicals and the classroom, there’s a lot to deal with.
Given all the demands of nursing school (and the profession as a whole), nursing students can be prone to more mental health challenges than the average college student. In this guide, you’ll learn about the unique mental health struggles nursing students like you may encounter and discover outside resources and self-care strategies that can help you overcome them. By knowing about the risks while you’re in nursing school, you’ll reduce your chances of experiencing burnout now and when you start your career.
Common Mental Health Challenges for Nursing Students
Some of the major mental health challenges that nursing students face include stress, anxiety, and depression. Plus, the stress of nursing school can exacerbate already existing challenges, including substance use disorders, eating disorders, and mood disorders.
Most nursing students and nurses experience burnout at some point in their career. According to the American Hospital Association, the term “burnout” was added to the World Health Organization’s International Classification of Diseases (ICD) in 2019. The ICD characterizes burnout as “chronic workplace stress that has not been successfully managed.” Burnout includes:
- Experiencing energy depletion or exhaustion
- Increased feelings of job-related cynicism
- A sense of lack of accomplishment or futility
When burnout was added to the ICD, approximately one-third of all nurses suffered from this condition. By 2021, a national survey by the American Nurses Association reported that 62 percent of U.S. nurses reported symptoms related to burnout. Here’s what to watch for—and what to do.
Stress
Stress for nursing students typically includes academic stress, emotional stress, and relationship stress. Academic stress is particularly acute in accelerated nursing degree programs; while these programs are great for entering the field quickly (especially following a career change), the demands are intense. If you notice yourself spending a lot of time studying with limited improvement in comprehension or retention, that could be a sign you’re experiencing intense academic stress.
Relationships and emotional well-being are affected by stress as well, particularly as you learn to balance your studies, new responsibilities, time with your loved ones, and time for yourself. If you’re increasingly disconnected from friends or family, consistently turning down invitations, or feel that your emotions are muted, you may be on the cusp of severe burnout and should reach out for support.
Anxiety
Nursing school is a huge responsibility. Students find themselves under a lot of pressure—plus they know that the challenges will continue and the responsibilities will increase once they start their nursing career. In its purest form anxiety helps you, signaling that something important is happening and that you need to focus. However, anxiety can quickly spiral out of control and distract you. If you experience racing thoughts (even after your test or after the day’s clinicals are over), are unable to calm down after doing deep breathing or using other relaxation tools, or constantly feel like a “deer in headlights,” that may signal that your anxiety is getting in the way. Learning to manage these issues while you’re a student is an excellent way to get yourself on the right track once you earn your degree.
Depression
Studies show that approximately one-third of nursing students worldwide suffer from depression. As a nurse, forming friendly relationships with patients bolsters good clinical care. However patients don’t always get better; the feelings of futility that may accompany a patient relapse or death are a pathway toward burnout or depression. If you experience a depressed mood more days than not over two weeks or longer, have a lack of interest in your usual activities, and experience changes in sleeping or eating patterns or energy levels, it’s time to consult a provider to screen for depression.
Other possible issues
When stress, anxiety, or depression feel like too much to handle, many people resort to more drastic means of coping, such as using dangerous substances, developing an eating disorder, or even turning to compulsive behaviors like shopping. The American Nurses Association indicates that 10%-14% of RNs in the US may have a problem with substance or alcohol use and, based on a smaller study group sample, as many as 5% of nurses may struggle with an eating disorder. While a little retail therapy may not seem like a bad thing, when used as a coping mechanism it can have negative effects on you, your family, and your finances.
- Substance use can increase when you are consistently stressed. Many people end a day with a declaration of, “I need a drink!” If you notice that you drink or use substances more days than not, rely on substances or alcohol to wind down after classes or exams, rush through assignments so you can start drinking, or feel you wouldn’t know how to cope without alcohol or substances, consider reaching out for support.
- Eating disorders are prevalent; many people have complex relationships with food that are exacerbated by stress. Some may use food to relieve stress, provide emotional comfort, or gain a sense of control. If you are repeatedly eating more than you intended or are having a tough time branching out from a few “safe” foods, discuss what’s happening with a healthcare provider.
- Compulsive shopping may not be a formal diagnosis, but during periods of high stress you might turn to shopping for the quick dopamine hit that comes with getting something shiny and new. If you notice that you’re having trouble financially because of your discretionary spending, buying things you don’t need, or have a tough time resisting scrolling your favorite websites for new purchases, seek assistance from a mental health professional.
Importance of Self-Care and Managing Symptoms
Self-care has become a mental health buzzword in the last decade, and for good reason: Healthcare professionals must learn to put on their own oxygen masks before assisting others. However, self-care is more than pedicures and cupcakes; it’s a deliberate, long-term practice to both help you feel better in the moment and have a better day tomorrow. These guidelines will help you learn to care for yourself during nursing school and beyond.
- Live a healthy lifestyle.
It’s the key to keeping stress under control and avoiding burnout.
- Sleep: When you’re stressed you might think of rest as optional, however rest and sleep are the most important ways to help your body and mind. Your body is going to find a way to get the rest it needs, either by you prioritizing regular sleep or by your body crashing under the strain of your exhaustion.
- Exercise: Resting your body is important, and moving it is important, too. However, finding time for exercise can be difficult. Can you walk to classes instead of driving? Ride your bike to meet friends instead of taking a rideshare? Lift weights while listening to virtual lectures? These strategies will remain helpful once you’re working in the nursing field.
- Healthy diet: Eating a variety of nutritious foods is crucial to overall health. Treats are fine, but if you notice yourself relying on less nutrient-dense foods, take-out, or even skipping meals, stop and think about how to prepare healthy meals ahead of time. Band together with friends to do a meal swap—have each person make an entree, then divide it among the group so everyone gets a portion of each dish. It’s a great way to share the labor and try some new foods!
- Find activities that ground you.
When you feel like your thoughts are going a thousand miles an hour, it’s important to know which activities help ground you. Brainstorm quick activities you can do daily and bigger undertakings that you might do once a month. Start with ideas like these:
- Journaling is a great way to reflect on your thoughts and emotions. Consider which type of journaling feels most helpful, whether it’s using an app on your phone, a small paper journal that you keep with you, or a fancier journal that provides a sense of ritual when you write.
- Many students have heard of mindfulness, yet they mistakenly think that knowing about it yields the same benefits as practicing it. Lots of apps are available to help you start small, such as with a two-minute mindfulness session, and then build from there.
- Physical activity provides a great way to stay connected socially and get some exercise. Intermural sports leagues allow you to meet new people and practice working as a team.
- Take breaks.
Be intentional about carving out time for yourself; mental rest can be as important as physical rest. After a break you’ll be refreshed and ready to take on a new challenge.
- Learn good time-management and organization skills.
This might not seem like self-care, but it absolutely is because of the impact on your stress level and anxiety. While sorting through a backlog of emails will take longer today, after you’ve done it you’ll save yourself time and decrease the risk of losing a message or missing an important deadline. Ask yourself, “What can I do today that will make tomorrow 15% easier for me?” Then do it!
Signs You Might Need Help & Where to Go for Support
During nursing school, you or your loved ones may notice symptoms of a more serious issue, such as panic attacks, poor sleep, change in appetite, feelings of helplessness or emptiness, withdrawing from social interactions, trouble concentrating, or thoughts of self-harm. It’s common to try to white-knuckle through these challenges, thinking “as soon as I pass this test, things will get better.” Remind yourself, though, that that’s not necessary or healthy. Help is available.
Get Help Through Counseling or Therapy
Most schools have free counseling resources for students. Sessions may be designed for short-term support, but your clinician will let you know if longer-term care would be helpful. Remember, therapy is most effective when utilized both as maintenance (like changing your car’s oil) and if you experience a major challenge. As a nurse caring for others, you may need a roster of people who are in the business of caring for you. Here is a great resource to help you find the right mental health professional.
Seek Medical Help for Your Depression or Anxiety if Needed
Therapy is a fantastic, evidence-based tool for managing mental health challenges. However in some cases it works best in tandem with medication. Typically we don’t hesitate to take medication for migraines or high blood pressure, so why would we hesitate to take medication for mental health needs?
Reach Out to Family and Friends
Sometimes it’s easiest to reach out to someone you trust and ask them to walk through a rough patch with you. You might also be surprised at the perspective someone close to you might be able to provide on the challenges you face. Leaning on those who love and know you best, is part of life, and helps to deepen your community and relationships at the same time. Their support will help you feel less alone as you navigate hard times.
Take Advantage of Additional Resources
If you are struggling, these resources can provide the help you need:
- National Suicide Prevention Lifeline: 800-273-8255
- National Eating Disorders Association Helpline: 800-931-2237
- Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline: 800-662-4357
- SAMHSA Disaster Distress Helpline: 800-985-5990
- American Nurses Association Suicide and Resilience Support
Expert Q&A
Heather ONeal, APRN, CN-M, IBCLC is an Advanced Practice Nurse Practitioner, Certified Nurse Midwife, and Internationally Board-Certified Lactation Consultant), professional podcaster, author, and clinical faculty at West Virginia University School of Nursing. Heather hosts and manages Breastfeeding for Busy Moms, an international online education and support community for lactating parents. She also cohosts the Milk Minute Podcast, an inclusive evidence-based podcast for lactating parents and their partners all over the world.
Q: What should a prospective student know before going into this field?
A: You should know how to advocate for yourself and safeguard your time. You need to set boundaries for your work-life from the onset and learn to not feel guilty about saying no to extra shifts. The guilt you feel for neglecting yourself and your family will far outweigh the guilt of leaving your work-family to deal with disaster. There will ALWAYS be a fire to put out at work and it is not solely your responsibility to keep that ship afloat. The first rule of nursing is to take care of yourself first.
Q: Have you noticed a shift in discourse or reduction of stigma regarding mental health care among nursing students?
A: As a clinical instructor at WVU, I have absolutely noticed a change in students’ willingness to discuss mental health struggles or advocate for what they need. I invite the students to take mental health breaks throughout long clinical days in order to build resilience for the long game. Students are very open to talking about their therapists and even establishing care with a therapist even when they aren’t in crisis.
Q: What are the impacts of mental health challenges that you observe as an instructor in a nursing student’s performance?
A: Working in a hospital environment is as much of a mental game as a physical game. The hours are long, and it can be grueling on your body, but it’s your mind that helps you maintain your efficacy as a care provider. Often, when a student is struggling with a mental health crisis, the progression can look like waning attention to physical appearance and hygiene, then increased social isolation during clinical rotations, then only being able to put in the bare minimum to assignments, and in some extreme instances, I’ve seen the worst cases develop into incidents of cheating or academic dishonesty. Unattended mental health crises seem to typically follow that trajectory, and I try to intervene early when I observe any of these behaviors.
Q: If a nurse needs help, what should that person’s first plan of action be?
A: Many hospitals have a peer support team that is free and provides support for nurses in crisis as it relates to work issues, such as the death of a patient, medication error, or workplace to name a few. That is an excellent place to start for nurses as well as students, because it allows you to talk with someone who has walked in your shoes. If someone is uncomfortable speaking with peers or the mental health crisis that is not directly related to their job, they often have access to several free visits through an Employee Assistance Program (EAP) or Student Counseling Center if they are still completing their studies. Many EAP and SCC programs will even offer couple’s counseling and will offer referrals to resources in the community for ongoing care.
Q: What are some of the best ways for nurses to implement self-care practices into their training and ultimately their careers?
A: Decide what’s important to you early on and choose a nursing job that can build around your non-negotiables. For example, if you are the kind of person that needs consistency in an exercise routine at the same time every day you might want to consider an 8-hour nursing job instead of a 12-hour nursing job. When you work three 12-hour shift the days of the week will often change and your body will be completely exhausted during and after those three days. It makes sticking to a workout routine extremely difficult – especially when you have a family as well.
You Are Not Alone
You don’t have to suffer in silence. If you’re struggling with your mental health, mobilize the available resources as quickly as you can. We think of healthcare workers as heroes, but that doesn’t mean they don’t need support, connection, and help. Learning how to ask for help, set appropriate boundaries, and tune in to your own needs, particularly during times of stress, are all skills that will help you succeed in your nursing career.
