Stress management and wellness for nursing students
IT’S WELL KNOWN that nursing burnout continues to rise. Wickstrom describes unmanaged stress as leading to negative outcomes, including increased medical errors, job burnout, turnover rates, and significantly higher rates of suicide in nurses compared to the general public. COVID-19 added complexity to this challenge. In The American Nurses Foundation’s COVID-19 Impact Assessment Survey, the data reveal a clear generational divide in nurses’ emotional well-being. Among those under 35, reports of anxiety (66%) and depression (43%) were nearly double those of nurses age 55 and older (35% and 21%). Even more troubling, roughly two-thirds of younger nurses said they felt burned out, compared to just one-third of their older colleagues—a pattern that raises serious concerns about the future stability of the nursing workforce.
In 2020, the American Association of Colleges of Nursing (AACN) issued a call to action for academic leaders to address the mental health crisis in nursing by implementing programs that provide students with tools to manage stress and optimize wellness before they enter the workforce. In addition, AACN revised the core competencies for professional nursing to require the integration of wellness and resiliency into curricula. Cuccia and colleagues emphasize that, amid a national nurse shortage, nursing leaders must prioritize building a culture of well-being and prepare graduates to optimize their mental health before entering the workforce.
To prepare student nurses to manage the challenges they’ll face upon entry into the workforce, we designed a hands-on, experiential course, Compassionate Care for Nurses, aimed at providing them with tools to enhance their mental health and well-being. We then implemented a quality improvement (QI) project to assess the course’s impact on their perceived stress levels and resiliency.
The course
To address the demands of patient care and the healthcare system, we used a hybrid (in-person and asynchronous) course model to teach compassion and self-care. The course combines well-being and integrative health concepts with structured reflective practices and in-person participation in stress management strategies.
In-person activities
Students engage in a variety of evidence-based integrative techniques, including meditation, mindfulness, yoga, tai chi, forest bathing, culinary medicine, and Nia dance. The in-person experiences help cultivate connection, belonging, self-care, and reflective practice for both students and faculty. (See In-person activities.)
In-person activities
Students enrolled in the Compassionate Care for Nurses course participated in various evidence-based integrative activities.
medicine
- Combining the joy of cooking with nutrition science, this evidence-based approach blends culinary training and wellness coaching to improve eating habits, enhance food agency (ability to make your own choices about food—including buying, preparing, and eating—in a way that fits your needs, culture, and resources), and support chronic disease prevention and treatment.
- Faculty and students participate in a group cooking class focused on food as medicine and food agency.
- Students visit a local university medical center’s patient garden, guided by the garden educator, to explore the health benefits of gardening and nature.
- The session features a mindful eating experience and a nature-based journaling activity to deepen engagement with the environment.
- This moving meditation blends dance, martial arts, and mindfulness to nurture body, mind, and soul.
- A Nia dance instructor leads this energizing session with students and faculty wearing silent “disco” headphones (which allow them to listen privately to the music or audio of their choice) for enhanced comfort and focus.
- This ancient Japanese practice engages the senses in a forest setting to promote meditation, physical wellness, immune function, and a deeper connection to nature.
- Students and faculty participate in this activity on a nearby trail network.
- Tai chi, an internal martial art and moving meditation, fosters connection to self and others. Scientific evidence supports its benefits in reducing burnout, falls, and blood pressure and improving cardiac function.
- Students gathered in-person to practice tai chi via online videos and then reflected on their experiences.
- This gentle practice focuses on meditation and breathing with foundational forms and poses.
- Students and faculty participated in a gentle yoga session facilitated by a guest instructor, fostering an environment of shared engagement, mindfulness, and well-being.
Connection
As reported by Cohen, approximately one in five Americans struggles with chronic loneliness; young adults experience the most impact. Cohen described that when we lack a sense of belonging, even temporarily, it can lower self-esteem, hinder performance, and make individuals feel more vulnerable.
The Compassionate Care for Nurses course lays the foundation for creating a learning community where students feel a sense of connection to themselves, their peers, and faculty, while also empowering them to make intentional choices that support their health and well-being. Understanding that self-care is personal, we encourage students to explore and reflect on various approaches to discover what works for them.
Reflection
Bowers and colleagues explain how reflective practice enhances well-being by helping nursing students recognize the impact of their work thereby boosting a sense of purpose. To foster this practice, the Compassionate Care for Nurses course guides students in reflecting on their own experiences. For example, they explore and reflect on the challenges faced by underrepresented minority nurses due to ongoing social and structural inequities in healthcare. Nurses are encouraged to examine their own cultural biases and consider how to approach nursing with cultural humility and compassion for themselves, colleagues, and patients.
Students engage in both group and individual reflection. Group reflection occurs through an online platform where students can creatively contribute to discussions and earn academic credit for their participation. A key resource for the course, Fontaine and colleague’s Self-Care for New and Student Nurses, offers insightful narratives, which students have noted as especially impactful in helping them feel heard and supported. For example, one student reported, “Reading and reflecting on what it looks like and means to feel seen was difficult. As a person identifying as LGBTQ, sometimes I wish I did not have to work to be fully seen, and although everyone is unique, what is normal? But when everyone does not have equal rights and faces discrimination, acknowledging difference is important.” (Reworded for anonymity.)
The project
We offered Compassionate Care for Nurses twice during the 2022–2023 academic year, in the fall and spring semesters. It was open to all baccalaureate nursing students (n=395) with a goal of enrolling 20 students in the first cohort. During the fall semester, 18 students enrolled in the course and 22 in the spring. The course, delivered in a hybrid format during the 15-week semester, included 9 weekly, 2-hour, in-person class sessions with the remaining weeks delivered online asynchronously. (See About the students.)
About the students
Most of the students who participated in the Compassionate Care for Nurses course were female identifying and white.
Demographics
Fall 2022
Spring 2023
Gender
Ethnicity
Race
Age
Measures
We used the satisfactorily valid and reliable Brief Resilience Scale-6 and Perceived Stress Scale-10 to evaluate the course’s impact on stress and resilience. We also asked students to complete a custom qualitative questionnaire to evaluate their satisfaction with the course. Of the 40 students enrolled in the fall and spring semesters, 20 (50%) completed the electronic questionnaires. We administered the questionnaires at the beginning and end of each course. We used paired t-tests for analysis with one- or two-tail significance levels (P <.05) reported.
Results
Both student groups began the course with moderate stress and low resiliency levels. By the end of the fall semester, students showed a statistically significant reduction in stress (P=.037) and a statistically significant increase in resiliency (P=.031). In the spring semester, although students didn’t report statistically significant changes, they still experienced lower stress and higher resiliency levels. (See Perceived stress and resilience.)
Perceived stress, resiliency levels
Pre- and post-course questionnaires indicate a significant difference in nursing students’ perceived levels of stress and resilience after participating in the fall 2022 semester Compassionate Care for Nurses course. Although not statistically significant, participants in the spring 2023 course also saw improvements.
The 20 students who completed the survey said that they would recommend the course to others and reported high levels of satisfaction with the course. At the beginning of the course, when asked what they were doing to manage their well-being and stress levels, one student responded, “Not really anything, I guess. But I don’t have much time to do anything else right now.” By the end of the course, the same student responded to the question, saying, “I’m getting out of the house as much as possible, which has had a profound impact on my well-being. I’m also spending less time on my phone and reading more. I’m more mindful of what I eat, and I listen to a lot of feel-good music when I need a good dance break.”
At the end of the course, one student shared, “I’ve learned new strategies for managing my mental health and overall well-being in everyday life.” Another student said, “I now feel much more in control of my stress. I didn’t realize until this moment that it’s likely tied to taking this class. I used to struggle with severe stress and anxiety, but I’m now able to manage it much better.”
Discussion
These findings suggest that experiential, skills-based interventions can support psychological resilience and healthier stress management in nursing students as they become nurses, a group particularly vulnerable to burnout. The course appeared to foster greater self-awareness and more intentional coping, highlighting the value of structured, supportive spaces within nursing education. High student satisfaction and willingness to recommend the course point to its relevance and potential impact. Although promising, these results stem from a QI initiative; further research with larger, more diverse samples will help assess long-term outcomes and broader applicability.
The success of the Compassionate Care for Nurses course led to the development of two similar nursing elective courses at our institution. The first, Cultivating Mindfulness and Compassion, a two-credit online version of the Compassionate Care for Nurses course, ran in summer 2025 for graduate nursing students. The second course, The Intersection of Mindfulness, Compassion, and Planetary Health, a three-credit travel study version of the course, ran in Puerto Rico over Spring Break 2024 and 2025. In the second course, students were immersed in mindfulness education and strategies while exploring the link between mindfulness, compassion, and planetary health. We plan to conduct a similar QI project to determine the courses’ impact on well-being and resiliency.
Nursing implications
The escalating rates of burnout, stress, and mental health challenges among nurses demand urgent attention—particularly considering the ongoing nursing shortage. Integrating well-being–focused interventions into nursing education represents a proactive strategy to support students before they enter the workforce. By equipping future nurses with resilience and effective coping skills, educators can help foster a more prepared, emotionally healthy, and sustainable nursing workforce.
Although no single intervention will solve the complexities of the nursing shortage, prioritizing student well-being within the curriculum serves as a meaningful step. Nurse educators, healthcare leaders, and policymakers share a responsibility to invest in the mental health of nursing students, recognizing its long-term impact on workforce retention, care quality, and healthcare outcomes.
Now entering its fifth semester, Compassionate Care for Nurses has seen enrollment double, reflecting growing student interest and demand. In addition, our QI project demonstrates that a nursing-specific wellness course can effectively reduce stress and strengthen resilience among students. In light of the ongoing challenges faced by the nursing profession, such a course equips students with vital tools to prevent and manage burnout, build supportive connections with peers and faculty, and prepare for a healthier transition into their careers. By proactively addressing mental health, the course helps students develop lasting strategies to avoid chronic stress, ultimately contributing to a stronger, more resilient nursing workforce.
The authors work at the University of Vermont in Burlington. Lili Martin and Rebecca Nagle are clinical associate professors in the College of Nursing and Health Sciences and affiliates of the Osher Center for Integrative Health. Geeda Searfoorce is the strategic communications manager at Osher Center for Integrative Health.
American Nurse Journal. 2025; 20(11). Doi: 10.51256/ANJ1125101
References
American Association of Colleges of Nursing. A call to action for academic nurse leaders to promote practices to enhance optimal well-being, resilience and suicide prevention in schools of nursing across the U.S. August 2020. aacnnursing.org/portals/0/pdfs/position-statements/7-2020-Resolution-For-AACN-Nurse-Wellness-Suicide-Prevention.pdf
American Association of Colleges of Nursing. Bold action taken to transform nursing education and strengthen the nation’s healthcare workforce. April 7, 2021. bit.ly/4mmEOS6
American Association of Colleges of Nursing. The essentials.aacnnursing.org/essentials
American Nurses Association. COVID-19 Impact Assessment Survey – The Second Year. March 1, 2022. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/covid-19-impact-assessment-survey—the-second-year/
Bowers M, Terry D, Irwin P. The impact of reflective practice on nursing students: A scoping review. Nurse Educ Pract. 2025;87:104468. doi:10.1016/j.nepr.2025.104468
Cohen GL. Belonging: The Science of Creating Connection and Bridging Divides. New York, NY: W.W. Norton & Company; 2023.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96. doi:10.2307/2136404
Cuccia AF, Falk J, Maxurek Melnyk B, Boston-Leary K. Trends in mental health indicators among nurses participating in Healthy Nurse, Healthy Nation from 2017 to 2021. Worldviews Evid Based Nurs. 2022;19(5):352-8. doi:10.1111/wvn.12601
Fontaine DK, Cunningham T, May N. Self-Care for New and Student Nurses. Indianapolis, IN: Sigma Theta Tau International; 2021.
Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. Brief Resilience Scale. APA PsycNet. 2008. doi:10.1037/t51423-000
Wickstrom A. CDC: Burnout keeps rising for nurses and other healthcare workers. NurseJournal.org. November 13, 2023. nursejournal.org/articles/cdc-nurse-healthcare-worker-burnout
