Challenges and stressors are common in life, and the nursing profession is no exception. Maintaining emotional wellness must be a priority for every nurse. Nurses use the nursing process, airway, breathing, circulation (ABC), disability, and NGN, recognizing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes to prioritize and provide patient care. However, sometimes, nurses care for others but not themselves. This trend must be corrected, and nurses must be deliberate about taking care of their emotional wellness and adopt effective coping strategies to promote emotional wellness and achieve personal and professional growth. According to Healthy People 2030, health and well-being are how individuals think, feel, and function both personally and socially, as well as how they assess their quality of life.
Emotional well-being is important in maintaining a sense of purpose and achieving self-actualization. Nurses assume various roles, including counselor, advisor, and advocate, which can cause nurses to become overwhelmed. Providing compassion and empathy without practicing self-care can lead to burnout, the body’s response to chronic stress. Work-related stressors, such as a high patient workload and nursing shortages, increase the nurse’s stress level and can result in failure to rescue and poor patient care outcomes. Furthermore, nurses often serve as preceptors and mentors for student nurses, which can elevate stress levels, especially when managing high-acuity patients. If nurses do not effectively manage these stressors, according to Maslach and colleagues, they are at risk for exhaustion, decreased job satisfaction, and detachment from work. Alteration in emotional wellness may be presented as fatigue, low productivity, decreased self-esteem, and decreased motivation. For example, the nurse may take sick days because of these symptoms; consequently, all stakeholders are at increased risk for poor outcomes, namely loss of revenue by the institution to pay for sick days, the patient also is at risk for conditions like pressure injury due to low staffing, with inability to reposition the patient every two hours. Equally important is that the nurse is at risk for mental health issues, which, if not appropriately addressed, can negatively impact health, for example, chronic diseases, depression, and anxiety. According to the World Health Organization, mental health conditions account for 12 billion lost workdays each year, resulting in an estimated $1 trillion in annual productivity losses.
When faced with stressors, nurses must recognize and accept their emotions and implement evidence-based tools to maintain and sustain emotional wellness. For instance, a nurse might feel overwhelmed when the patient assignment does not align with the nurse-to-patient ratio. To manage these feelings, they can practice deep breathing exercises and submit a safe staffing or grievance report following organizational policies. According to Dr. Martin Seligman, the “father of positive psychology,” he introduced the PERMA framework, which includes five elements of psychological well-being that nurses can use to safeguard their emotional health.
Positive Emotions (P) Nurses should intentionally cultivate optimism daily. One effective way to do this is by taking a daily dose of “vitamin G” (Gratitude) and acknowledging small accomplishments. When confronted with negative emotions, nurses can practice mindfulness and deep breathing by inhaling through the nose and slowly exhaling through the mouth. Embracing positive emotions like joy and contentment builds hope and improves overall life satisfaction. For example, the nurse may be assigned to a patient with a terminal diagnosis that is in the depression stage of grieving by modeling hope and providing compassionate care to the patient, this may inspire and motivate the patient, having the assurance that there are healthcare providers that are there to assist and bring joy even in the time of difficulties. This experience can motivate the nurse to continue demonstrating positivity, enhancing the patient’s experience and emotional well-being.
Engagement (E) requires nurses to be fully absorbed in their work activities. For example, while administering medications, nurses must adhere to the three medication checks and the 11 rights of medication administration. Staying completely engaged and minimizing distractions reduces stress and the risk of medication errors. When the nurse is in the “ flow state “ of medication administration, she is deeply immersed in ensuring that the medication she administers to the patient using best practice guidelines can alleviate the patient’s signs and symptoms. Nurses must also engage in hobbies, such as joining a running club, book club, etc. When fully engaged, the nurse will lose track of time and self-consciousness and achieve the goals, thereby improving emotional wellness professionally and personally.
Relationships (R) Nurses should actively cultivate and sustain strong therapeutic relationships with patients and peers. Mentoring a new graduate nurse allows one to reflect on nursing roles, professionalism, and ethical-legal aspects of the profession. According to Benner’s five stages of Novice to Expert Theory: novice, advanced beginner, competent, proficient, and expert, by mentoring new graduates through the transition from novice to expert, the nurse can use this framework to assist the new graduate nurse to acquire nursing skills and competencies to practice safe evidence-based nursing care. Through mentoring, the nurse can motivate the new graduate nurse to seek excellence in nursing education and help her socialize into the nursing role. The relationship can continue after the new graduate nurse becomes an expert in nursing. The nurse can continue to mentor new graduates formally and informally, building and sustaining therapeutic professional relationships.
Meaning (M) Finding meaning and relevance in their work is essential for nurses. At a micro level, they can initiate or participate in innovative projects, such as conducting quality improvement initiatives. By fostering a spirit of inquiry, nurses can identify issues in clinical settings that do not align with best practice guidelines. They can pose questions using the Population/Problem, Intervention, Comparison, Outcome, Time (PICOT) framework to generate guidelines that inform clinical decisions and improve outcomes. Participating in these projects provides internal and external gratification, empowerment, and ownership of outcomes, ultimately enhancing well-being.
Accomplishment (A) Nurses should proactively pursue academic success by setting goals and creating a portfolio to track their progress. When establishing professional objectives, nurses must ensure these goals are specific, measurable, attainable, realistic, and time-framed. For example, by the end of year two, a nurse may aim to reach the competent/proficient stage. Additionally, they should plan to attend conferences and seek certification in a specialty to remain updated with best practice guidelines, thereby enhancing their sense of accomplishment and overall well-being.
As nurses provide primary, secondary, and tertiary-level patient care, they must practice self-care, show compassion, and intentionally prioritize their emotional well-being to maintain and sustain their emotional health.
Careen Purcell DNP, RN, CNE, CNEcl is Assistant Professor at City University of New York in Brooklyn, NY.
References
Barker RK, Tuominen LP, Larson MR, et al. Enhancing mindfulness and well-being in higher education. Int J Community Well-Being. 2021;4(4):625-642. doi:10.1007/s42413-021-00118-6.
Benner, P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984.
Seligman MEP. Flourish: A Visionary New Understanding of Happiness and Well-Being. New York, NY: Free Press; 2011.
World Health Organization (WHO), International Labor Organization (ILO). Mental Health at Work: Policy Brief. Geneva, Switzerland: World Health Organization and International Labor Organization; 2022.
