Reduce burnout and enhance job satisfaction.
- Work-related stress among healthcare providers, particularly nurses on medical–surgical units, has significant implications for professionalism, care quality, efficiency, and overall quality of life.
- Research underscores the global imperative to prioritize mental health and well-being among healthcare workers.
- The Mental Health Resource Nurse role aims to support mental health, reduce stress, and improve staff satisfaction.
THE INCREASING PREVALENCE of work-related stress among healthcare professionals, especially nurses, has become a growing concern. This stress affects not only the well-being of the nursing staff but also the quality of care delivered to patients. On medical–surgical units, the fast-paced and demanding nature of direct care further exacerbates stress and anxiety among nurses. As noted by Aiken and colleagues, burnout, job dissatisfaction, and high turnover rates have been linked to unaddressed mental health concerns within this workforce. (See What the research says.)
What the research says
Research into the mental health and well-being of nurses and other healthcare providers points to the need for resources. For example, research by Søvold and colleagues emphasizes the global necessity for prioritizing mental health and well-being among healthcare workers.
Resilience
Foster and colleagues conducted an integrative review examining resilience in mental health nursing. They found that workplace stressors, such as challenging patient interactions and organizational demands, negatively impact nurses’ well-being, leading to burnout and decreased job satisfaction. The study highlighted the importance of resilience as a protective factor, suggesting that enhancing resilience can mitigate these adverse effects.
Job stress, quality of life, caring behaviors
Research by Babapour and colleagues investigated the relationship between job stress, quality of life, and caring behaviors among nurses. The study revealed a significant negative correlation between job stress and quality of life. In addition, the study linked increased job stress to decreased caring behaviors, which can adversely affect patient outcomes. These findings underscore the critical need for targeted mental health support and resilience-building programs for nursing staff to enhance their well-being and maintain high-quality patient care.
COVID-19
A study by Martin and colleagues examined 29,000 RNs across 45 states, revealing that 62% experienced increased workloads during the COVID-19 pandemic, and those with 10 or fewer years of experience reported more than 50% emotional exhaustion, fatigue, and burnout, leading to a 3.3% decline in the U.S. nursing workforce from 2020 to 2022. A survey by the American Nurses Foundation also showed that this pattern contributed to a 3.3% decline in the U.S. nursing workforce between 2020 and 2022, with modest stabilization observed since 2023. This turnover exacerbates the workload for remaining staff, perpetuating a culture of stress and burnout within nursing units.
The far-reaching consequences of work-related stress among healthcare workers impacts both their professional and personal lives. Nurses, in particular, face unique challenges that contribute to stress and burnout. On medical–surgical units, they provide direct bedside care to multiple patients, many with complex needs. The demanding nature of nurses’ roles, coupled with long hours and emotional strain, places them at high risk for mental health issues. Nurses who experience high-stress levels may suffer from job dissatisfaction, leading to increased turnover rates.
This quality improvement (QI) project addressed the lack of mental health support for nursing staff by introducing the mental health resource nurse (MHRN) role. The MHRN focuses on providing mental health support and fostering a healthy work environment to enhance staff satisfaction and alleviate burnout. In this project, we integrated the role into the medical–surgical inpatient unit of our organization.
About mental health support
Implementing dedicated mental health support roles, such as MHRNs, within nursing may help to address some of the concerns about stress and burnout. This approach has established precedents in various professional settings. For instance, according to the National Association of School Nurses, school nurses play a pivotal role in addressing students’ mental health needs, providing support, and facilitating access to appropriate resources. Similarly, as described by the Australian Government Department of Health, Disability, and Aging, peer support specialists who’ve experienced mental health challenges can serve as integral members of mental health teams, offering unique support to individuals navigating their own mental health journeys.
The MHRN role aims to bridge the gap between mental health support and daily nursing practice. Responsibilities typically include conducting mental health checks with the team, providing counseling and emotional support, facilitating stress management workshops, and mediating between nursing staff and mental health professionals. By integrating these functions onto the medical–surgical unit, the MHRN works to enhance staff well-being, improve job satisfaction, and reduce burnout rates among nurses.
Project description
The decision to implement this QI project was based on staff-collected data regarding self-reported anxiety and stress of 45 staff members from a 24-bed medical–surgical unit at a teaching hospital with over 900 beds. To implement the MHRN role, four volunteer-selected nurses from the unit received training and certification in Mental Health First Aid (MHFA) from the National Council for Mental Wellbeing. According to the council, more than 4 million people across the United States have received training and MHFA certification to support individuals experiencing mental health or substance use issues.
The MHFA certification program includes education about recognizing common signs and symptoms of mental health challenges, engaging appropriately with individuals in crisis, and connecting individuals with professional help. It also includes expanded content on trauma, substance use, and self-care. In this project, we offered the certification to four volunteer bedside nurses within our organization as part of their professional development, with costs covered by the medical–surgical unit’s education budget.
After the training, orientation sessions familiarized unit staff with the MHRNs’ role and objectives in helping their medical–surgical peers. In addition, the MHRNs provided education during staff huddles and special educational sessions supported by the unit’s leadership team. In addition to preparing the MHRNs to address the unique challenges faced by nursing staff in this environment, the orientation ensured staff understood the scope of the role and the support MHRNs would provide.
Communication with the nursing staff served as a vital component of the implementation process. The MHRNs offered assistance to all unit staff, including RNs, certified nursing assistants (CNAs), and support staff. Staff members received information about the new MHRN role and were encouraged to engage with the MHRNs for support.
In addition, the MHRNs provided staff education on mental health topics and stress-coping mechanisms relevant to their work on the unit. They prepared a monthly newsletter with meaningful information that combined unit experience and community resources to improve mental health. Their staff recognition initiative aimed to boost morale and helped with peer-to-peer recognition of staff who offered support during daily tasks and crises. Their monthly check-ins and support sessions provided resources and counseling to staff, as needed, for 8 consecutive months before conducting a post-implementation assessment.
Project results
The QI project team (four direct care RNs and the unit’s nurse manager) evaluated the effectiveness of the MHRN role via surveys administered to the nursing staff before and after the intervention. The surveys measured staff satisfaction with mental health resources and self-reported stress and anxiety levels. A Likert scale (with “Good,” “Somewhat Good,” and “Neither Good nor Bad” options) enabled respondents to rate their mental health and anxiety levels.
This approach allowed the project team to collect nuanced data, which facilitated quantitative analysis of subjective experiences. All 45 participating staff members (27 RNs, 13 CNAs, and five clerical/support staff) completed the surveys. We used a chi-squared test for independence to compare the pre- and post-intervention distributions of mental health ratings, anxiety levels, and perceptions of the intervention. We determined significance using a threshold of P <0.05. (See Intervention results.)
Intervention results
Participating nurses completed pre- and post-intervention self-assessments regarding their mental health, anxiety levels, and perceptions of the mental health resource nurse role (MHRN).
Mental health
Anxiety
MHRN role (Having a mental health/well-being initiative on my unit will help my morale at work.)
Mental health ratings
Analysis of participants’ self-reported mental health ratings showed statistically significant improvement after the intervention (χ² = 10.83, p = 0.028). Negative perceptions of mental health (“Somewhat bad” and “Bad”) decreased from 15.91% to 2.22% and 4.55% to 0.00%, respectively. “Somewhat good” responses increased significantly from 25.0% to 42.2%, reflecting overall improvement in perceived mental health.
Anxiety levels
The comparison of perceived anxiety levels before and after the intervention revealed a statistically significant reduction (χ² = 9.58, P = 0.048). “Somewhat bad” responses decreased significantly from 34.88% to 9.52%; “Good” responses increased from 13.95% to 23.81%; and “Neither good nor bad” responses rose from 20.93% to 35.71%.
Perception of the MHRN role
Analysis of participants’ perceptions regarding the impact of the MHRN role revealed a highly significant change (χ² = 21.06, P < 0.001). These results reflect responses to the survey question, “Having a mental health/well-being initiative in my unit will help my morale at work.” Positive responses (“Yes”) increased from 32.5% to 90.91%, demonstrating strong support for the initiative. Negative responses (“No”) decreased significantly from 47.5% to 9.09%.
These findings demonstrate the positive impact of the MHRN role on the mental well-being of this unit’s staff. The success of the initiative points to the potential for implementation of similar interventions across other healthcare settings to address the mental health needs of nursing staff. (See Needs assessments)
Limitations
Reliance on self-reported data may introduce response bias, potentially affecting the accuracy of the findings. Also, the post-intervention survey only measures the immediate or short-term effects of interventions. In addition, ensuring that the MHRNs had sufficient time to dedicate to their new role while still fulfilling their nursing duties required careful planning and coordination with unit leadership.
Needs assessments
As part of the mental health resource nurse (MHRN) intervention, the project team asked unit nurses to complete pre- and post-intervention needs assessments.
Mental well-being pre-intervention needs assessment
The survey aims to collect data for future project implementation in Units 10–5 and will take only 3 to 4 minutes to complete. Your feedback will help us improve our employee experience and implement a new resource role.
2. How do you rate your anxiety level since working in healthcare?
3. Are you aware of the resources [this organization] has available to help you support your mental well-being?
4. Would you be willing to try well-being resources if they were available on your unit?
5. Would having a mental health/well-being initiative in your unit help your morale at work?
6. How comfortable do you think you will be communicating concerns, feelings, and issues to a certified mental health peer?
7. Would you like to have a mental health resources nurse available on your unit?
Mental well-being post-intervention needs assessment
The survey aims to collect data for future project implementation in Units 10–5 and will take only 3 to 4 minutes to complete. Your feedback will help us improve employee experience and implement a new resource role.
1. How would you rate your mental health since you started working in healthcare?
2. How do you rate your anxiety level since working in healthcare?
3. Are you aware of the resources [this organization] has available to help support your mental well-being?
4. Would you be willing to try well-being resources if they were available on your unit?
5. Would a mental health/well-being initiative in your unit help your morale at work?
6. How comfortable do you think you will be communicating concerns, feelings, and issues to a certified mental health peer?
7. Would you like to have a mental health resources nurse available on your unit?
8. Since the implementation of the mental health resource nurse initiative, more people have served as liaisons to help the work environment.
9. The Mental Health Liaison of the Month is a great recognition for your peers.
10. Should the mental health resource nurse role be expanded and formalized in the organization?
Discussion
Implementing the MHRN role on this medical–surgical unit successfully addressed work-related stress and burnout among nursing staff. The significant reductions in self-reported stress and anxiety levels, coupled with an increase in staff satisfaction with mental health resources, underscore the importance of providing dedicated mental health support within healthcare settings.
Several factors impacted the success of the MHRN role. For example, training provided the MHRNs with the skills and knowledge necessary to recognize and address mental health challenges among their coworkers. A study by Reeves and colleagues emphasized that clear role definitions and comprehensive training for existing staff play a crucial role in successfully integrating peer support workers into mental health service teams. The MHFA certification training equipped the MHRNs to offer timely and appropriate support, which helped to alleviate stress and prevent burnout.
In addition, integrating the MHRN role into the daily operations of the medical–surgical unit ensured readily available mental health support for staff. The regular check-ins and support sessions provided by the MHRNs created a sense of continuity and reliability, making it easier for staff to seek help when needed.
The focus on communication and engagement also played a crucial role in intervention success. By actively encouraging staff to engage with the MHRNs and use the available resources, the initiative fostered a culture of openness and support within the unit. Research by Berlin and colleagues indicates that promoting open communication about mental health reduces stigma and facilitates help-seeking behaviors among healthcare workers. The culture shift encouraged staff to prioritize their well-being, especially during their shifts and after.
Despite its success, the intervention encountered challenges. Some staff members initially hesitated to engage with the MHRNs, citing concerns about confidentiality and the potential impact on their professional reputation. Addressing these concerns through ongoing communication and reassurance proved essential to overcoming this barrier. (See Intervention additional results: Pre- and Post-intervention responses)
Intervention additional results: Pre- and Post-intervention responses
Following is a sampling of results from the pre- and post-intervention self-assessments.
Comfort communicating concerns to a mental health peer (Q6)
A statistically significant improvement was observed in participants’ comfort levels when communicating concerns to a certified mental health peer (χ² = 13.98, P = 0.007).
| Response | Pre-intervention | Post-intervention |
| Somewhat comfortable | 34.09% | 39.02 |
| Comfortable | 27.27% | 19.51 |
| Somewhat uncomfortable | 22.73% | 2.44 |
| Neither comfortable nor uncomfortable | 13.64% | 31.71% |
| Uncomfortable | 2.27% | 7.32% |
Key Observations. “Somewhat uncomfortable” responses decreased dramatically from 22.73% to 2.44%. “Neither comfortable nor uncomfortable” responses increased from 13.64% to 31.71%, indicating mixed but improved comfort levels.
Awareness of mental health resources (Q3)
No significant change was observed in participants’ awareness of available mental health resources (χ² = 3.35e-07, P = 1.00).
| Response | Pre-intervention | Post-intervention |
| Yes | 52.27% | 52.27% |
| Somewhat | 36.36% | 36.36% |
| No | 11.36% | 11.36% |
Availability of mental health resource nurse (Q8)
A statistically significant improvement was observed in participants’ desire to have a mental health resource nurse available in their unit (χ² = 14.28, P = 0.0002).
| Response | Pre-intervention | Post-intervention |
| Yes | 52.27% | 92.00% |
| Somewhat | 43.18% | N/A |
| No | 4.55% | 8.00% |
Mental health liaison feedback
The Mental Health Liaison of the Month is a great recognition for my peers. (Q9)
| Response | Percentage |
| Somewhat | 71.05% |
| Yes | 23.68% |
| No | 5.26% |
Should the mental health resource nurse be expanded and formalized as a role in the organization? (Q10)
| Response | Percentage |
| Yes | 89.47% |
| No | 10.53% |
Stable, motivated, and satisfied
Introduction of the MHRN role on the medical–surgical unit demonstrated the transformative potential of innovative strategies to address the mental health needs of nursing staff. By providing dedicated mental health support, the MHRN role helped to reduce stress and burnout, improve job satisfaction, and create a healthier work environment.
This initiative offers a scalable model that other healthcare settings can adapt to their needs. It allows for systematic implementation and evaluation of the MHRN role across different units and specialties. (See Practical application.)
Practical application
For nurse managers and healthcare leaders looking to implement a similar mental health resource nurses (MHRN) initiative, consider the following steps:
- Identify and train MHRNs. Select nurses with a strong interest in mental health and train them in mental health first aid to equip them with the necessary skills and knowledge.
- Integrate the role into daily operations. Make the MHRN role integral to the unit’s daily operations with regular staff check-ins and support sessions funded through professional development allocations.
- Foster a culture of openness. Encourage staff to engage with the MHRN and take advantage of available mental health resources. Promote a culture of openness and support to reduce the stigma frequently associated with seeking help.
- Evaluate and adjust. Regularly evaluate the intervention’s effectiveness by encouraging feedback. Staff passion and interest in supporting their peers’ mental well-being are essential to continuing the role.
- Tap already existing resources for support. For example, the American Nurses Foundation Nurse Well-Being: Building Peer and Leadership Support (nursingworld.org/foundation/programs/nurse-wellbeing) and the American Nurses Association Healthy Nurse Healthy Nation initiative (healthynursehealthynation.org).
A systematic review and meta-analysis by Li and colleagues found that nurse burnout is associated with lower patient satisfaction and diminished quality of care. By prioritizing nurses’ mental health and well-being, healthcare organizations can create a more stable, motivated, and satisfying workforce, thereby improving patient care outcomes.
Yarisbell A. Collazo is a nurse manager at UF Health in Gainesville, Florida.
American Nurse Journal. 2026; 21(1). Doi: 10.51256/ANJ012613
References
American Nurses Foundation. Pulse on the Nation’s Nurses Survey Series. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/survey-series-results/
Aiken LH, Sermeus W, Van den Heede K, et al. Patient safety, satisfaction, and quality of hospital care: Cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717. doi:10.1136/bmj.e1717
Aiken LH, Sloane DM, Griffiths P, et al. Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Qual Saf. 2017;26(7):559-68. doi:10.1136/bmjqs-2016-005567512
Australian Government Department of Health, Disability, and Aging. Mental health careers – Fact sheet – Roles and responsibilities of mental health professionals. May 31, 2023. health.gov.au/resources/publications/mental-health-careers-fact-sheet-roles-and-responsibilities-of-mental-health-professionals
Babapour A-R, Gahassab-Mozaffari N, Fathnezhad-Kazemi A. Nurses’ job stress and its impact on quality of life and caring behaviors: A cross-sectional study. BMC Nurs. 2022;21(1):75. doi:10.1186/s12912-022-00852-y
Berlin G, Burns F, Hanley A, Herbig B, Judge K, Murphy M. Understanding and prioritizing nurses’ mental health and well-being. McKinsey & Company. November 6, 2023. mckinsey.com/industries/healthcare/our-insights/understanding-and-prioritizing-nurses-mental-health-and-well-being
Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: A systematic review. BMJ Open. 2023;13(6):e071203. doi:10.1136/bmjopen-2022-071203
Foster K, Roche M, Giandinoto J, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviors of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs. 2020;29(1):56-68. doi:10.1111/inm.12610
Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB. Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Network Open, 2024;7(11):e2443059. doi:10.1001/jamanetworkopen.2024.43059
Martin B, Kaminski-Ozturk N, O’Hara C, Smiley R. Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. J Nurs Regul. 2023;14(1):4-12. doi:10.1016/S2155-8256(23)00063-7
National Association of School Nurses. Mental health. nasn.org/nasn-resources/resources-by-topic/mental-health
National Council for Mental Wellbeing. Mental Health First Aid. thenationalcouncil.org/our-work/mental-health-first-aid
Reeves V, Loughhead M, Halpin MA, Procter N. Organisational actions for improving recognition, integration and acceptance of peer support as identified by the current peer workforce. Community Ment Health J. 2024;59(8):1500-9. doi:10.1007/s10597-023-01179-x
Søvold LE, Naslund JA, Kousoulis AA, et al. Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. Front Public Health. 2021;9:679397. doi:10.3389/fpubh.2021.679397
Key words: mental health, burnout, mental health resource nurse
