Nursing Students’ Guide to Maintaining Good Mental Health

As current and future healthcare professionals, the importance of recognizing and treating mental health disorders in others is part of the training. It is important to acknowledge that good mental health is an integral part of a patient’s overall well-being. While maintaining good mental health is essential to overall health and well-being, mental illnesses are common and treatable. And despite our training to recognize and treat these conditions in patients, it is also important to recognize and identify mental health issues in ourselves and other fellow healthcare professionals and students. Because while 1 in 5 people will experience a diagnosable mental illness during their lifetime, everyone faces challenges in life that can impact their mental health.

Issues impacting the Mental Health of Nursing Students

Training and working as a healthcare professional can be stressful, which can certainly impact your mental health. Getting into training programs can be competitive and overwhelming, not to mention the actual classes, absorbing the vast amount of content, and maintaining good grades to stay in the program and qualify for scholarships. Here are five common issues that can affect the mental health of nursing students:

School is Stressful

Nursing school is more competitive than ever. Classes are full of new and complex information to learn. There is much to learn before even entering simulation lab or clinicals. Then students are expected to maintain high grades to continue in the program each semester. Some students can handle the fast pace and pressure more than others.

Balancing Life and Other Obligations

Finding the school/work/life balance routine can be hard to do when starting in nursing school. It can be overwhelming to know where to start to organize your life. Trying to balance school life, such as studying, classwork, and online classes, with a job and a family can be difficult. Some negative approaches to this stress include procrastination, self-medicating with alcohol or drugs, eating poorly, stopping exercise, and lack of self-care. It can cause increased stress which can exacerbate anxiety and depression.

Trouble Maintaining Relationships

Being a nursing student with all the associated obligations can make it hard to maintain your existing relationships and develop new healthy relationships. Family, friends, and romantic relationships may suffer due to a lack of time and effort to spend with these people. They may not understand or respect the time commitment and effort needed for training and studying, or the long hours worked, including holidays and weekends.

Workplace Environment Issues

Being a healthcare professional comes with its own stressors. While training and working as a nurse, you may be treating the patient on their worst days. You may see traumas, dying patients, death, and infant and child loss. These are heavy burdens for most people to handle. Some nurses may use gallows humor to deal with these issues, others may internalize and bottle up the feelings and emotions from dealing with these issues daily. Finding a way to reflect on these experiences without bottling them up and internalizing them may take trial and error.Shift work can also be stressful for nurses. Working in a hospital or long-term care facility often calls for working long 12-hour shifts, working weekends, holidays, and taking call, when the rest of your family and friends are off. Sometimes it is hard to be working when the rest of your family is celebrating. Some nurses can feel depressed during holiday times due to these issues.

Other workplace issues that can be detrimental to mental health include workplace bullying, working short-staffed, not feeling supported by management or peers. Feeling safe on the job and having enough equipment and supplies to do your job safely. Not having enough of the correct PPE can be stressful. Inadequate staffing ratios can also add to excess worry.

Global Pandemics (and Other Issues Beyond Our Control)

The COVID-19 virus pandemic has placed undue stress on global citizens, exacerbating mental health conditions in many, and causing increased situational anxiety and depression and an increase in suicides and substance abuse. The fear and panic have caused people to mass stockpile, which has led to shortages of cleaning supplies, paper products, food, and medical supplies. But it has also created an increase in mental health issues among healthcare workers. For example, front-line workers in hard-hit areas are seeing increases in death and dying, which can result in survivors’ guilt and PTSD. Anxiety and depression are on the rise. There has also been discrimination and stigma against healthcare workers wearing scrubs or other work gear in public. They have been shunned, and worse, physically assaulted due to public fear of transmission of the disease.

How Stress and Mental Health Issues can Manifest in Nursing School

It is estimated that up to 55% of young adults report symptoms of mental health disorders during health professionals training. The most common issues reported include anxiety at 41% and depression at 36%. Sometimes more severe diagnosis is reported, such as bipolar disorder and schizophrenia. Often, when not identified properly or left untreated, one may see people self-harm or self-medicate through alcohol or substance abuse. Others may develop an eating disorder or develop sleeping disorders.

Mental health issues can also manifest in physiological ways. Mild anxiety and nervousness is your body’s way of adapting to prepare for heightened awareness for an anticipated event. If you have an important exam, adrenaline and other stress hormones are released to help raise awareness and prepare you to focus on the task at hand. However, prolonged stress can cause a physical and emotional toll on your body.

Here are some clues someone is having mental health issues that need to be addressed:

Uncontrollable worry or dread not relieved by relaxation, talk, or other calming techniques
Stomach or digestions problems, such as diarrhea, nausea, loss of appetite, or binging
Trouble concentrating, memory issues, difficulty thinking clearly
Increased heart rate
Changes in energy
Difficulty Sleeping
Irritability, restlessness, and anger issues
Extreme anxiety manifests in panic attacks. Often the person experiencing a panic attack cannot catch their breath, have chest pain, and feel as if they are having a heart attack.

How to Overcome and Maintain Optimal Mental Health

Nursing school can be overwhelming. Balancing school or work while trying to live a healthy lifestyle is not easy but can be achieved by gradually making small changes and building on those successes. Small changes can have a big impact. Consider the following tips below to help you maintain optimal mental health.

1. Structure Your Time

Routines are helpful for anyone. They help organize our days into patterns and make it easier to get things done without having to think hard about them. Anxiety issues thrive with lots of unstructured time. Sometimes virtual learning and online classes may seem more flexible and conducive to your busy lifestyle. But often, virtual learning can take a backseat to the rest of your life, and tasks can be procrastinated and put off to the last minute.

Take time to map out your schedule. Get your syllabus and map out due dates and assignments on a calendar. Write in work and family obligations. Then block out time for studying and stick to that schedule. For example, plan study blocks from 9 am to noon Monday, Wednesday, and Friday. Maybe it is better to study when your kids are in bed? Then mark your schedule to study from 8 pm to 11 pm nightly. The key is to schedule your study time like you would your job. Mark it off on the schedule and commit to that time. Meal planning can also help automate your busy days, which can help decrease worries.

2. Identify a Support Network

Identify supportive people who you can lean on when you are stressed or need help. Have a few go-to people who may be able to provide support in different areas in your life. Take time to routinely call, text, video chat, or meet for coffee.

In addition to family or friends, it is also wise to find a classmate or professor whom you can go to when you need help in your classes. Talking to a counselor or therapist can also help get your through stressful times and help identify tools to help you manage difficult times. Attending support groups with others dealing with similar issues and mental health challenges may also help.

3. Know Your Campus or Workplace Resources

Reach out to the campus crisis center or mental health center. Many workplaces offer an EAP (employee assistance program) for free initial counseling and resource management.

4. Create New Healthy Routines

Reaching for that glass of wine or tub of ice cream or hitting up your favorite fast food place every time you get stressed may make you feel good in the moment, but ultimately can exacerbate anxiety and depressive issues and is bad for your body. Develop new, healthy routines as an alternative. Routines can help automate activities, taking the thinking out of it, which mitigates anxiety. If there is a certain time of day that you worry more, try and replace it with a new healthy habit or routine. Taking a walk or exercising outside regularly is a great new habit. Fresh air and sunshine help raise serotonin levels, which can help improve mood. Set a daily timer to remind yourself to stretch your body or walk.

5. Take Brain Breaks

We all know that taking brain breaks from studying can help you retain more information. Take a recess break like you did in elementary school. Also, taking planned breaks from news sources, social media, and electronics can help you focus and reset your mindset.

6. Practice Mindfulness and Gratitude

Being present in your daily activities and practicing mindfulness are great ways to protect one’s mental health. Acknowledge those worrisome feelings, then take a moment to reflect, and move on. With anxiety disorders, sometimes moving on is hard. Meditation, breathing, and mindfulness apps can help. Finding the positives in life doesn’t mean ignoring the negative. Practicing gratitude can train your brain to look for good things that are happening, which helps you recover mentally and emotionally.

7. Keep a Journal or Diary

Write down your worries or thoughts into a journal to get them out of your head and onto paper. A cognitive-based therapy creating thought charts can be a helpful exercise. Identify those thoughts or events that are causing worry. Then create self-compassionate phrases such as “it is normal to be worried about final exams.” Come up with plan-of-action phrases such as “listening to my worried thoughts are not helpful, so I will take a walk and listen to a funny podcast.” By following this process and writing this down into a thought chart, it validates anxious thoughts without letting us get trapped in them.

8. Get Good Sleep

When you sleep, your body rests and heals. Impaired sleep interferes with natural sleep balance and hormonal regulation. Sleep has been proven to improve problem-solving skills and enhance memory.

9. Be Active

Exercise can help lead to a better mood since endorphins are released during activity. Setting a goal to exercise just three days a week and sticking to that goal, also gives you a feeling of reward and accomplishment. Exercise can also help you sleep better, increase energy, and concentrate better.

10. Avoid Drugs and Alcohol

You may start drinking alcohol to have fun or to relax and get your mind off other stress. But drugs and alcohol can cause you to feel down or hungover, cause sleep issues, and cause problems with attending class or work obligations. Focus on healthy alternatives for fun activities and relaxation, such as exercise, coloring, reading, or writing.

Additional Resources on Mental Health

Despite the attempt to reduce the stigma of mental illness and informing the public of warning signs of these disorders, death from suicide and suicide attempts are still on the rise. Below are additional resources that identify and provide help for mental health issues.

Speak Up – Dr. Steve Arkin, a prominent neurologist, shares his story of his son’s struggle with mental illness, and his attempt to help end the stigma of mental illness.

National Alliance on Mental Illness – NAMI is one of the nation’s largest organizations working to raise community awareness and support of those in need of mental health support. NAMI has several resources and guides to help provide tools needed for identification and crucial conversations to support mental health.
Mental Health America – MHA is an organization that promotes mental health wellness as an integral part of a person’s overall health. One in five people will experience a mental health condition, yet everyone experiences challenging times that affect their mental health. There are tools that every person can use to help those who are struggling. It should be as normal to take a mental health screen as it is to screen for other chronic health conditions like heart disease or diabetes. Help to normalize mental health screening by taking a screen at MHAscreening.org. MHA has shared several guides and worksheets to help explore mental health issues.

There may have once been a stigma against mental illness, but please know that if you are struggling with mental health issues, you are not alone. This guide provides suggestions, tips, and tricks for maintaining mental health and identifying issues, but it is not a replacement for professional help provided by a licensed therapist or counselor. If you find yourself in crisis, please reach out to any one of these hotlines

Connect with a Crisis Counselor – Text HOME to 741741. This service is free and available 24/7.

SAMHSA’s National Helpline – Call 1-800-662-4357. This service is free and available 24/7, in English and Spanish.

The NAMI HelpLine – Call 1-800-950-6264. This line is available Monday through Friday, 10 am – 6 pm ET. Or you can email [email protected].