Helping Nursing Students Cope with Stress

Early recognition of stress – and ways to relieve stress and emotional trauma—can help prevent burnout in student nurses. That’s according to a study conducted by five faculty members of the University of Colorado College of Nursing:  Associate Professor of Clinical Teaching, Specialty Director of Psychiatric Mental Health Nurse Practitioner Program and Psychiatric Mental Health Endowed Professorship Kerry Peterson, PhD, DNP, PMHCNS-BC, PMHNP-BC, FAANP, Senior Instructor of Clinical Teaching Laura McGladrey, PMHNP, FNP, FAWM, Senior Instructor of Research Laurra Aagaard, MA, MS, Instructor of Clinical Practice Sarah Stalder, MSN, PMHNP-BC, and Professor and Chair of the Behavioral, Family, and Population Health Division Paul Cook, PhD. William Mundo, MD, MPH from the Denver Health Medical Center is also one of the study’s authors.

“Stress Impact and Care for COVID-19: Pilot Education and Support Course Decrease Burnout Among Nursing Students” was published in August in the Journal of the American Psychiatric Nurses Association.

The study’s authors say nurses are at the forefront of the fight against the COVID-19 pandemic and are at risk of developing stress injuries and burnout.

“(Nurses) are often working in situations with tremendous stress with complex ethical dilemmas and limited resources,” the authors wrote. They also say other things including feelings of uncertainty, frustration with health care disparities, and feeling overstretched are adding to nurses’ distress.

The Pandemic’s Impact on Nurses and Nursing Students

The American Nurses Foundation impact survey from 2022 found 75% of nurses reported feeling stressed – and 60% reported feeling burnt out.

The authors say some nurses working during the pandemic suffered stress, depression, anxiety, sleep-related disorders, and post-traumatic stress.

“COVID-19-related burnout is more likely to happen when healthcare professionals experience disruption in their personal lives, when they feel pushed beyond their training, when they work directly with COVID-19 patients, and when they must make life-prioritizing decisions at work,” the authors say.

Nursing students were also impacted by the pandemic and experienced many of the same psychological symptoms, including stress and depression.

“One study at our university identified 25% of graduate nursing students reported moderate to extremely severe negative emotional states, and just under 24% reported symptoms consistent with the criteria for post-traumatic stress disorder,” the authors say.

Helping Students Cope

In response to the growing number of nursing students facing pandemic related stress, CU Nursing created a program of educational and support resources. A free, online course called “Stress Impact and Care for COVID-19” launched in January 2021, along with support groups run by a psychiatric mental health nurse practitioner (PMHNP). It was offered to 360 nursing students.

The course looked at stress responses and different self-care techniques so students could build resilience when facing stress. Students were encouraged to identify when outside resources might be needed for support because of stress injuries. They also considered cultural contexts that could affect someone’s stress levels or sources of support.  

“This proactive approach to stress management was expected to produce benefits beyond the typical, more reactive mental health support that the college had provided to students in the past,” the authors wrote.

Sixty-two percent of the 360 students completed surveys before and after the course. The authors say students saw decreased levels of stress and burnout. They found students reported gains in knowledge on key course topics – including social connection during the pandemic, seeking help, and recognizing signs of distress in colleagues.

“Participant scores on multiple mental health outcomes increased from baseline to post-test, including feeling calm and connected to others, managing worries related to COVID-19, and having a sense of autonomy,” the authors say.

They say these results can guide similar initiatives to support nursing students in the future, nurses in the workforce, or other healthcare providers.

“Nursing leaders can use psychoeducational strategies to mitigate the impact of stress, build confidence, and support nursing students entering the workforce during these unprecedented times,” the authors say. “Ultimately, an emotionally healthy nursing workforce is essential to patient care, and a functional health system.”