Nuances of Nurse Stress

There are numerous facts and nuances in the study of nurse stress.

Because our work and work environments are complex, there are plenty of angles to look at.

Trends across all industries and workforces show that

personal and professional Burnout has become ubiquitous.


Measurements of employee stress levels of all industries are at record highs. This stress and burnout is associated with increasing competition, rapid market changes, and the slow post-recession recovery. And of course, healthcare is a part of these trends. (Young et al)

For any organization to flourish or even survive, the strength of their workforces is critical.

That’s why Employee Engagement Programs have become such a focus for all organizations.

The goal is to reduce stress through improved staff participation.

Yet, the benefits from engagement programs for nurses has been hard to attain.

A study by the Advisory Board showed that “Among the top 5 opportunities for improving nurse engagement, the area in which organizations have the lowest performance is reducing nurse stress and burnout” (Koppel et al).   This was attributed to the high level of stress in healthcare.


The following are the areas identified in nursing research and literature that reflect nurses’ stress experiences.

Moral Distress – the conflict within

This involves “the perception that core personal values or ethical obligations have been violated” (Morris & Dracup); or being constrained from acting in a manner consistent with what one knows is morally right (Pavlish et al).

And, of course, moral distress can overlay with emotional exhaustion, etc… The main distinction is that it is values based.

Burnout – has to do with energy

This involves “complete draining of one’s energy due to overwork or overstress” (Young et al).

There are several facets:

  • Mental energy – has to do with accuracy and response time
  • Emotional energy – has to do with the interpersonal environment
  • Physical energy – has to do with physical condition and stamina

Results show that these decline through the course of a work day/shift.

Obviously each of these has different measurements and interventions.

Compassion Fatigue – the loss of ability to nurture

This is a newer concept. It is a response to an accumulated effect of secondary traumatic stress (from ‘bearing witness” to patients suffering) and burnout. The nurse reaches a point of being unable to turn off stress, and can become overwhelmed or angry, and detached over time. (Potter et al).

Programs are emerging in hospitals and HC systems to help nurses gain health and healing.

The problem is that the programs are typically not used until after the moral distress, burnout or compassion fatigue has set in.


This is where the path is two way …

The hospital doesn’t build it or offer it fast enough

OR the nurse doesn’t ‘go there’ fast enough..

And the chance for prevention is lost.

Potter P, Deshields T, Rodriguez S. Developing a Systemic Program for Compassion. Nursing Administration Quarterly, 37(4), 326-332; 2013.
Young S, Duff S, Stanney K. How Nurse Leaders Can Reduce Burnout: Focus on Mental Energy. Nurse Leader, April 2016.
Kopper J, Virkstis K, Strumwasser S, Katz M, Boston-Fleischhauer C. Regulating the Flow of Cahnge to Reduce Frontline Nurse Stress and Burnout. JONA, 45(11), November 2015.
Pavlish C, Brown-Saltzman K. SUPPORT An Evidence-Based Model for Leaders Addressing Moral Distress. JONA, 46(6), June 2016.
Morris P, Dracup K. Editorial- Time For a Tool to Measure Moral Distress? AJCC, 17(5), Sept 2008.

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