Nursing & Mental Health: Balancing Stressors, Stigma & Health

Christopher Friese, PhD, joined Michigan Minds for the National Nurses Week and Mental Health Awareness Month Special Series. Friese is a professor at the U-M School of Nursing and the director of the Center for Improving Patient and Population Health (CIPPH). His research focuses in two areas—measuring and enhancing the quality of cancer care delivery and understanding and improving the delivery of nursing care to a variety of  patients. His research findings were among the first to establish a significant relationship between favorable nurse practice environments and lower surgical mortality. 

Friese was recently featured in an article by the Detroit Free Press that provides an inside look at the exhaustion nurses have been experiencing due to the pandemic. He elaborates on the strain and stress nurses were facing even before the COVID-19 pandemic, and shares how these factors only became more challenging throughout. 

“Things for nurses have been difficult for some time, and we’ve learned through this pandemic because it’s really exposed the fault lines of where we see the problems—and what it’s really done is widen the cracks of existing problems in the system.”

Christopher Friese

He provides insight on studies his team led at U-M that analyze feedback from nurses regarding their concerns. Not being adequately protected against the coronavirus, issues in the health care system with having to take care of very sick patients in short spurts of time, and not seeing attention to the physical and mental health of healthcare workers are three key factors that Friese explains nurses have been dealing with. 

These challenges that nurses and health care workers face impact their mental health and wellbeing. Friese expands on this: “One of the things we’re particularly worried about is that nurses might really be stressed from both their workplace and their home life. In terms of stressors, whether that be in the workplace—unsafe staffing, unreasonable patient loads, not feeling supported by their employer—and then in the home situation they might be dealing with caregiving for spouses, children, older parents, and managing household challenges during economic crises. 

“All of these things are coming to play for nurses and what we don’t really see is targeted support for nurses on how to balance these matters and that leads us to think that we need very specific outreach and support strategies for nurses, because their profile looks very different from what we see in the US population and even in other healthcare workers.”

Friese provides insight about the stigma that occurs in the workplace regarding the mental health of nurses and other health care professionals. He shares that nurses and other health care workers are less likely to access mental health resources for a number of reasons. First, Friese explains there’s a stigma about being a health care professional and needing to seek care for yourself. There is also the issue that a concern may not be handled confidentially or anonymously, which poses the fear that an employer may find out and the employee will face judgment. 

Friese emphasizes the importance of breaking these stigmas that act as barriers for health care workers to access mental health support. 

“We haven’t really set up a mental health system where we are screening ahead of time before problems occur, so that we’re offering referrals to confidential easy to access services. And then we’re also missing sort of a peer-to-peer influence. What we know from the mental health literature is that often a peer-to-peer group can be very powerful. We have these for physicians, but we don’t have them for nurses.”

Friese recently co-authored a paper with his colleague and U-M School of Nursing Associate Professor Deena Costa, PhD, titled, Policy Strategies for Addressing Current Threats to the U.S. Nursing Workforce. He shares key messages from this paper, including evidence that early graduates, the youngest nurses in the field, are leaving faster than older nurses—which is an alarming trend that needs to be addressed. Friese also comments on regulations and solutions that can be imposed to help solve some of these challenges. 

“Nurses have delivered extraordinary care in really exceptional times and it’s time for us as a society to return that investment that nurses have made for centuries now. They’ve always put themselves behind and put the patient and community first, and now what we see very clearly from research at the University of Michigan and elsewhere is that nurses need our help. And there are policy strategies and other approaches we can do in our local communities, state and federal to make the environment safer for nurses.”

During the podcast, Friese expressed the importance of seeking mental health support, and provided the Suicide Prevention Lifeline as a resource, which can be accessed by or calling 1-800-273-8255. The Suicide Prevention Lifeline’s online chat and calling services are accessible 24/7 across the US.