4 Ways to Maintain Your Mental Health as a Nursing Student

Written by Sidney Lebrun & Leona Werezak

October 10th was World Mental Health Day, and it arrived at an unprecedented time in healthcare and education history.

While nursing school is known to challenge even the most resilient scholars, the COVID-19 pandemic has further threatened nursing students’ best efforts to stay healthy—both physically and mentally. 

A few statistics help demonstrate the magnitude of mental health problems for college students, including those who are in nursing programs:

• 71% of students interviewed state their stress and anxiety in school have increased since COVID-19
• 64% of young adults who are no longer in college are not attending college because of a mental health-related reason
• Suicide is the second leading cause of death in those aged 10-34.

And right now, there are some good reasons why nursing students struggle with their mental health. 

It’s time to look at what’s taking a toll on nursing students’ mental health. And it’s time to dispel some of the myths about mental health issues so those working to manage their mental health (which is many of us!) don’t think this is uncommon or unusual.

5 Reasons Nursing Students Are Struggling With Their Mental Health 

1.  COVID Has Added to the Workload for Nursing Students

Whether you’re in an ADN, BSN or bridge program or you’re working to fulfill your dream of earning a master’s degree in nursing, there’s no shortage of information to be learned as a nursing student!

While the amount of new information to learn in nursing school is abundant (to say the least!), COVID-19 has added to the workload in both educational and clinical settings.

On top of an already heavy course load, many nursing students are required to take additional courses to certify they’re knowledgeable about COVID-19, supplement their already fully-packed skill set with PPE regimens and swabbing practice, and arrive at clinical sites early to undergo additional screening. 

Regardless of the program you’re in, nursing school is extra stressful right now and all this is a lot to learn and do on top of everything else you have on your plate.

>> Related: Top Mental Health Resources for Nurses During COVID-19

2. Nursing Students Face Social Dilemmas and Restrictive Settings

Two years ago, the terms “social distancing” and “lockdown” were foreign concepts. Today, we use these terms on a regular, if not daily, basis. 

Aside from the physical health risk associated with COVID-19, social dilemmas pose a mental health risk to nursing students. When most of the world went into lockdown earlier this year, people were told to keep their social circles small, which required students to disconnect from many people as well as their social lives.

With the transition to more online learning that occurred during the lockdown, many nursing students felt “Zoom university” didn’t help them to foster and grow social relationships as they did in-person prior to the pandemic. This resulted in nursing students feeling detached from their peers. And it has left many students struggling to feel connected and supported by their peers ever since.

Although many nursing schools have welcomed students back to campus this fall, social distancing, masking, and closure of communal spaces has made it more difficult than ever for students to reach out and share their stress and anxiety with peers—many who are experiencing the same thing. 

3.  Tension!—Globally, Locally, and Personally

Unfortunately, the stress of COVID-19 has caused tension and emotional exhaustion for many—from the highly-regarded professor on Zoom to the newly-admitted hospital patient you work with as a nursing student.

Stress caused by the pandemic is widespread and impacts everyone differently, often manifesting suddenly without warning. This can be obvious and unexpected such as an emotional outburst in private, or it can be subtle and disguised in the form of sleep pattern changes, appetite fluctuations, and lack of energy and motivation.

4. Pre-Existing Conditions Made Worse

As noted earlier, high rates of stress and anxiety are found in college students, particularly since the pandemic began. However, having mental health problems or a mental health condition prior to the pandemic can be the tipping point for many people. 

A professor and psychiatrist at Michigan Medicine explains “Even if someone hasn’t received a formal diagnosis of anxiety or depression, the stress and social distancing requirements of the coronavirus pandemic may make their mild symptoms worse, or tip the balance into more full-blown episodes.” 

5. Difficulty Balancing Life, Work, and School

Commitment to nursing school is both time-consuming and expensive. Most nursing students have a heavy course load as well. Add to this mix the responsibilities of monthly bills, family commitments, childcare, job insecurity, and a pandemic while squeezing in some personal care and social time and well—it’s no wonder a nursing student’s mental health begins to suffer.

6 Common Myths About Mental Health and Wellness for Nursing Students

Myth #1 - Mental Health Problems Only Happen to People With Certain Biological Conditions or Genetic Makeup

Mental health issues are not caused only by biological or genetic conditions. Environmental factors such as living in a dysfunctional family, a divorce, and social and cultural expectations can also contribute to poor mental health. 

Psychological factors such as trauma, neglect, or the loss or absence of a parent early in life can also result in mental health issues at any age.

Myth #2 - Mental Health Problems Won’t Happen to Me

Mental health problems are very common—especially in college students. 

An online survey conducted in the fall semester of 2020 found that “A high proportion of students are dealing with anxiety (82%), followed by social isolation/loneliness (68%), depression (63%), trouble concentrating (62%), and difficulty coping with stress in a healthy way (60%)”.

One study estimates approximately 42% of students in healthcare programs develop a mental disorder with a higher prevalence in females (62%) and at an average age of onset of 23.5 years old.

Myth #3 - There’s Nothing You Can Do to Help a Person With Mental Health Problems

This couldn’t be further from the truth! There are many things you can do to help someone trying to cope with a mental health problem. 

Be willing to start the conversation telling the person you’re concerned about them and you’re willing to offer a listening ear. Offer to help with potential barriers the person may have in accessing mental health help. This may include offering transportation to appointments or help with childcare.

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Myth #4 - People With Mental Health Problems Have Those Issues for Life

This is simply not true. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), studies show most people recover from mental health issues and do not need lifelong treatment.

Myth #5 - People With Mental Health Problems Cause Those Issues Themselves

Although an individual is ultimately responsible for their own feelings, thoughts, and actions, this does not mean a person “caused” their mental health problems to occur or is to blame for them. 

As noted in Myth #1 above, sometimes things happen in people’s lives that they have no control over which can take a toll on their mental health.

Myth #6 - If You Have a Mental Health Disorder, You’ll Have to Disclose it to Potential Employers if Asked on Job Applications

Not true! According to the Americans with Disabilities Act (ADA), “employers can’t require applicants or employees to disclose a disability… So, in most cases, disclosing a psychiatric disability is a choice, not a requirement. 

Individuals who choose not to tell about their mental health condition are not “lying” or “hiding.” They are using a legally protected choice.” 

There are a few exceptions to this such as when a person requests work accommodations. Nursing students and nurses with mental health issues are protected against workplace discrimination by law under the ADA.

17 Signs Your Mental Health Is At Risk as a Nursing Student

Everyone experiences fluctuations in mood and energy and has negative thoughts from time to time. However, a mental health condition likely exists if one or more of the following signs or symptoms develop, persist over time, and interfere with your ability to function resulting in frequent stress:

• Difficulty concentrating
• Withdrawal from family, friends, & activities 
• Difficulty coping with common daily stressors & problems
• Feeling “down” or sad often
• Significant changes in eating & sleep habits
• Difficulty relating to and understanding people and common situations
• Confused thoughts
• Excessive worry, fear, anxiety or feelings of guilt
• Feeling tired & lacking energy often 
• Excessive or uncontrolled eating, alcohol, or substance use
• Changes in sex drive
• Significant highs and/or lows in mood
• Thoughts of self-harm, suicide, or harming others
• Extreme anger or violence
• Paranoid thoughts or behavior
• Hallucinations
• Delusions

How Can I Protect My Mental Health as a Nursing Student?

If after reading this far, you think you might be dealing with a mental health problem or your mental health is at risk, you’re probably wondering what you can do about it. 

Here are some important things you can do to protect your mental health or help with your recovery.

1.  Practice Self-Care and Mindfulness

Self-care is the antidote to many stressors in life, particularly situation-based stressors. An increasingly popular method of stress reduction is referred to as mindfulness. 

The purpose of mindfulness is to reduce external stimuli and focus on calming oneself through the mind. Over time and with practice, mindfulness has been shown to decrease stress-based behavior and emotions, as well as prevent chronic health problems. 

However, if you’ve tried mindfulness exercises and found they just aren’t for you. That’s okay! 

Some other self-care options you can benefit from include:

• Journaling: Science has shown that while writing, you use the left side of your brain, which is analytical and rational. This allows the right side of your brain the space to create and feel. This can connect you with your environment, reduce stress, and allow you to practice self-care while expressing your emotions. 
• Saying No: “No” is a complete sentence. If you feel overwhelmed by nursing school, the state of the world, and the pressures of life, try removing some responsibilities from your schedule. This can be as simple as saying “No, I cannot meet today”, or “No, I can’t pick up that shift”. While you may have good intentions, self-care must come first to properly give yourself time and space to heal or rest.
• Sleep, Sleep, Sleep: As a student, sleep is often the first thing to be compromised. However, during sleep, the brain reorganizes and recharges itself by removing the toxic waste byproducts that have accumulated throughout the day. It can be difficult to manage the stress of nursing school when your brain is unable to maintain normal functioning.

2.  Structure Your Time

Anxious thoughts thrive in unregulated, unstructured time. Beat the negative but opportunistic thoughts by having a schedule and consistently sticking to it.

Treat school like you would a job. On weekends, block out 2 hours at a time when you know you’re most likely to focus (early in the morning? Later at night?). As if you are answering to your boss at a job, show up to study and focus for the duration of that time.

Use a calendar or planner to maintain your study boundaries as well as any upcoming exams, events, clinical hours, and appointments.

Consider meal planning. If you’re unable to or don’t want to create meals in advance, simply having them written down and mentally planned out can eliminate a lot of the time spent ruminating over ideas in the moment when you’re tired and hungry.

Taking color-coded notes is a valuable skill to have to help you retain information and study better. This guide teaches you a specific strategy to take color-coded notes.

3.  Know When (& Where) to Reach Out for Help 

Despite the best effort you’ve put towards self-care, the strain of the pandemic coupled with the intensity of nursing school and your other obligations may have overwhelmed your ability to cope.

That’s okay—you’re not alone (remember the statistics above?). There are resources to help you if (or when) this occurs. 

If you’re currently a nursing student

If you’re currently a nursing student and your mental health is deteriorating or might be on the verge of, it’s best to be as proactive as possible and check out the resources available to you on campus. Most universities and colleges include mental wellness in their tuition and health care costs and want you to reach out. 

However, if you can’t find specific mental health and wellness information from your university or college website, the campus physician or nurse practitioner will be able to refer you to the services and professionals that can help you. You may also have a number of options via telehealth with your insurance provider too. 

If you feel you’re struggling with your studies, don’t hesitate to ask for a meeting with your instructors and let them know. Informing your instructors that you’re having difficulty gives them a chance to help you. 

An instructor may offer special accommodations, assignment submission extensions, campus resources you might not know about, or even suggest a leave of absence for a semester. Don’t forget—your instructors are nurses and human too. They were once students, just like you, and they care about your mental health.

If you decide you need to take a break from nursing school to focus on your mental health, don’t fret! Studies have shown that fewer than half of post-secondary students finish their degree in 4 years. So this is nothing to be ashamed or afraid of.

If you’re a future nursing student, or currently on a break from school

Take this time to establish daily routines that work for you, particularly around healthy eating, stress management, sleep, and physical activity. Find stress-relieving activities that work for you and make them daily habits before you start school. By establishing healthy habits now, you’ll be less likely to experience mental health issues that overwhelm you when you begin nursing school.

If you’re moving away from home to go to nursing school, consider going to your primary health care provider for a check-up of both your physical and mental health. 

If you already have a diagnosed mental health condition, ask your physician to help you find a psychologist, pharmacy, or primary care provider closer to your school before you go. While you will likely have a support system available through your university’s health center, your primary care provider may have a recommendation that is better suited to your specific needs.

4. Continue Working to Remove the Stigma 

Despite World Health Organization (WHO) initiatives like World Mental Health Day that help increase awareness and acceptance and reduce the stigma surrounding mental health conditions, significant stigma still exists about this illness. 

As nursing students and nurses, we all need to continue to raise awareness that mental health is just one facet of a person’s overall health. Illness of any kind is nothing to be ashamed of or hidden—it needs to be empathetically acknowledged, treated, and prevented when possible.

The important thing to remember is you’re not alone, and you are not flawed or to blame if you’re concerned about your mental health and need help. 

How Can I Afford to Pay for Mental Health Services?

As a student, the financial burden of tuition and other school and living expenses can leave you feeling financially reluctant to reach out for mental health care.

However, the good news is most insurance plans cover students up to the age of 26 under a parents’ plan. If this is not an option for you, there are other avenues you can take.

For example, your university or college likely offers a medical insurance program to students that include mental health services. And you have the option to pay for private insurance if you choose to as well.

You can also try out online therapy platforms such as Better Help. They offer affordable, online counseling via a computer, tablet, or smartphone. You can use this link to enjoy 10% off your first month with Better Help. Discount code “nurseorg" will be automatically applied.*

YOU Must Put YOUR Mental Health First!

It doesn’t matter if you’re able to ace that big exam, excel in clinical settings, or get that extra patient connection if you aren’t well yourself.

Remember! You are someone’s child, parent, friend, or sibling long before you are someone’s nurse. YOU matter first!

If you or someone you know is in immediate danger due to mental or physical distress, contact 911 right away.

If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Hotline at 1-800-273-TALK (8255). Trained professionals are available to talk 24/7, 365 days a year.

Sidney Lebrun is a writer and graduate nursing student from Edmonton, Alberta, Canada. She is currently practicing as a registered nurse in the field of palliative care while completing her final practicum in forensic psychiatry. She is also the Social Media Marketing and Newsletter face behind NCLEX Education. She is passionate about all sectors of health care, with special interest in end-of-life, gerontology, ethics, and nursing education. When not in a nursing role, you can find her writing poetry, browsing a local book store, or playing with her hairless cat. 

*As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.