The Relationship Between Workplace Stress and Depression in Nurses

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By Jennifer Larson, contributor

June 17, 2010 - Imagine this workplace situation: an overcrowded unit in an overcrowded and understaffed hospital. Patients constantly need your attention, and yet your documentation and other tasks make it hard to keep up. And the doctors and nurse managers are slow to respond when you need them, because they are also stretched to the limit.

Now imagine yourself working in that place, day after day after day. What is your mood like?

You might be stressed out. You might be angry. And according to two recently released studies, you might be much more prone to depression than nurses and health care workers in other types of health care facilities, especially the less crowded ones.

A study published in the May 4 issue of the Journal of Clinical Psychiatry suggested a possible relationship between hospital overcrowding and the stress level of the nurses who work on those overstuffed units. And the chronic stress experienced by those nurses and other staffers may raise their risk of developing depression.

The study, which was conducted in 16 hospitals from 2003 to 2004, found a higher rate of absenteeism in the staff who worked in the most crowded units; these workers took leave for depression twice as often as the people who worked on less-crowded units.

A second study with similar results appeared in the May 19 issue of Health Policy. Using data from the 2005 National Survey of the Work and Health of Nurses in Canada, the researchers found that depression is a major reason for absenteeism among nurses who work in hospitals, compared with nurses who work in other settings.

Additionally, a study in the February 2010 issue of the American Journal of Nursing has also noted the phenomenon, reporting that mild-to-moderate symptoms of depression are common among hospital nurses.

While the situation may be beyond nurses’ immediate control, what makes matters worse is that many RNs aren’t very well equipped to handle the stress and its effects, said Sandra Thomas, Ph.D., RN, author of Transforming Nurses’ Stress and Anger: Steps Toward Healing.

“It depends partly on your personality, partly on your life experiences,” said Thomas, a professor of nursing at the University of Tennessee in Knoxville and the editor of Issues in Mental Health Nursing. “Unfortunately, a great many nurses don’t have very good coping mechanisms.”

Thomas noted that she does not minimize an institution’s responsibility to give nurses the necessary resources to do their job. It is important that hospital leaders staff appropriately and provide the right kind of support.

But nurses can also learn to help themselves. Negative thoughts and poor emotional management do contribute to depression, but those things are correctable, according to Thomas.

“You can learn new coping skills,” she said.

Thomas advises nurses to speak up for themselves when they feel they are being treated unfairly. She teaches them to not just bury their worries but instead to be assertive about making their own needs a priority, which will enable them to continue taking care of others.

“What happens if you stuff down a lot of negative emotions like anger and hurt and they’re not expressed and you don’t take any action?” Thomas said. “Eventually that can contribute to the condition that has the name of depression.”

The Cleveland Clinic in Cleveland, Ohio, wanted to help employees ask for and receive support when needed. So it established a program called Code Lavender a few years ago to help employees (and patients and their families) cope with stressful situations on the job—the sort of situations that might just lead to depression if left unaddressed.

Barb Picciano, RN, coordinator of the healing services team which oversees Code Lavender, said that the program has definitely had a positive impact on the people it has touched so far. It’s very easy for caregivers, including nurses, to get burned out, and this program helps them feel cared for, too.

“Helping them work through their stresses will increase everything: happiness, productivity, their effectiveness,” she said.

When a staffer calls the health services 24-hour hotline with a Code Lavender request, a team responds to the unit with special plans to reach out to the employees who were affected. They might need counseling services, snacks and water, time to meditate, healing touch therapy, or another service which various members of the team are trained to provide. The team follows up with whatever the individuals might need later on, as well.

“We don’t do the same thing on every unit that calls a Code Lavender,” Picciano said. “We find out what they need, as a group.”

And while no formal statistics on retention are available at the present, the Code Lavender team has learned that the program is very much appreciated by the nurses and other staff members who have benefitted from it.

“Their feedback is very positive,” said Picciano. “They say, ‘We could use this all the time. We’re happy that someone cares about our concerns, our feelings.’”

That kind of resource could be extremely beneficial in other places, too.

Thomas suggests that nurse managers make a conscious effort to be more aware of each staff member’s condition and refer them to whatever type of assistance program is available at their hospitals. She called it “a kindness” to help them realize that they need help—and then get the help they need.

“We can’t afford nurses burning out and being unable to work,” she said. “They’ve gone through all this training and have all this experience. We can’t afford to lose them.”

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