Healthcare workers

Nursing assistants, home health aides, techs, housekeepers and transport staff keep care running. Their work is physically hard and emotionally close to patients, yet they are often paid less and noticed less. NIOSH lists demanding physical work, injury risk and financial strain among the drivers of health worker stress.

Extra pressures

• Bonding with residents or patients, then grieving them
• Feeling unheard by managers
• Injuries from lifting and moving patients
• Money stress and working more than one job

Doctors, physician assistants and nurse practitioners carry heavy responsibility for diagnoses and decisions. Training is long and demanding, and many learn to push feelings aside to get through it.

Common pressures

• Being on call and missing family events
• Fear of mistakes and lawsuits
• Heavy paperwork and screen time that takes time from patients
• Worry that seeking mental health care will affect their license

Counselors, social workers, case managers and peer specialists in health settings listen closely to people’s pain. The National Child Traumatic Stress Network calls secondary traumatic stress a common hazard of this work.

Nurses spend more time at the bedside than anyone. They notice every change, comfort families and often care for too many patients at once. Long and back-to-back shifts are common.

NIOSH training notes that long shifts are strongly linked with worse health outcomes for nurses, and that more than 40 hours of work a week is linked to risks for both nurses and patients.

A large U.S. study found that women who work as nurses died by suicide at about twice the rate of women in the general population. Reaching out early matters.

What can help

• A buddy system to check in after hard shifts
• Guarding sleep on your days off
• Speaking up about safe staffing
• Taking your break, even when it feels impossible

NIOSH names high administrative burden and little control over schedules as drivers of burnout. Many clinicians say charting, prior approvals and inbox messages eat into the time they trained to spend with patients.

What can help

• Ask your team which tasks could be shared or dropped
• Batch inbox and charting time where you can
• Bring workflow problems to leaders with a suggested fix
• Protect at least part of your day for the work that feels meaningful

Health workers are with people at their most frightened and in their last moments. NIOSH lists exposure to human suffering and death as a core source of stress in this work.

What can help

• A brief pause or moment of silence after a patient dies
• Letting yourself grieve patients you were close to
• Memorial or remembrance events at work
• Talking with a chaplain, peer or counselor

When teams are short, everyone does more. Breaks get skipped, shifts get longer and the chance to talk after a hard moment disappears. In CDC’s survey, the share of health workers who said there were often not enough staff rose from 25.7% in 2018 to 32.0% in 2022.

The same survey found that health workers who had enough time to finish their work had much lower odds of burnout. Staffing is not just a budget issue. It is a mental health issue.

NIOSH notes that many health workers put others’ well-being ahead of their own, which can delay them from getting help. There is also a long history of stigma around health workers seeking mental health care.

AACN lists frustration, feeling inadequate, sadness, fear, powerlessness, anger and blunted emotions, along with physical effects like poor sleep, headaches, fatigue and stomach upset.

According to the VA, moral injury can also bring shame, trouble forgiving yourself, and feeling betrayed by leaders or systems. It is not a diagnosis. It is a way of describing a wound to your sense of right and wrong.

AACN suggests

• Connect with a mentor you trust
• Lean on coworkers, friends and family, and tell them when you are struggling
• Learn the physical and emotional warning signs of moral distress
• Pay attention to your inner voice when something feels wrong
• Speak up about how resources are shared, and ask for open decisions
• Use your ethics committee, employee assistance program or a counselor

Small steps

• Find ways to act on your values, like mentoring or pushing for change
• Name what happened and what value it went against
• Separate what you controlled from what you didn’t

AHRQ describes clinicians feeling responsible for the outcome, along with shame, anger, a sense of failure, low mood, feeling inadequate and losing confidence. Some go on to have trauma reactions, such as replaying the event.

It might sound like

• “Everyone knows. They all think I’m dangerous.”
• “I can’t stop going over it.”
• “Maybe I shouldn’t be doing this job.”

One well-known model, based on interviews with clinicians, describes a path through chaos right after the event, intrusive reflections, restoring personal integrity, enduring the review process, getting emotional first aid, and then moving on. Some people leave the field, some survive, and some come out stronger.

AHRQ describes a three-tier model: support from your own unit, trained peer supporters, and fast access to professional counseling. In one survey, clinicians said they most wanted one-to-one peer support. Fast access to help after an event appears to be especially important.

What you can do

• Ask whether your organization has a peer or “care for the caregiver” program
• Remember that one event does not define your whole career
• Talk with someone you trust within the first days
• Use the “After a hard outcome” worksheet to sort out what happened

Try this

• Check in again a week later, not just that day
• Don’t gossip about the event
• Offer practical help with the rest of their shift
• Say: “That sounds really hard. How are you doing?”

Try this

• Get checked for injuries, even ones that seem small
• Notice if you feel jumpy or on guard in the days after
• Take a short break before going back on the floor if you can
• Talk it through with a coworker, peer supporter or counselor

OSHA notes that many more incidents of violence in healthcare probably go unreported. Reporting every incident, even “small” ones, helps show how big the problem is.

What can help

• Ask what support and leave options are available
• Check in with coworkers after a scary moment
• Report through your workplace system and keep your own notes
• Talk with your supervisor about a safety plan

CDC suggests strong workplace policies against harassment and violence, along with training supervisors to support their teams.

Things to ask for

• A clear, simple way to report
• Enough staff so nobody works alone with a high-risk patient
• Follow-up support after every incident
• Training on calming tense situations

Changing between days and nights confuses your body clock. NIOSH notes that research on long and rotating shifts is mixed, but long hours combined with short sleep are linked to worse health.

Try this

• A planned short nap before a night shift can help alertness
• Ask for schedules that rotate forward (days → evenings → nights) if possible
• Get daylight when you wake up
• Shift your bedtime a little before a change

Try this

• Keep a short wind-down routine, even 10 minutes
• Make your room dark, cool and quiet (blackout curtains, earplugs, fan)
• Put your phone on do-not-disturb and tell family your sleep hours
• Wear sunglasses on the drive home to signal “nighttime” to your brain

Try this

• A warm shower to mark the end of the workday
• Avoid using alcohol to fall asleep; it breaks up sleep later in the night
• Slow breathing: in for 4, out for 6, for a few minutes
• Write down what is on your mind, then close the notebook

Compassion fatigue can feel like you have nothing left to give. You still want to help, but you feel flat, irritable or numb with patients. Some people feel guilty because they “should” care more.

It might sound like

• “Another sad story. I can’t take it.”
• “I just don’t feel anything anymore.”
• “I used to love this job.”

What can help

• Notice it without judging yourself
• Refill with things that bring you joy outside work
• Share the load: talk with peers who understand
• Take real time off and protect it

Secondary traumatic stress is emotional distress that comes from hearing about or seeing another person’s trauma. It can look like images that pop into your mind, bad dreams, feeling on edge, or avoiding reminders.

What can help

• Grounding skills, like naming five things you can see
• Limiting extra trauma exposure off duty, such as graphic news
• Supervision or debriefing where you can talk about the hard parts
• Talking with a therapist who understands health workers

CDC found that health workers who trusted management, had a supportive supervisor and had enough time to do their work had much lower odds of burnout. Self-care helps, but it can’t fix a broken system.

Impact Wellbeing is a NIOSH campaign made with the Dr. Lorna Breen Heroes’ Foundation. It focuses on prevention: fixing the causes of burnout before people get unwell.

It offers

• A guide that helps hospital leaders make system-level changes
• Resources workers can use to start conversations and ask for change
• Tips for talking about burnout, moral injury and mental health at work

Try this

• Check in after hard shifts or patient deaths
• Make it easy to swap shifts for appointments
• Protect breaks and time off
• Share your own experience of getting support
• Thank people specifically for their work

CDC found that health workers with supportive supervisors had much lower odds of burnout.

Ways to help

1. Notice changes and mention them gently: “You seem more tired lately. How are you really doing?”
2. Listen without rushing to fix it.
3. Offer practical help: cover a task, bring food, walk them to their car.
4. Encourage support: the EAP, a peer program, or a confidential line.
5. Check in again a few days later.

Ideas that help

• Agree on a simple signal for “hard shift, I need quiet”
• Avoid “I could never do your job,” which can make them feel more alone
• Look after your own stress, too
• Plan small, regular time together that work can’t take

NIOSH says there is a strong and long-standing stigma around health workers seeking mental health care, and its work aims to remove barriers to getting care. The Impact Wellbeing campaign helps hospital leaders make it safer to ask for help.

Ask before you start

• Is this service separate from my employer?
• What, if anything, would ever be shared, and when?
• Who will see my information?

Cognitive behavioral therapy (CBT) helps with stuck thoughts like “I should have done more,” worry, low mood and sleep. Trauma-focused therapies, such as cognitive processing therapy, prolonged exposure and EMDR, help when hard memories won’t let go. For anything medical, consult with your clinical provider.