on August 22, 2023 Clinician

Nurses Are Under Pressure: Here's What They're Not Telling You

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Registered Nurses in the United States play an essential role in the healthcare system. While their contributions are indispensable, the profession is accompanied by a range of unseen pressures that can significantly impact nurses' well-being and the quality of care they provide.

Nurses are often exposed to emotionally challenging situations, including patient suffering, end-of-life care, and challenging family dynamics. This emotional toll can lead to compassion fatigue, a phenomenon characterized by emotional exhaustion and decreased empathy. Research revealed that compassion fatigue is prevalent among nurses, affecting their mental health and job satisfaction (Flarity et al., 2013). While nurses are trained to provide emotional support, they often lack resources to cope with the emotional demands of their profession. This unseen pressure can lead to a cycle of emotional exhaustion, impacting both the nurses' ability to provide compassionate care and their own well-being, and increases their risk for developing PTSD. Nurses may develop flashbacks, nightmares, avoidance of triggering situations, heightened anxiety, and emotional numbness. The demanding nature of nursing work, coupled with a lack of sufficient emotional support and debriefing provided by unit management, can exacerbate the risk of PTSD.

The administrative burden and documentation demands placed on nurses contribute to another layer of unseen pressure. Electronic health records (EHRs), while intended to improve efficiency, have added to the nurses' workload due to hospital administration increasing charting requirements in order to meet quality metric outcomes. A study showed that nurses spent 27% of their time on electronic health record tasks, 25% on direct patient care, 17% on personal time, 15% on indirect patient care, and 6% on communication. These EHR requirements diverted their attention away from direct patient care (Bakhoum et al., 2021). The pressure to maintain accurate records while juggling other responsibilities can lead to burnout and compromise patient safety.

The pressure to leave bedside nursing and pursue graduate education is another feeling common among nurses. Many nurses desire to further their education and pursue advanced degrees, such as becoming a Nurse Practitioner (NP) or Certified Registered Nurse Anesthetist (CRNA). While this decision can lead to career advancement and increased autonomy, it also comes with its own set of pressures. NPs and CRNAs have more responsibilities, higher earning potential, and greater influence on patient care decisions. However, this decision can be challenging, as it involves leaving behind a desirable 12 hour shift schedule that nurses prefer because more time off helps balance work and personal commitments (Dall'Ora et al., 2015). Nurses may also grapple with feelings of guilt, as they worry about potentially leaving their colleagues short-staffed or abandoning the hands-on care they are passionate about. Additionally, the pursuit of an advanced degree requires a significant time and financial commitment. Balancing work, education, and personal responsibilities can lead to increased stress and burnout. While further education can provide new opportunities, it's essential to acknowledge the sacrifices and pressures that come with this decision.

Nurses in the United States face a multitude of unseen pressures that can significantly impact their well-being and career choices. Acknowledging and addressing these pressures through supportive workplace environments, mental health resources, and comprehensive education about the potential consequences of certain career paths are crucial steps to ensuring the overall well-being and success of nurses in their professional journey. 


Bakhoum, N., Gerhart, C., Schremp, E., Jeffrey, A. D., Anders, S., France, D., & Ward, M. J. (2021). A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department. Journal of emergency nursing, 47(5), 733–741. https://doi.org/10.1016/j.jen.2021.03.007

Dall'Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H. (2015). Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ open, 5(9), e008331. https://doi.org/10.1136/bmjopen-2015-008331

Flarity, Kathleen DNP, PhD, CEN, CFRN, FAEN; Gentry, J. Eric PhD, LMHC, CAC; Mesnikoff, Nathan MA, BCCC. The Effectiveness of an Educational Program on Preventing and Treating Compassion Fatigue in Emergency Nurses. Advanced Emergency Nursing Journal 35(3):p 247-258, July/September 2013. | DOI: 10.1097/TME.0b013e31829b726f

Amanda McDonald

Amanda is a registered nurse with over 5 years of experience caring for ICU, med-surg, and ambulatory patients in the hospital and outpatient setting. She is a newly certified Family Nurse Practitioner and is looking forward to her transition into her next stage of clinical practice. She is located in Chicago, IL and is excited to provide care for her community.

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