ANA California identifies barriers and solutions to nurses’ mental health crisis


Soraya Marashi


The American Nurses Association (ANA) California has been making efforts to address barriers impeding nurses’ access to mental health care in the state amid heightened demands as a result of pandemic-related burnout and stress. 


Stay one step ahead. Join our email list for the latest news.



Dr. Marketa Houskova, Executive Director of ANA California, and Carolyn Duenas, Advocacy Institute Fellow at the organization, and Jared Fesler, the organization’s Communications and Programs Manager, told State of Reform how their organization is working to make mental health care more accessible for nurses and support their wellbeing.

With female nurses having double the suicide risk of women in the general population even before the pandemic, ANA California has launched a campaign to advocate and find solutions for the mental health crisis that California nurses are currently experiencing. 

This crisis is also reflected in data showing that one in three newly-licensed registered nurses are leaving the profession within 2 years of licensure, 26% of nurses aged 55-64 are planning to retire in the next two years, and a forecasted shortage of 40,000 nurses statewide.

“It’s going to definitely affect outcomes for patients,” Duenas said. “If you don’t have the staffing, how are we going to really take care of the patients the right way? It’s going to have a domino effect if we don’t really take care of the mental health of these nurses.”

In an analysis authored by Duenas, ANA California identifies several overarching barriers to addressing nurses’ access to mental health services and solutions. One of the barriers is the stigma attached to mental health illnesses among nursing professionals. Duenas explained how difficult it is for nurses, the ones that are supposed to be healing people, to admit that they need help for fear of judgment by their employers and colleagues.

“We have a hard time even allowing the people that we work for to know that we’re having these issues because, what if there are consequences? Maybe we’ll have a hard time getting [our] licenses because we have an issue, or are having a hard time getting a job because we disclose these issues.”

A lack of employer awareness and responsibility also exists, according to ANA California, where Risk Management and Human Resources departments refrain from acknowledging, and thus accepting accountability for, an employee’s mental health in an effort to control liability. 

Additionally, ANA California identified that there is a lack of evidence of nurses’ utilization and effectiveness of offered services and solutions. Duenas emphasized the need to measure the perceived or real benefits attributed to the utilization of these services and solutions, as well as the need to educate nursing leadership on these results.

In the analysis, ANA California also points to mental health solutions and services for nurses in California that have proven effective at health care institutions, including programs such as HeartMath, Wambi, Schwartz Rounds, MindBodyStrong, and Transcendental Meditation in order to give health care institutions a place to start to look for mental health resources for their nurses.

The solutions mentioned by ANA California largely involve ways to promote wellness in conjunction with their stressful daily lives, such as providing nurses with a regularly scheduled time to destress and talk about their daily experiences, as well as lessons for mental techniques for deep relaxation and stress reduction, and ways to vent to colleagues anonymously.

Duenas added that she put together a wide range of solutions to purposefully include both digital platforms and traditional, in-person programs, so that nurses of all age ranges could be represented. 

“I wanted to put [together a variety of different solutions] because you have your 60 something year old nurses, [where they] can do a little bit of the technology, but they like old school therapy too, and then you have your brand new 20 something year old nurses [that are more tech-savvy],” she said. 

Looking ahead, Fesler said ANA California’s research into barriers and solutions for nurses’ mental health care would be ongoing.

“We’ve actually been connecting with other institutions and organizations to create events that would be [hosted] at the hospitals and institutions that would help them get these mental health products,” Fesler said.

Houskova noted her optimism for the future of a health care system where mental health care services for providers are more readily available and accessible.

“It’s not just nurses, it’s our colleaguesphysicians, physical therapists, physician assistants, we’re all struggling in this together,” she said. “I think that the years coming up, with more studies and more data, will show us what the needs will be of the future health care workforce, and hopefully, we will learn from this [so that] when this happens again, a system will [already] be set up. I think nurses will say, ‘At least I helped the next generation of nurses.’”