As WHO/Europe releases new data from its Mental Health of Nurses and Doctors (MeND) survey – one of the largest studies to date on the mental health and well-being of doctors and nurses across Europe – Cecilia’s story offers a glimpse into the daily realities behind the numbers.
Cecilia has been a nurse in the north of Italy, since 2012. Over more than a decade in the public health system, she has witnessed first-hand how the pressures on nurses have evolved – and intensified. Her experience reflects many of the challenges highlighted in the MeND report, from chronic understaffing to the emotional toll of long and stressful shifts.
People are leaving the profession
“People are leaving the profession,” she says. “And as I can see with my own eyes, they’re leaving high-risk or emergency contexts such as the ICU [intensive care unit] and emergency room. These were the most engaging contexts a few years ago.”
For Cecilia, the daily reality of short-staffed wards and stretched resources means working under constant pressure. Institutions are often forced to operate with the minimum number of staff permitted by law, she explains, even though patient numbers and needs have not decreased. The result is heavier workloads, longer shifts and less time to provide the kind of care patients deserve.
Beyond the staffing shortages, Cecilia points to a deeper problem, including the lack of professional recognition and development for nurses. “There’s a big gap between the real competencies of nurses and what we are allowed to do, or paid to do,” she says. “We gain skills through experience or training, but our salary doesn’t change.”
This mismatch, she believes, prevents nurses from growing professionally and leads many to frustration or burnout. “As a symptom of this problem,” she adds, “some of my colleagues, including myself, have pursued a second degree or qualification, partly to develop our interests, and partly as an alternative career option.”
Impact on mental health
Cecilia also describes how opaque career paths can make matters worse. Career opportunities, she says, are not always transparent. Often, it seems as though there is no reward for training and effort. Careers do not follow a linear path from the commitment and skills that nurses demonstrate in their work. That fosters disaffection towards the role and undermines the credibility of the system, she says.
The impact on mental health is tangible. “Usually, I come home feeling mentally tired, which I think is normal in an emergency setting,” she explains. “But when you feel that way after almost every shift because of poor working conditions, that can also have an impact on your interactions with colleagues. And that’s when it becomes unhealthy. Everyone is stressed, and that can lead to conflict.”
The consequences are clear across the workforce. “In the last year, at least a fifth of my colleagues either left the profession or changed to a lower-stress setting,” she says. “About half of them were younger than me.” Others, herself included, are considering leaving.
What has also changed, she observes, is the sense of self-sacrifice that once defined the profession. “We’ve always had a strong value of ensuring health services for citizens, no matter the cost. But now more people are prioritizing their own health – especially mental health – before taking on extra shifts. The daily stress is so high that we know we wouldn’t recover well if we kept adding more.”
Despite the challenges, Cecilia still sees sources of strength in teamwork and solidarity. “The support we give each other, discussing cases, helping colleagues through stressful situations, is good, but not enough,” she admits. “If every nurse is already stressed or tired, how can he or she really help others?”
She believes change must come from both leadership and policy. “Supervisors can help by guaranteeing good working conditions, by holding regular briefings and team building, by promoting the nursing role within the organization,” she says. “But I also hear of head nurses leaving their roles to go back to regular shifts, so the problem seems endemic.”
A call for action, and hope for change
For Cecilia, what would make the biggest difference is “regular psycho-physical monitoring and support from institutions,” she says. “We need better working conditions, clearer career pathways that we can pursue, and salaries that reflect our responsibilities. Nurses are the largest workforce in the health system; we make a difference to citizens’ health. That is something I’m proud of, despite everything, and needs to be recognized.”
As WHO/Europe prepares to publish the results of the MeND survey, Cecilia hopes the findings will finally bring visibility to the reality she and many others live every day – offering a window of opportunity.
“I hope the findings will support and confirm what we’ve been feeling, and push politicians to take real action to improve our working and mental health conditions.”