Stress may be considered commonplace in the landscape of our lives today, still we cannot simply accept this as the norm when it is known that stress negatively impacts one’s health and wellness and can also harm those we care for (Fruh, 2021, p. 641; U.S. Department of Health and Human Services (USDHHS), 2022, para. 6). Specific harm is addressed in the American Association of Colleges of Nursing’s (AACN) 2020 resolution, which states that “workforce stress and nurses’ physical and mental health are linked to medical errors and safety hazards” (para. 8).

In healthcare it is known that workers, including nurses, face numerous stressors during their shifts (Alvarez & Mulligan, 2020, p. 369). The American Nurses Foundation (ANF) found that 60% of acute care nurses report feeling burnt out, and 75% report feeling stressed, frustrated, and exhausted (2022, p. 1). A national nursing workforce study found up to half of nurses feel emotionally drained, used up, fatigued or burned out (Smiley et al., 2022). Nearly a quarter of those were newer to their careers, highlighting this population as being more vulnerable to experiencing negative feelings (Smiley et al., 2022).

Nursing Student Stress

With the understanding that those with less nursing experience are at a higher risk, it is important to note that “stress and health-related challenges begin before individuals even enter the nursing workforce” (Fruh, 2021, p. 640). Vo et al. (2023) found that over 40% of nursing students experience moderate stress and up to 25% report anxiety with risk being highest in their last years in the nursing program (p. E94). Studying, clinical days, written assignments, and exams compile in their third and fourth year, causing what could be a perfect storm of stress for nursing students.

Call for Action

The Office of the Surgeon General released an advisory in 2022 calling attention to the critical nature of burnout in healthcare stating that mental health and wellness deserves to be a priority as healthcare has “long faced systemic challenges…even before the COVID-19 pandemic, leading to crisis levels of burnout” (USDHHS, 2022, para. 1). With the levels of burnout and stress, the National Academy of Medicine (2022) has laid out a plan that includes changes in healthcare education, expecting that attention be paid to fostering “professional well-being” (para. 2). Furthermore, the American Academy of Colleges of Nursing (2020) declared a resolution in conjunction with U.S. Schools of Nursing to “protect the health and well-being of nursing students and faculty” (para. 1). Their call to action asks that academic leaders “develop a culture of wellness and resiliency” (AACN, 2020, para. 2). With the newest AACN Essentials published in 2021, accredited schools must ensure graduates are able to “demonstrate healthy, self-care behaviors” and go beyond themselves by considering the health of their work environment as well (n.d., para. 3). Ultimately the hope voiced by the National Academy of Medicine (2024) is that healthcare workers will thrive, and that improved care is not only delivered to clients but joyfully so.

Prioritizing the well-being, and self-care of healthcare workers is essential; however, implementing such a shift can be challenging. Nurses are often socialized and professionally conditioned to place patient needs above their own, making it difficult to recalibrate this mindset toward a more balanced approach that emphasizes both patient care, and personal well-being (Alvarez & Mulligan, 2020). This shift requires intentional focus from nursing faculty, as nurses may struggle to integrate self-care practices without structured training and reinforcement. A gap in nursing education often leaves healthcare professionals underprepared to prioritize their own well-being, underscoring the need for programs that embed self-care principles into the curriculum (Alvarez & Mulligan, 2020). Ensuring nurses are equipped with both the knowledge and motivation to care for themselves is essential for fostering sustainable, high-quality care environments.

Integrating Self-Care Strategies into the Nursing Maternity Curriculum

The calls for change regarding burnout, attention to the mental status of healthcare workers and the requirement to achieve AACN expectations that graduates incorporate healthy lifestyle behaviors were acted upon by one maternity faculty member at Salisbury University. The action taken was incorporation of reflection activities that had students consider their own self-care and then utilize goal development to plan realistic changes.

The didactic maternity course was ideal for these activities since pregnancy can be a unique time where clients are looking to make healthy lifestyle changes, such as with nutritional and exercise choices, while also ceasing harmful habits such as smoking and illicit drug use. And so, the faculty member was able to capitalize this content in the classroom by having students reflect on their own health behaviors and identify goals aimed at self-care. The self-care strategies were integrated into the assignment instructions and focused on healthy coping mechanisms, nutrition, and smartphone use.

The Theory of Planned Behavior fits into the development of these assignments as it explores “the relationship between behavior and beliefs, attitudes, and intentions” along with the construct of the individual’s perception on whether they can control the behavior change (National Cancer Society, 2005, p. 16). In the activities, students reflect on their current behaviors and their attitudes surrounding them. Students then create self-care goals identifying future healthy intentions. This process of reflection and goal development can help empower them to plan positive behavior change and have the rewarding experience of controlling their behaviors to meet goals.

Below are the four self-care assignments, presented with the exact instructions provided to students to guide them through successful completion.

1. Healthy Coping Mechanisms
   • Some individuals resort to unhealthy coping mechanisms, including teratogens such as alcohol, smoking, marijuana, and other substances, as a means of managing stress. However, developing healthy coping strategies is essential for effective self-care and long-term well-being.
   • What coping mechanisms do you envision yourself using as a future nurse to benefit your own self-care?
   • Create a goal with one realistic change you want to make regarding your coping mechanisms.
2. Healthy Eating
• Healthy eating can be part of self-care, this exercise will help you consider your own eating patterns. Write down everything you ate in a 24-hour period.
• Compare to “Review” slide with pregnancy recommendations in the PowerPoint slides.
• Circle all nutrient dense foods.
• Cross through all foods that were empty calories.
• Rate your eating habits based on a 0-10 scale with 0 being the poorest and 10 being the most healthy.
• Create a goal with one realistic change you can make to improve your eating habits.
3. Healthy Smartphone Use
   During the chapter where students learn about fetal testing and monitoring, students learn about kick counts. Students are taught that pregnant clients are to be in a no or low distraction environment while doing fetal movement or kick counts. This includes not being on their phone. Since not being on their phone is included, the assignment instructions share how a recent Surgeon General report focused on social media use, included that on average people spend 3.5 hours per day on social media alone and 46% indicated that being on social media makes them feel worse (USDHHS, 2023). Social media is linked to depression, anxiety, poor sleep, body dissatisfaction, disordered eating behaviors, social comparison, and low self-esteem. Students are asked to consider social media and phone use in their own lives and how their habits can be a part of self-care (USDHHS, 2023).
   • Review in settings how many touches, pickups, hours you use your phone in a day. Were you surprised by any of this information? Explain why or why not.
   • Reflect on what healthy phone usage looks like for yourself
   • Create a goal with one realistic change related to your own social media or phone usage.

   Reflection on Goals

   Two weeks after students have submitted their responses to the above assignments, they are then asked to reflect on the goals they developed and any progress they have made in achieving them. Assignment wording is: Now that some time has passed, reflect on each of the goals you created. For each goal, determine if it was met, not met, partially met or unable to be evaluated and then provide some explanation to support your decision.

   Conclusion

   Faculty believed students were engaged as evidenced by the assignments being submitted almost always and usually containing thoughtful goals and reflections. Unexpected benefits were that the instructor was able to get to know the students better through their sharing and at times offered university resources when student submissions seemed to suggest a need. Furthermore, the faculty member was able to provide guidance on students identifying realistic goals, encouraging them when there was positive progression toward reaching a goal and sharing that being flexible with their expectation of incorporating healthy behaviors is important as well. Ultimately, the faculty member saw the assignments as a positive addition to the course and is looking forward to continuing them in subsequent semesters.

   As nursing faculty members, we are keenly aware of the challenging and complex environment our students are about to enter. We are being called upon to consider the health and well-being of the students we teach now and of their future selves. Therefore, we should be intentional about preparing them to care for themselves and helping them establish healthy coping mechanisms in nursing school so that they can rely on these throughout their professional careers. The reflection and goal development activities shared in this paper are one example of ways to help prepare students.