If you asked nurses how they reduce job stress, you probably wouldn’t expect them to reply, “By writing.” In fact, a recent research study of nurses’ preferences for stress-relieving activities didn’t include writing as an option. Few people would choose writing to relax.

At the beginning of a writing workshop with nurses, I often ask, “Who hates writing?” My hand is the first to go up, followed by that of nearly everyone in the room—and for good reason. Writing reports, patient assessment findings, and other types of clinical documentation can be the most tedious aspect of healthcare work.

Resistance to writing also may reflect who nurses are and how they are trained to handle stress. One nurse manager declared, “My nurses are no-nonsense people. They roll up their sleeves and get the job done. They don’t want any touchy-feely stuff.” Nurses are known for selfless dedication and a generous spirit. Taking time to reflect on feelings about life events may not be in their nature—or in the nursing curriculum. When asked how stress management is addressed in nursing education, nurses commonly reply, “It isn’t.” Nurses are expected to focus on the patient in front of them and put all else aside.

Expressive writing, or writing about thoughts and feelings, encourages emotional expression. It doesn’t require good grammar, spelling, or public disclosure. Research indicates expressive writing may produce multiple health benefits, including reductions in anxiety, depression, somatic symptoms, and fatigue.

Emotional expression through writing is a proven way to discharge intense feelings. Cognitive processing, or organizing chaotic thoughts into clear and manageable ones, may have a cathartic effect, freeing the mind to focus on a nurse’s highest priority—excellent patient care. Meditation and yoga may be popular stress relievers, but writing can address sources of stress, such as personal or professional issues that cause distraction, sleeplessness, poor health, and poor performance.

What to write about

What should nurses write about? Expressive writing can shift attention to enjoyable topics, serving as a respite from distress. It can also be used to identify upsetting events and related feelings. Topics of a universal nature allow nurses to control the content to best meet their needs. “How did you get here?” can evoke anything from describing the route to work to a significant event that influenced the decision to become a nurse. “What games did you play as a child?” can help create stepping stones from childhood to the present, recalling favorite activities long forgotten in the business of patient care. The prompt “What I meant to tell you…” can produce writing as simple as finishing a conversation with a friend, or it can produce something deeper, perhaps recalling something left unsaid after the death of a patient or loved one. The writer decides how deep to go with disclosure. That sense of control can be the first step toward regaining emotional balance.

When writing causes distress

Can writing cause distress? Yes, especially when you’re addressing difficult issues for the first time. Research suggests that intense feelings during and immediately after writing are temporary and followed by a sense of well-being. The few times I have observed emotional distress in a writing workshop, the writer’s tears were soon replaced with smiles and gratitude for having the chance to express what needed to be said.

Writing as an emotional release

A regular practice of writing to manage feelings can create a health-enhancing pattern of emotional release. This stress relief may ward off extreme conditions, such as job burnout, that can cut short a promising nursing career. Over time, comfort with writing as a coping tool might lead the writer to organize regular group writing sessions for nurses. These sessions can help create a more supportive work environment. (To learn about writing resources for nurses, including journals for nurses and facilitation guides for nurse educators, visit the Josie King Foundation website, http://josieking.org/from-the-experts/nursing/.)

Expressive writing is an effective way to introduce self-care into nursing education. The practice can be continued throughout a nurse’s career to improve quality of life and the quality of patient care.

Selected references

Hasson D, Gustavsson P. Declining sleep quality among nurses: a population-based four-year longitudinal study on the transition from nursing education to working life. PLoS One. 2010;5(12):e14265.

Kemper K, Bulla S, Krueger D, Ott MJ, McCool JA, Gardiner P. Nurses’ experiences, expectations, and preferences for mind-body practices to reduce stress. BMC Complement Altern Med. 2011;Apr 11:11-26.

Martino ML, Freda MF, Camera F. Effects of guided written disclosure protocol on mood states and psychological symptoms among parents of off-therapy acute lymphoblastic leu­ke­mia children. J Health Psychol. 2013;18(6):727-36.

Morgan NP, Graves KD, Poggi EA, Cheson BD. Implementing an expressive writing study in a cancer clinic. Oncologist. 2008;13(2):196-204.

Pennebaker JW, Mayne TJ, Frances ME. Linguistic predictors of adaptive bereavement. J Pers Soc Psychol. 1997;72(4):863-71.

Nancy Pierce Morgan is the director of arts and humanities and a writing clinician at the Georgetown Lombardi Comprehensive Cancer Center in Washington, DC.