ICU nurse Mindie Antebi recently cared for a patient who died unexpectedly following a procedure. The patient was her own age, and Antebi had wished her well before she left the unit.
Within an hour, the patient was dead.
“I wished her well as we took her to her procedure, and within an hour, I was seeing her lifeless body in the bed,” recalled Antebi, BSN, RN, creator and host of the Call the Nurse Podcast.
The death occurred at the beginning of her shift. Antebi still had other critically ill patients who needed her attention.
“Even after all these years, some losses hit you in ways you don’t expect,” she said. “She died at the beginning of my shift, and I battled that day, moving on as if nothing happened.”
A small study of neonatal and pediatric critical care nurses suggests that structured cognitive-behavioral skills training may help nurses manage the stress and anxiety of demanding clinical environments.
A separate national randomized controlled trial involving 501 nurses provides broader evidence for this approach. At six months, nurses who received an online cognitive-behavioral skills program alongside mental health screening and referral had approximately a 30% lower relative risk of burnout than those who received screening and referral alone.
The findings raise an important question: Can practical mental health skills help critical care nurses cope with the emotional demands of their work, and will hospitals give them the time to use them?
Seven Weeks of Skills Training in Critical Care
A 2026 study published in Worldviews on Evidence-Based Nursing, examined the MINDBODYSTRONG™ Mental Fitness Program, developed by Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAAN.
Researchers implemented the seven-week intervention among 15 neonatal and pediatric critical care nurses at a 222-bed academic pediatric hospital.
The program uses cognitive-behavioral skills-building to help participants recognize unhelpful thinking patterns, manage stress, regulate emotions, solve problems, and develop healthier coping strategies.
Participants attended weekly virtual sessions. All 15 completed the program, and 14 completed both the initial and follow-up assessments.
Researchers reported improvements in anxiety, perceived stress, depression, and burnout. The largest effects involved anxiety and perceived stress, while improvements in depression and burnout were smaller.
All participants who completed the program evaluation found it helpful and recommended offering it more widely.
Why Critical Care Stress Can Be Difficult to Leave Behind
Critical care nursing requires sustained vigilance, rapid decision-making, and the ability to move from one emotionally difficult situation to another without time to process what happened.
“Critical care nursing combines prolonged vigilance, frequent interruptions, sensory intensity, and limited opportunities to decompress during a shift,” said Carolina Estevez, PsyD, a psychologist at SOBA New Jersey.
“When this pattern repeats, concentration, sleep, emotional regulation, and connection to work may suffer, increasing vulnerability to chronic stress, anxiety, and burnout.”
Vanessa Ruiz, ND, RN-BSN, founder of Nurses for Natural Health and a chapter leader with the American Holistic Nurses Association, said repeated exposure to stressful situations can leave nurses feeling constantly on alert.
“The vigilance that makes critical care nurses excellent can become a state they can’t turn off.”
Antebi recognizes that pattern.
“I’ve been a nurse for almost 20 years, and I can tell you there are still days I sit in my car after a shift just trying to process what happened before I walk into my own home,” she said.
What the National Trial Found
A separate 2026 randomized controlled trial published in Worldviews on Evidence-Based Nursing examined whether adding a digital cognitive-behavioral intervention to confidential mental health screening and referral could improve outcomes among nurses experiencing psychological distress.
Participants were randomly assigned to receive either mental health screening and referral or those services plus the online MINDBODYSTRONG program.
Unlike the weekly virtual sessions used in the critical-care project, the national trial evaluated seven self-paced video modules lasting nine to 20 minutes each. Topics included thinking patterns, stress management, problem-solving, emotional regulation, communication, and sleep.
At six months, 37% of nurses in the intervention group met the study’s burnout threshold, compared with 52.9% in the screening-and-referral group. The difference was statistically significant.
The intervention group also experienced greater reductions in anxiety and depression scores, although those differences were not statistically significant compared with the control group.
Researchers also found statistically significant improvements in healthy lifestyle behaviors at three months and healthy lifestyle beliefs at six months.
However, the study had limitations. Of the 501 nurses randomized, 329 completed at least one follow-up assessment and were included in the analysis.
Although the national trial provides stronger evidence than the smaller critical-care project, it was not limited to ICU nurses. Its findings cannot establish whether critical care nurses would experience the same benefits.
What Nurses Can Use During a Difficult Shift
Cognitive-behavioral skills training helps people recognize stress responses and develop practical strategies for managing them.
“Cognitive-behavioral skills are relevant because they can be rehearsed before a stressful moment and retrieved quickly,” Estevez said. “A brief grounding step, a clear problem-solving sequence, or planned decompression turns a broad intention to cope into an observable behavior.”
Ruiz said these techniques must be simple enough to use during demanding clinical situations.
“They have to be small and practiced until automatic.”
For Antebi, recognizing emotional distress is particularly important.
“Something I’ve been thinking about a lot is how nurses are trained to recognize when something is wrong with our patients, yet we aren’t always very good at recognizing when something is happening within ourselves.”
After the unexpected death of her patient, a hospital chaplain noticed her distress and offered support.
“He took the time to ask me if I’m ok, gave me a hug, and told me how blessed the patient was to have me at her side the past few days,” Antebi recalled.
“Even those simple gestures helped me to stop, take a breath, and process what had just happened rather than going straight back to the unit and continuing patient care.”
Why Skills Training Alone Isn’t Enough
The findings are encouraging, but experts caution against treating cognitive-behavioral training as a solution to every cause of nurse burnout.
The national trial was randomized, but its findings relied on self-reported outcomes, and most participants were White.
Estevez said additional research should include larger, multisite randomized trials, independent replication, and longer follow-up periods.
“Small studies are valuable for testing feasibility, acceptability, and early outcome signals,” she said. “Their estimates are less precise, uncommon harms can be missed, subgroup comparisons are unstable, and results from one setting may not generalize across nursing environments.”
Ruiz also noted that the national study measured burnout using a single self-reported question and did not report how frequently participants used the therapist or referral services available to both groups.
For healthcare organizations, the findings suggest an opportunity to expand mental health support, but not a reason to overlook workplace conditions.
“Skills-building and organizational change should proceed together,” Estevez said. “Individual coping should not be used to reinterpret a system-level hazard as a personal resilience problem.”
Will Hospitals Give Nurses Time to Participate?
For bedside nurses, access to mental health programs is only part of the challenge. Finding time to participate may be equally difficult.
Antebi believes hospitals should provide protected, paid time for mental health training and ensure staffing levels allow nurses to participate without adding to their workloads.
“I would love to see hospitals offer protected, paid time for programs like this, with adequate staffing to allow nurses to participate because we can’t tell nurses their mental health is a priority and then expect them to figure out how to prioritize it on their own.”
Ruiz agreed that participation requires organizational support, including protected time, visible leadership support, and confidentiality.
Antebi believes hospitals must also address the conditions contributing to burnout.
“We must acknowledge that nurse burnout isn’t just an individual problem,” she said. “Staffing, workload, scheduling, leadership, and workplace culture all play a huge role.”
She believes the most effective approach combines practical coping skills with meaningful improvements in working conditions.
“We can teach nurses how to manage their stress, regulate their emotions, and develop healthier coping skills, and I support that, but those skills can’t fix an environment that is consistently overwhelming or unsafe.”
The MINDBODYSTRONG Mental Fitness Program is available through Springer Publishing’s CourseConnect platform for individual nurses and healthcare systems.
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