After 25 years in nursing, Lisa Cruz, RN, had become accustomed to handling whatever came her way. She could remain calm during emergencies, manage demanding patient assignments, and continue caring for others even when she was exhausted.
But somewhere along the way, something changed.
In her book, Keeping Up With the Cruzes: Overcome the Bullshit and Design the Life You Want, Cruz recalls caring for a patient whose baby was stillborn. She performed the necessary clinical tasks, said the right things, and completed her documentation. But emotionally, she felt nothing.
“I was not heartless. I was drained. But I kept showing up and doing what needed to be done,” she writes.
Burnout hadn’t arrived through a single breakdown or dramatic turning point. It developed gradually, leaving her increasingly disconnected from a profession she once loved.
Cruz tried changing nursing specialties, adjusting her schedule, and finding positions that might offer a better work-life balance. She also tried familiar stress-management recommendations, including vacations and self-care.
None provided lasting relief.
“I think there’s a place for self-care, but you can’t exercise, meditate, or vacation your way out of being completely exhausted,” Cruz says.
Her experience raises a larger question: If self-care isn’t enough to prevent burnout, what actually helps nurses?
Research suggests that structured psychological interventions can help nurses manage stress and reduce burnout risk. But experts say the real answer also requires changes to the working conditions that contribute to exhaustion.
Why Self-Care Has Its Limits
For Cruz, burnout wasn’t primarily about poor leadership, inadequate compensation, or feeling unappreciated.
Her biggest challenges were scheduling, workload, and not having enough time to recover between shifts.
After leaving labor and delivery for what she hoped would be a less demanding position in mother-baby postpartum nursing, she discovered that the workload remained intense.
She often started a 12-hour shift caring for five mother-baby couples, discharged those patients, and admitted five more before her shift ended.
Staffing shortages were common, and Cruz often volunteered for overtime to help cover the gaps.
“The extra money was nice, but I was also contributing to my own burnout without realizing it,” she says.
Justinna Dixon, PhD, RN, a psychiatric nurse scientist and health policy researcher who is a postdoctoral fellow at the University of Pennsylvania, says individual factors shape how nurses experience and manage burnout. But workplace conditions often determine how much those strategies can accomplish.
“There are many factors that influence the presentation and management of burnout among nurses and other clinicians,” Dixon explains.
Those factors include physical and psychological health, social circumstances, staffing ratios, workplace resources, and broader organizational conditions.
Dixon says interventions addressing organizational problems offer the greatest potential for widespread improvements in clinician well-being.
The distinction matters because nurses may do everything recommended to manage stress while still working under conditions that make recovery difficult.
What Actually Contributes to Nurse Burnout?
Among the organizational factors associated with burnout, Dixon identifies workload and the resources available to manage it as particularly important.
“One of the strongest organizational factors that affect nurse burnout is their workload and the resources they have to handle it,” she says.
Insufficient staffing increases responsibilities and limits time for patient care. Inadequate equipment, technology, and support personnel create additional obstacles.
Dixon experienced those problems herself while working as a mental health nurse at a hospital where staffing shortages and insufficient safety precautions contributed to widespread dissatisfaction and turnover.
She recalls that most employees stayed fewer than six months.
High turnover also meant fewer experienced nurses were available to mentor new employees and provide essential onboarding education, perpetuating the staffing challenges.
Dixon says decades of nursing research have shown that adequate staffing matters for patient outcomes, nurse well-being, and retention.
Another concern is moral distress.
Dixon describes it as the psychological strain nurses experience when they believe they know the ethically appropriate action but encounter barriers that prevent them from taking it.
For nurses who know what patients need but lack the resources to provide appropriate care, repeated experiences of moral distress can contribute to burnout.
Encouraging those nurses to become more resilient does little unless the barriers preventing them from delivering care are also addressed.
Can Evidence-Based Strategies Help Nurses Manage Burnout?
Although individual coping strategies cannot resolve systemic workplace problems, certain psychological interventions may help nurses manage stress and protect their mental health.
Cognitive-behavioral approaches teach specific skills to identify unhelpful thinking patterns, respond to stressful situations, and develop healthier coping behaviors.
One example is the MINDBODYSTRONG™ Mental Fitness Program, a cognitive-behavioral skills-building intervention developed by Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAAN.
A 2026 randomized controlled trial published in Worldviews on Evidence-Based Nursing examined whether adding an online version of the program to mental health screening and referral could improve outcomes among nurses at risk for mental health challenges.
The study enrolled 501 nurses across the United States. Participants received either confidential mental health screening and referral or those services combined with seven online MINDBODYSTRONG modules.
At six months, 37% of nurses in the intervention group met the study’s burnout threshold, compared with 52.9% who received screening and referral alone. The difference was statistically significant, representing approximately a 30% lower relative risk of burnout.
However, between-group differences in anxiety and depression scores were not statistically significant. The study also relied on self-reported outcomes, and the follow-up analysis included only 329 of the 501 randomized participants.
The findings suggest that structured cognitive-behavioral skills training may help reduce burnout. However, the study did not examine whether those benefits would persist in workplaces with excessive workloads, inadequate staffing, or other organizational challenges.
What Healthcare Organizations Can Change
For healthcare leaders seeking practical ways to reduce burnout, Dixon points to emerging findings from her research involving nurses in 10 U.S. states.
Preliminary survey results suggest that hospitals with lower reported nurse burnout also had higher percentages of nurses who observed administrative efforts to improve staffing, protect uninterrupted breaks, and provide more time for direct patient care.
The findings are observational and do not establish that those efforts directly caused lower burnout rates. However, Dixon believes they identify opportunities for healthcare organizations.
Some changes, such as improving staffing levels, may require substantial resources and long-term planning. Others may be more achievable.
Dixon identifies protecting nurses’ breaks from interruptions as one intervention that could help without requiring the same investment as major staffing changes.
Healthcare leaders can also examine how much time nurses spend providing direct patient care versus managing competing demands.
Cruz finds those concerns familiar.
“I think nurses have a responsibility to take care of themselves, set boundaries and recognize when they’re reaching their limits. But healthcare organizations have a responsibility to make sure their nurses have reasonable workloads, adequate staffing and enough time to recover.”
She also recognizes the challenges of delivering care around the clock.
“Patients don’t stop needing care because we’re exhausted. Babies don’t stop being born because we’re short-staffed. I don’t pretend to have all the answers,” Cruz says.
Dixon believes wellness programs and workplace improvements must happen together.
“I believe the best approach is for resilience and wellness programs to happen concurrently with addressing working conditions for staff,” she says.
Otherwise, nurses may perceive wellness initiatives as an attempt to shift responsibility for burnout onto employees.
For healthcare administrators, Dixon recommends a multilevel approach that addresses individual, organizational, and broader healthcare system factors rather than relying on resilience training alone.
Recognizing When It’s Time to Seek Support
For individual nurses, recognizing when occupational stress has become something more serious can be difficult.
Cruz spent years defining strength by her ability to keep going, no matter the circumstances.
“What I wish someone had told me earlier is that being strong doesn’t mean you have to keep pushing through everything. I spent 25 years being the calm one, the dependable one, the nurse who could handle whatever came her way. I thought that was strength. And for a long time, it was. Until it wasn’t.”
She eventually recognized that her ability to tolerate difficult situations had become part of the problem.
“Somewhere along the way, I confused being strong with being able to tolerate absolutely anything.”
For nurses experiencing persistent exhaustion, emotional detachment, or difficulty recovering between shifts, seeking support may be an important step.
That can include discussing workload concerns with supervisors, accessing confidential mental health services, seeking professional counseling, or exploring evidence-based stress-management programs.
Setting boundaries and recognizing personal limits can also help nurses determine whether their working conditions remain sustainable.
For some, protecting their mental health may ultimately mean changing roles, specialties, or workplaces.
When Leaving Nursing Becomes the Answer
Cruz spent years searching for a way to regain the fulfillment she once found in nursing.
She explored different clinical specialties and eventually tried positions outside traditional bedside care, including legal nurse consulting and IV vitamin therapy.
But the changes didn’t restore what she had lost.
In her book, Cruz describes gradually spending more time helping at her husband Ricky’s automotive repair business and less time searching for another nursing position that felt right.
The transition wasn’t sudden. She wasn’t simply leaving nursing. She was moving toward building something with her husband.
Looking back, Cruz believes nurses need to recognize that leaving a profession they once loved doesn’t invalidate the work they accomplished.
“I think we need to stop treating burnout as something nurses just need to become more resilient to overcome. Sometimes the problem isn’t that you aren’t strong enough. It’s that you’ve been strong for too long without enough time to recover.”
She also acknowledges that sometimes, despite every effort to make a career work, moving on becomes the healthiest decision.
“That doesn’t make you a failure. It doesn’t erase all the years you spent caring for others. I loved being a nurse for a long time. And then I didn’t.
Both things can be true.”
Cruz’s experience underscores why preventing nurse burnout requires more than encouraging individuals to develop better coping skills.
Research suggests that structured psychological interventions can help, while organizational improvements involving staffing, workloads, protected breaks, and workplace resources address some of the conditions contributing to burnout.
For nurses, recognizing when they need support is important. For healthcare organizations, ensuring that support extends beyond wellness programs is equally essential.
Protecting nurses’ mental health shouldn’t depend solely on how much more they can learn to endure.
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