Nurse Educator

Promoting Nursing Student Mental Health Wellness

The Impact of Resilience-Building and Faculty Support
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Catherine A. Stubin, PhD, RN, CNE, CCRN-K;

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Lisa Ruth-Sahd, DEd, RN, CCRN, CEN, CNE, CCFP, ANEF; and Thomas A. Dahan, PhD

ABSTRACT
Background: Being aware of elevated levels of student psychological distress by nursing faculty, and subsequently responding
to it, may diminish nursing students’ experience of negative mental health well-being.
Purpose: Relationships between perceived faculty support, resiliency, and the prevalence of depression, anxiety, and stress
among undergraduate nursing students were explored.
Methods: An exploratory mixed-methods design was used for this descriptive, cross-sectional study. The Depression, Anxiety,
and Stress Scale-21, Brief Resilience Scale, Perceived Faculty Support Scale, a demographic questionnaire, and open-ended
questions were used to collect data. A convenience sample of 989 undergraduate baccalaureate nursing students from across
the United States completed the surveys.
Results: Study results revealed resilience strategies and psychological and functional supportive faculty behaviors and actions
are substantial predictors of lower depression, anxiety, and stress in undergraduate baccalaureate nursing students.
Conclusions: Investments in faculty development to support nursing student resilience may reduce the degree of negative
mental health well-being that students exhibit related to nursing education and promote their successful transition to nursing
practice.
Keywords: mental health, nursing faculty, resilience, student psychological distress
Cite this article as: Stubin CA, Ruth-Sahd L, Dahan TA. Promoting nursing student mental health wellness: the impact of resilience-building
and faculty support. Nurse Educ. 2024;49(3):119-124. doi:10.1097/NNE.0000000000001535

T
he psychological well-being of nursing stu-
dents is paramount as it affects their educa-
tional progression and successful transition to
nursing practice. Research validates that stress and
mental health (MH) issues are experienced by nursing
students in higher amounts than in the general college
student population.1-3 Being aware of elevated levels of
student depression, anxiety, and stress by nursing fac-
ulty, and subsequently responding to it, may diminish
nursing students’ experience of negative mental health
well-being (MHWB).2
Relevant Literature
Nursing education has consistently been associated
with poor MH in nursing students.2,4,5 As a result of the
COVID-19 pandemic, nursing students experienced re-
markably higher levels of stress.4,5 In addition, a high
prevalence of anxiety and depression exists among nurs-
ing students.2,6,7 As noted by Mcdermott and colleagues,7
approximately 20% of undergraduate nursing students
screened positive for probable depression. Psychological
Author Affiliations: Assistant Professor (Dr Stubin) and Assistant Teaching
Professor (Dr Dahan), Rutgers University School of Nursing–Camden,
Camden, New Jersey; and Professor Emerita (Ms Ruth-Sahd), York
College of PA, York, Pennsylvania.
The authors declare no conflicts of interest.
Correspondence: Dr Catherine Stubin, Rutgers University School of
Nursing–Camden, Nursing & Science Bldg, 530 Federal St, Ste 433,
Camden, NJ 08102 (Catherine.stubin@rutgers.edu).
distress has negative effects on students’ quality of life
and educational path, and contributes to academic fail-
ure.2,4,6 Equipping students to persist through difficul-
ties is critical, as negative MH affects nursing students’
journeys as professional nurses.5
The pressing requirements of nursing education can
be mitigated by fostering resilience and adaptive coping
mechanisms. Resilience is the successful adaptation to
challenging life experiences through mental, emotional,
and behavioral flexibility, and acclimation to internal
and external demands.8 Broadly, resilience can be de-
fined as adapting to adversity.9 Recent studies identify
the important role of resilience in assisting nursing stu-
dents to overcome challenges and promote MHWB.10-12
External support is one of the processes that sup-
ports students’ MH and fosters academic success. Fac-
ulty support, one of the main external support systems,
is composed of both psychological and functional fac-
ulty actions and behaviors.13,14 Hamby et al15 found
that social support is an environmental influence that
positively affects resilience.
Supplemental digital content is available for this article. Direct URL
citations appear in the printed text and are provided in the HTML
and PDF versions of this article on the journal’s website (www.
nurseeducatoronline.com).
Accepted for publication: September 4, 2023
Early Access: October 5, 2023
DOI: 10.1097/NNE.0000000000001535

Nurse Educator • Vol. 49 • No. 3, pp. 119–124 • Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. www.nurseeducatoronline.com 119

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

 Several systematic reviews were conducted that ex-
amined the impact of perceived faculty support and
caring on nursing students. The researchers concluded
that nursing faculty caring behaviors are instrumental in
motivating student progression through the curriculum
and faculty support plays a significant role in students’
academic success in relation to both classroom and clin-
ical learning.16,17 Jafarian-Amiri et al17 added that clini-
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cal education requires a caring environment that fosters
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a supportive atmosphere and clinical stressors must be
mitigated by nursing faculty. Faculty support and cre-
ating a safe space for learning in the online classroom
environment was also essential to classroom learning.18
Current Study
While there is an abundance of research on nursing student
MHWB, there is no literature exploring the relationship be-
tween baccalaureate nursing student stress, anxiety, depres-
sion, resilience, and perceived faculty support. To address
this gap in the literature, the current research study builds
on findings from a descriptive, cross-sectional pilot study by
Stubin and Hargraves13 that explored the relationship be-
tween perceived faculty support and prevalence of depres-
sion, anxiety, and stress among undergraduate nursing stu-
dents. Utilizing a mixed-methods concurrent triangulation
design, the researchers examined relationships between per-
ceived faculty support and prevalence of depression, anxi-
ety, and stress among undergraduate nursing students (n =
74). Results revealed that the prevalence of depression, anx-
iety, and stress was 65.75%, 72.60%, and 83.56%, respec-
tively.13 Perceived faculty support was moderate. An inverse
correlation between select faculty supportive behaviors and
depression, anxiety, and stress was evident. This suggests
that student stressors may be related to faculty actions, and
symptoms of negative MHWB among undergraduate bac-
calaureate nursing students are prevalent.13
Meleis’ Transitions Theory19 provides the theoretical
framework for this study. This theory describes the ex-
periences of individuals transitioning from one state of
being to another.20 As baccalaureate nursing students are
transitioning through the nursing curriculum, there are
demanding academic and psychological pressures, which
can lead to stress, anxiety, and depression. Meleis19 sug-
gests that educators can ease a transition by serving as a
role model to support students and facilitate resiliency.
Aims
The aims of this study were to (1) investigate the prevalence
of stress, anxiety, depression, resilience, and perceived
support from nursing faculty among undergraduate bac-
calaureate nursing students; (2) examine the relationship
between undergraduate baccalaureate nursing students’
stress, anxiety, depression, resilience, and perceived fac-
ulty support; (3) explore the differences in undergraduate
baccalaureate nursing students’ stress, anxiety, depres-
sion, resilience, and perception of faculty support related
to their age, gender, ethnicity, and program level; and (4)
120 Nurse Educator • Vol. 49 • No. 3
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
identify approaches nursing faculty may use to promote
MHWB among undergraduate baccalaureate nursing
students in the academic learning environment.
Methods
This study used an exploratory mixed-methods design
and was approved by the authors’ university institution-
al review board and considered exempt. This design pro-
vided insight into the study variables that the use of one
research design alone could not capture.
Subjects
A nationwide convenience sample of 989 undergradu-
ate baccalaureate nursing students completed the sur-
veys and were recruited from 31 Commission on Col-
legiate Nursing Education (CCNE)-accredited nursing
programs across 21 states in the United States. Email
recruitment letters were sent to the program directors
or deans of the nursing programs to invite their students
if they desired them to be included. The survey was
distributed to approximately 4900 students.
Instruments
Data were collected in the spring of 2023 using 4 mea-
surement tools. First, a 4-item demographic question-
naire included items about participant characteristics
including age, gender, race/ethnicity, and current level in
nursing program.
Second, the 21-item version of the Depression, Anx-
iety, and Stress Scale (DASS-21)21 was used to measure
students’ emotional states related to depression, anx-
iety, and stress. The extensively validated self-report
questionnaire consists of 7 items per stress, anxiety, and
depression subscales. Participants rate each item on a
4-point Likert scale from 0 (did not apply to me at all)
to 3 (applied to me very much, or most of the time). Tra-
ditionally, subscale scores are summed up and then mul-
tiplied by 2 to allow for interpretation. Subscale scores
range between 0 and 42, in which higher scores indicate
greater symptoms of depression, anxiety, and stress. For
the purposes of this research to compare magnitudes of
responses, scores were averaged and standardized.
Third, the 6-item Brief Resilience Scale22 was used
to measure resilience because it has been shown to be
a useful measure with strong reliability and construct
validity. Three items of the scale (“I have a hard time
making it through stressful events,” “It is hard for me to
snap back when something bad happens,” and “I tend
to take a long time to get over setbacks in my life”) are
reverse coded. Scores on these items ranged from −2 to
+2, and an average score is calculated for this scale and
then standardized for comparison purposes.
Fourth, faculty support was operationalized by the re-
vised Perceived Faculty Support Scale (PFSS).23 The PFSS
consists of 24 items on a 7-point Likert scale from 1
(strongly disagree) to 7 (strongly agree) (mid-point = 4).
This scale contains 2 subscales: psychological (14 items)
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 and functional (10 items). These measures have shown Table 1. Demographics and Instrument Scales
practical utility in measuring nursing faculty support.15
n (%) or Cronbach’s
Psychologically supportive behaviors include actions Mean ± SD α
such as listening, caring, and being approachable, en- Current level in nursing program
couraging, and respectful. Functionally supportive be- Freshman 100 (10.1)
haviors include being available, setting clear and reason- Sophomore 125 (12.6)
able expectations, giving fair evaluations, role modeling, Junior 351 (35.5)
Senior 413 (41.8)
and presenting information clearly. Scores were averaged Race/ethnicity
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and standardized for comparison purposes. Lastly, quali- Black, non-Hispanic 39 (3.9)
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tative content and thematic analysis were used to analyze White, non-Hispanic 669 (67.6)
participants’ responses to 2 open-ended questions. Asian/Pacific Islander 103 (10.4)
Hispanic 128 (12.9)
Mixed-Methods Approach Other 50 (5.1)
Instrument scales
To approach the first aim of the study, the prevalence Depression Subscale of DASS-21 1.99 ± 0.73 0.90
of the variables, the traditional scoring methods for the Anxiety Subscale of DASS-21 2.03 ± 0.69 0.83
DASS-21 were used, and scores were classified based on Stress Subscale of DASS-21 2.47 ± 0.67 0.84
the published guidelines for severity of symptoms. The Resilience Scale 0.16 ± 0.70 0.82
Faculty Support–Functional 5.04 ± 1.13 0.92
second aim was achieved by exploring the interconnec-
Faculty Support–Psychological 5.33 ± 1.14 0.96
tions of the various continuous scale measures using Abbreviation: DASS-21, Depression, Anxiety, and Stress Scale, 21-item version.
Pearson’s product moment correlations. The third aim
was achieved via the Ordinary Least Squares (OLS) lin-
ear regression model tested to predict the outcomes of the prevalence of depression, anxiety, and stress among
depression, anxiety, and stress. Each model controlled the sample. Scale scores were then compared to the pub-
for year in program, gender, ethnicity, and age. Each lished classifications from normal to extreme severity
model also included the covariates of interest (Resilience, established by the creators of the instrument.21 These
Faculty Support–Psychological, and Faculty Support– classifications are summarized in Table 2.
Functional), and these measures were standardized to
aid interpretation. Heteroskedasticity robust standard Aim 2: Relationships Between Variables
errors were used to improve inference. Quantitative Correlations among the scales indicate strong correla-
analysis was conducted using Stata/MP 17.0.24 tions between the depression, anxiety, and stress items
Qualitative data added depth and clarity to the quan- (r ranging from 0.63 to 0.73). The correlations among the
titative findings and provided rich, detailed descriptions DASS-21 subscales and the resilience measure were mod-
of nursing students’ perceptions of nursing program erate and negative (r ranging from −0.386 to −0.434).
stressors and ways nursing faculty can promote MHWB Faculty psychological support was moderately negatively
among nursing students. Participants’ responses to the correlated with the DASS-21 subscales (r ranging from
2 open-ended questions were analyzed extensively and −0.279 to −0.339). Faculty functional support also ex-
independently by the 2 researchers to find repeated pat- hibited a moderate negative correlation to the DASS-21
terns of meaning. A third outside qualitative nursing re- subscales (r ranging from −0.281 to −0.335). Correla-
search expert also comprehensively analyzed the data, tions among resilience and both faculty support measures
which served to decrease the potential for researcher were weakly correlated (r = 0.145 for psychological sup-
bias and data distortion. All discussed the noted com- port, r = 0.151 for functional support), suggesting these
monalities in the data, which assisted in clarifying and measures are independent. The correlation between the
identifying the emerging themes. 2 faculty support measures was very strong (r = 0.866).
However, variance inflation factors of these measures
Results suggest collinearity did not significantly influence the
Summary Statistics regression models. The regression results are visualized
Respondents selecting outside of the traditional gen- in the Supplemental Digital Content Figure, available at:
der binary were grouped for analyses, and 89% of re- http://links.lww.com/NE/B435.
spondents selected female. The average age of the sam-
ple respondents was 23.8 years and this variable was Table 2. Depression, Anxiety, and Stress Scale, 21-Item
standardized for analysis. The scales for the DASS-21, Version (DASS-21) Scale Scores
resilience, faculty psychological support, and faculty
Depression Anxiety Stress
functional support are summarized in Table 1 with other n (%) n (%) n (%)
demographic information. Normal 444 (38.21) 314 (27.00) 358 (30.76)
Mild 175 (15.06) 95 (8.17) 178 (15.29)
Aim 1: Prevalence of Variables Moderate 287 (24.70) 237 (20.38) 241 (20.70)
Subscale scores of the DASS-21 were summed up and Severe 111 (9.55) 169 (14.53) 260 (22.34)
then multiplied by 2 to generate a scale score to assess Extremely severe 145 (12.48) 348 (29.92) 127 (10.91)

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Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

 Aim 3: Predicting Differences in Variables
Total Variance Explained by Regression Models
Overall, 27.98% of the variance in depression was ex-
plained by the regression model predicting that outcome.
For anxiety, 23.72% of the variance in anxiety was
explained by the regression model. For stress, 22.24% of
the variance in depression was explained by the regres-
sion model. The 3 covariates of interest explain 21.23%
of the variance.
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Variance Explained by Variables of Interest
The 3 covariates of interest explain 26.33% of the vari-
ance in depression, 21.23% of the variance in anxiety,
and 20.30% of the variance in stress. Increases in re-
silience scores show moderate-to-large effect sizes on
depression, anxiety, and stress ranging from −0.32 to
−0.40 (with all P values < .001).
Both forms of faculty support are associated with
smaller effect sizes. Increases in faculty support from a
psychological perspective decreased reported depression
by −0.186 (P = .003). Psychological support decreased
reported anxiety by −0.145 (P = .005). In contrast to
the depression and anxiety measures, faculty psycholog-
ical support was less salient for lower stress (β = −.108,
P = .057). Increases in functional support from faculty
decreased reported depression by −0.122 (P = .059)
and anxiety by −0.093 (P = .073), suggesting that this
kind of support is less salient for these symptoms. How-
ever, faculty functional support was salient for lower
stress (β = −.125, P = .033).
Other Variables’ Influence on Depression,
Anxiety, and Stress
A standard deviation increase in age reduced the associa-
tion with depression by −0.061 (P = .004), with anxiety
by −0.082 (P < .001), and with stress by −0.048 (P =
.011)—suggesting that older students exhibit fewer neg-
ative MH symptoms. For ethnicity, students identifying
with other racial and ethnicity categories reported sig-
nificantly higher depression scores (β = .306, P = .006)
and higher anxiety scores (β = .245, P = .005) than
their White peers. Other differences by demographic cat-
egory are detailed in the Supplemental Digital Content
Figure, available at: http://links.lww.com/NE/B435.
Aim 4: Qualitative Findings on Faculty
Approaches to Promote Mental Health
The first open-ended question, “Describe the top 3 stress-
ors you experience in your nursing program” generated
assorted responses. Major themes that captured partici-
pant responses included: overwhelming course load (ex-
ams/assignments), psychological distress (self-doubt/im-
poster syndrome/fear of making a mistake and harming
a patient/overwhelmed/exhausted), peers (competitive/
unsupportive/peer pressure), and nurses/clinical site (un-
willing to help students/treated poorly by hospital staff).
122 Nurse Educator • Vol. 49 • No. 3
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
However, approximately 60% of student responses cen-
tered on faculty actions and behaviors as a top nursing stu-
dent stressor. Terms such as belittling, critical, unsupport-
ive, inflexible, unprofessional, inconsistent, and unclear
were used by participants to describe some nursing faculty.
The second open-ended question asked participants to
“Describe ways in which nursing faculty can promote
MHWB among nursing students in the academic envi-
ronment.” Promoting self-care and wellness activities
was a theme identified by participants. A few individual
responses stated faculty did encourage student MHWB
practices and self-care. Students identified wellness strat-
egies such as meditation, deep breathing, stress balls,
informing students of campus stress-relieving activities
and MH resources, and self-care seminars as essential to
contributing to their MH wellness.
Most qualitative data supported positive faculty ac-
tions and behaviors as crucial for promoting nursing stu-
dent MHWB. Exhibiting functional and psychological
faculty supportive behaviors was the major theme that
emerged from this dataset. Maintaining consistent sched-
ules, having realistic and clear academic expectations,
decreasing busywork, constructing better study guides
and examination blueprints, extending examination and
assignment deadlines, and varied methods of instruction
were functional faculty supportive behaviors identified
by participants to promote MHWB in students.
Additionally, faculty members’ psychological support
such as being flexible and approachable, listening to the
student, communicating, being supportive, encouraging,
and patient, and demonstrating kindness, compassion,
and respect were supported by the qualitative data. One
participant commented: “I think that being approach-
able and encouraging are the best qualities our faculty
can have to help us thrive. You know going into nursing
school that it isn’t going to be easy and that you’re going
to make mistakes. Having faculty who reassure you and
are always there to listen has been one of the greatest
resources I’ve found in nursing school. When it comes to
understanding the hardships of nursing school, there is
no better shoulder to lean on than them.”
Discussion
This study sample was representative of both the cur-
rent nursing population25 and the geographic regions
(Northeast, Southeast, Midwest, Southwest, and West-
ern) of the United States. When comparing our results
with the current literature, there were no studies that
examined the intersectionality of the variables in this
study. Our results indicated strong correlations between
depression, anxiety, and stress. This result was confirmed
by the participants’ comments as many indicated that
nursing school is extremely stressful and becomes more
stressful during program progression.
Nearly 30% of anxiety scores for the sample popula-
tion were in the extremely severe classification. Further-
more, over 33% of students reported severe or extremely
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 severe stress and 22% reported severe or extremely se-
vere depression levels. This is alarming and represents a
significant public MH concern among nursing students.
Study results revealed resiliency strategies as most salient
to lower nursing student stress, depression, and anxiety.
Devi et al11 also found resilience to be a critical media-
tor in nursing student negative MHWB. There is a need
to offer resiliency training to enhance students’ MHWB
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and resilience.10,26 Additionally, these programs should
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be integrated throughout the nursing curriculum to assist
students in achieving this psychological well-being.13
There are numerous educational approaches to sup-
port the development of resilient attributes in students.
Mindfulness-based stress reduction strategies, fostering
an attitude of gratitude, and meditation practices reduce
student stress and promote attitudes for nurturing re-
silience.9,27,28 Storytelling29 and reflective practice28 have
also been identified as effective approaches to enhancing
student resilience. Various concepts ranging from react-
ing to stress, to managing an emergency, can be intro-
duced through storytelling, and corresponding reflection
exercises and activities. Reflective writing helps cultivate
self-awareness, provides the opportunity to identify con-
nections between resilience and practice, and serves as a
method to develop a resiliency plan for future practice.28
Factors that improve physical health also improve
emotional well-being and resilience, such as self-care,
sleep, exercise, and diet.9 Additional strategies to build
resilience include life coaching,30 muscle relaxation exer-
cises, communication skills, problem-solving skills, study
skills, and conflict-resolution skills.2,4,31 These experiences
can be executed via lectures, reflective journaling, expe-
rience sharing, roleplaying, or homework assignments.4
Furthermore, an environment of mentorship must be es-
tablished to promote student MHWB and resiliency. Fac-
ulty can ease transitions by functioning as role models.19
Peer support is also vital to develop resiliency4,6,30 and can
be achieved through student organizations such as the
Student Nurses Association and in campus chapters of
the National Alliance on Mental Illness.32
Although not as impressive as resilience, faculty
supportive actions and behaviors were substantial pre-
dictors of lower depression, anxiety, and stress in the
sample population. According to Transitions Theory, fac-
ulty assistance and support are essential facilitators for
successful transitions.19 Furthermore, faculty supportive
behaviors have been found to reduce student academic
stress and foster student retention throughout a nursing
program.13,33 Faculty members’ psychological support
was more strongly associated with reduced nursing stu-
dent depression and anxiety in this study. Phrases such as
“listening to students” and “being more approachable”
were used by participants when describing supportive
faculty behaviors to promote student MHWB. Li et al34
also noted an inverse relationship between student stress
levels and nursing faculty caring actions and the neces-
sity for fostering caring behaviors in nursing students.
Nurse Educator • Vol. 49 • No. 3
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Functionally supportive faculty behaviors were more
strongly associated with lower student stress in the sam-
ple population. While it is impossible to eradicate all
sources of student psychological distress, there are strat-
egies nursing faculty can utilize to diminish classroom
student stressors. Faculty may consider developing a
collaborative schedule with other faculty leads to plan
assignments and examinations so students are not “over-
loaded” and have an equal distribution of work across
the semester. Additionally, planning of assignments that
align with the course and clinical objectives should be
shared with students so they may perceive the relevance
of assignments, and not just “busy work.”
Limitations
Study limitations include self-selection, recall, and
nonresponse bias. Additionally, the 2 open-ended ques-
tions were investigator developed and did not have
established validity or reliability.
Implications
There are several implications for nursing education. The
quantitative results suggest that investments in faculty
development to support student resilience may reduce
the degree of depression, anxiety, and stress that stu-
dents exhibit related to nursing education. Because the
functional and psychological support were not strongly
correlated with resilience, these kinds of support do not
appear to influence student responses to adversity.
Nursing faculty should commit time to developing
relationships with undergraduate nursing students both
in the classroom and clinical setting to promote MH
awareness and resilience and create a positive learn-
ing environment to foster student success. Additional-
ly, nurse educators must be the first line in addressing
students’ MH problems, being the “eyes and ears” in
the classroom as they advocate for students.35 Faculty
have a responsibility to be aware of warning signs of
negative MHWB in nursing students, and how to locate
university resources for these students.35 Regular fac-
ulty development seminars should be offered, focusing
on recognizing signs and symptoms of possible student
negative MHWB, responding sensitively to students,
and awareness of resources for referral.27,36 Nursing fac-
ulty can be involved in advocating for increased avail-
able on-campus and community resources for negative
MHWB in students and work closely with counselors
to provide compassionate, comprehensive student care.
The unique opportunity this study provided was the
triangulation of qualitative data that added depth and
clarity to the quantitative data and helped to inform im-
plications for education that will foster student success
and promote MH stability. The literature validates that
hospital leadership teams must focus on the well-being
of their health care team, but this study suggests that we
must begin this focus with nursing students so they may
carry over healthy resiliency skills into their practice.
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 Conclusions
This study begins to build the body of knowledge and
clarify the relationship between nursing faculty support-
ive behaviors and actions and undergraduate baccalau-
reate nursing student success. Nursing faculty members
who are mindful of communication, clear with expecta-
tions, and thoughtful and respectful regarding MH issues
will make a positive impact on nursing students’ learn-
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ing, MH outcomes, and successful transition to profes-
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sional nursing practice.
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