Stress First Aid Uses Colors to Take Nurses' Emotional Temperature

Pilot program is teaching U. of South Alabama Health University Hospital nurses to support peers in distress.

This story has been updated to clarify that the Pulse on the Nation’s Nurses Survey Series was conducted by the American Nurses Foundation, not the United Health Foundation.

A pilot program designed to identify, respond, and reduce stress reactions for nurses will help to “create a sense of community and provide nurses with emotional resources so they can feel empowered and supported,” says Sherry Fryman, RN, MSHA, chief nursing officer for University of South Alabama Health University Hospital, one of four pilot sites.

Stress First Aid, a peer support framework first developed by the U.S. military for battle-scarred soldiers, teaches individuals, either peer-to-peer or through leadership, how to identify stress in other individuals, in groups or teams, or even at the organizational level. It is being piloted at four U.S. healthcare sites, including University Hospital in Mobile, Alabama, funded by a grant from the American Nurses Foundation, the philanthropic arm of the American Nurses Association (ANA), and the United Health Foundation.  

The other sites are:

• BayCare Health, Tampa Bay, Florida
• Indiana University Health, locations throughout Indiana
• Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

"Stress First aid is a set of knowledge and skills that we use every day to gain control of our experiences with stress," said Catherine Gaudet, MSN, RN, CNL, a clinical nurse leader at University Hospital and a co-champion of a new pilot program. "Stress can be necessary and helpful, but if stressors are not dealt with effectively, long-term mental and physical impacts can occur."

Nurses have suffered greatly from immense stress and burnout caused by the COVID-19 pandemic. The American Nurses Foundation's Pulse on the Nation’s Nurses Survey conducted in November 2022 found that 64% of respondents said they felt stressed, 60% said they were frustrated, and 57% reported feeling exhausted.  

The pilot program’s purpose is to identify and reduce stress reactions before they develop into lasting issues. Upon identification, it suggests actions that can be taken to deal with that level of stress.

Helping nurses to speak about their stress/burnout using a common language normalizes talking about it so they can provide support to their peers.  

How it works

Stress First Aid provides a scale consisting of colors—green, yellow, orange, and red—to describe stress levels.

Green means everything is proceeding smoothly, and the individual is in control, with optimal functioning. As stress builds, an individual may experience mild distress and feel irritable (yellow), severe and persistent distress (orange), and finally, stress causing life impairment (red).

"By giving stress a color, we allow nurses to express where they feel they are at on the ‘stress continuum’ without assigning any blame or shame for feeling stress," said Amy Campbell, DNP, RN, assistant professor in the USA School of Computing and a co-principal investigator on the project. "Similarly, this language also allows their peers to immediately identify steps they can take to better support a peer in distress.”"

At University Hospital, the program is still in its initial stages. Gaudet and another champion, Chris Clark, RN, a clinical nurse leader, are training nurses in their units how to respond to others in stress, including observing and listening, getting help, or simply covering someone’s duties while they take a break.

"This program gives you the ability to identify what stress level you’re in and, more importantly, what stress level your co-workers are in. It lets us take the temperature of the unit," Clark said. "It’s a learning language, so we can help each other."

This story has been updated to clarify that the Pulse on the Nation’s Nurses Survey Series was conducted by the American Nurses Foundation, not the United Health Foundation.