Integrating Self-Care into Nursing Education and Practice: Strategies for Sustainable Wellbeing

Abstract

Self-care is a complex concept that incorporates various strategies designed to promote personal wellbeing and prevent illness, which is a critical need in nursing given the profession’s inherent stressors. The physical, emotional, spiritual, and psychological demands placed on nurses can significantly influence their wellbeing and the quality of care they provide. Yet, professional accountability and responsibility for self-care remains contested within the profession. To support a healthier and more sustainable healthcare workforce, Approved Education Institutions (AEIs) delivering pre-registration nursing programmes can play a pivotal role in embedding self-care ethos and practices into the nursing curricula. Grounded in educational psychology and drawing on insights from related theories, this paper explores barriers to self-care, proposes actionable interventions, and advocates for its integration as a cornerstone of nursing education.

1. Self-Care

The concept of self-care is widely recognised as important for patients (Westland et al., 2024; Wyman et al., 2024) but less so for nurses. Self-care integrates physical, psychological, and behavioural aspects of health and wellness practices, which can enhance the overall health outcomes of individuals and communities (Riegel et al., 2021). It is an intentional act whereby an individual takes time to enhance their physical, emotional, and spiritual aspects to achieve and maintain a balanced and fulfilling life. The benefits linked to a more productive and effective workforce in the helping profession have been widely reported (Tan et al., 2023). It is highly relevant for the nursing profession and can help nurses mitigate various occupational stressors (O’Malley et al., 2024). Hence, instilling and cultivating a culture of self-care needs to start in the formative years of a nurses’ career. Given the stressful and demanding nature of the preregistration nursing programmes, prioritising self-care can contribute to helping nursing students to alleviate stress and anxiety in managing the demands of their study, thereby laying the foundations for a healthier and more sustainable career (Ramluggun, 2024).

2. The Contentious Nature of Self-Care

Despite the recognised importance of self-care for nurses’ wellbeing and workforce sustainability, its implementation remains contentious due to conflicts within professional accountability, cultural norms, ethical dilemmas, gaps in education, and organisational constraints like heavy workloads. While self-care is encouraged, external factors such as disruptive work environments, resource shortages, and workplace trauma (O’Malley et al., 2024) often hinder nurses’ ability to practice it. Morning (2015) describes these as “disruptive contexts,” where internal (personal and professional identity) and external (organisational and societal) factors dynamically interact, undermining self-care practice. A deeper understanding of these contextual relationships is imperative for fostering effective self-care in nursing (Tsui & Adam, 2023). For instance, self-sacrifice, which is a longstanding culture in the nursing profession, places the needs of the patient above nurses’ personal needs (Ciezar-Andersen & King-Shier, 2021).

In the UK, the Nursing and Midwifery Council (NMC) Code for professional standards of practice and behaviour for nurses, midwives, and nursing associates puts the interests of the patients first (NMC, 2018). It is an ethical compass that guides nurses’ professional behaviour and practice to meet the required professional standards, prioritising primarily the wellbeing and the safety of patients. However, putting the patient first in everything nurses do can create an environment where self-care is perceived as secondary and a selfish act. Patient centred care should be paramount, but it should not be at the detriment of nurses’ health and wellbeing. The expectation held by some that nurses must endure challenging conditions, work long and unsociable hours often without breaks, disregard their own basic physical and psychological needs, and not complain reinforces the perspective that self-care is less important.

The culture of self-sacrifice in nursing driven by heavy workloads, staffing shortages, and extended shifts often leads to compassion fatigue, burnout, and presenteeism, where nurses continue to work while unwell, risking their health and patient safety (Kelly, 2020; Salvagioni et al., 2017). Organisational pressures to exceed expectations further reinforce this behaviour, creating a disruptive context that undermines self-care and erodes nurses self-esteem (Bay et al., 2025). Such unsupportive pressured environments, where staff feel guilty for taking sick leave, contribute to disillusionment, particularly among younger nurses, ironically increasing absenteeism (Baydoun et al., 2016). Therefore, it is important to foster a culture which promotes meaningful dialogue in safe spaces (Morning, 2015) where nurses do not feel stigmatised or perceived as weak or less dedicated to their profession when they prioritise their own self-care. Nurses should not experience conflicting feelings between taking time for self-care and maintaining their professional identity. They need to be supported with relevant education and training to mitigate the tension between professional responsibilities and self-care practices. In their ethical duty to provide the best care possible, they equally need to be enabled to balance their own needs with the presenting patient needs and organisational expectations. Protective factors such as self-compassion, which entails treating oneself with the same kindness, can help nurses regulate and balance the emotional demands of their practice (Ramluggun & Nathoo, 2019). By fostering self-compassion nurses are then more likely to engage in self-care practices.

3. Adopting the Ethos of Self-Care in Healthcare Organisations

From the healthcare organisational context, it is within their remit to influence and ensure that appropriate support structures are in place to reduce the barriers to self-care practices. As previously highlighted, there is a dynamic contextual relationship between the internal context of the nurse and the organisation. Reflecting this, there is the potential for contextual disruptive relationships to emerge. These can lead to barriers, having a detrimental impact not only on nurses wellbeing but also on the wider functioning of the organisation in terms of job satisfaction and workforce retention in an era of global nursing shortages. Adopting the ethos of self-care in nursing practice requires systemic and cultural changes in healthcare organisations’ leadership and working environments. A contextual approach, which identifies interventions from within the four contexts of internal, immediate, organisational and societal can endorse a self-care framework. Here, health organisations are adequately resourced to prevent understaffing by offering flexible scheduling options to maintain a work–life balance and providing self-care education and training within a workplace wellness programme to recognise and address early signs of compassion fatigue and burnout. It is important to humanise the challenges faced by nurses in their practice, normalising the seeking of help for stress and other mental health issues.

Self-care initiatives need to be incorporated into nurses’ daily routines with appropriate resources, time, and safe spaces to engage in meaningful dialogue with the organisation as well as the promotion of self-care activities. These activities should encompass physical, emotional, social, and practical strategies, designed to promote and maintain a positive sense of wellbeing. Interventions such as mindfulness-based stress reduction have proven to be effective in reducing stress levels and improving emotional wellbeing (Wexler & Schellinger, 2022). Evaluation of these self-care initiatives can be achieved by implementing mechanisms to measure and monitor nurses’ wellbeing and job satisfaction, using these insights for continuous improvement. These improvements need to be recognised, celebrated, and disseminated through awards and acknowledgments.

4. Self-Care in Nursing Education

Approved Education Institutions (AEIs) and their practice partners must account for the nursing programme’s demands on student wellbeing and integrate evidence-based self-care strategies into curricula (Fairchild & Salena, 2025). In England, a recent survey (RCN, 2024) reported that half of nursing students have considered quitting the programme before graduation, citing mental health issues as a key factor. AEIs are striving to support students’ mental health needs to meet the increasing demand for meeting students’ needs for emotional support., but their wellbeing services are stretched, highlighting the demand and the resource gap (Hughes et al., 2025). Furthermore, the efforts to meet students’ mental health needs are not always well coordinated and lack an integrative proactive mental wellbeing strategic approach (Ramluggun et al., 2022).

Part 1 of the NMC (2023) standards for nursing education and training stipulates that AEIs, with their practice learning partners, must empower students with information and support to encourage them to take responsibility for their own mental wellbeing and physical health. As part of this requirement, every student on the preregistration nursing programme could be provided with a self-care plan. Recognising the internal context’s relationship with the other three contexts (immediate, organisational, societal), students can experience the intrinsic motivation to develop a range of self-care options allowing everyone to find what works best for them, based on their own needs, to then develop an effective self-care plan. Self-determination theory (Ryan & Deci, 2017) posits that autonomy is one of the innate psychological needs necessary to enhance motivation. Therefore, it is important that the self-care plan is not prescriptive, and that students are empowered to develop their own plan with support from AEIs students’ wellbeing services. This includes recognising students’ diverse needs and unique preferences to create an inclusive, supportive, and empowering environment that encourages self-care practices for nurses and nursing students. This inclusive environment in nursing education and practice should ensure that self-care strategies are respectful of and tailored to diverse cultural norms and values, providing equal access to self-care resources. For example, ensuring safe and inclusive space for students who may be less likely to prioritise their wellbeing and practice self-care, such as international students compared to domestic students (Han et al., 2024), so they can engage in self-care without fear of judgement. Hence, a culture of self-care practices should consider all potential disruptive contexts in developing approaches to overcome these barriers. AEIs can integrate self-care education into nursing curricula by teaching self-care practices which emphasises the importance of valuing one’s own health and wellbeing. Such initiatives should proactively identify the potential triggers for stress and anxiety within the nursing programme in the building and strengthening of a culture that actively supports self-care.

For instance, heavy workload which includes assignment submissions while achieving practice learning proficiencies can divert mental resources from learning due to extraneous cognitive load (Sweller et al., 2019). Therefore, it is important to recognise the overwhelming strain of cognitive load on students’ mental resources which can lead to significant stress and anxiety among nursing students (Chen et al., 2014) which can be reduced by creating manageable assessments strategies and streamlined processes to minimise an unduly heavy assessment loads. Providing support systems to help students navigate the demands of their education could incorporate self-care practices to prepare them for the summative requirements of their programme. Hence, incorporating stress-reduction strategies such as self-care breaks and encouraging practices such as mindfulness and other relaxation exercises can strengthen students’ personal resources, helping them to process information to manage the demands of the programme more effectively.

Reflection is an integral element of nursing practice and education which is embedded in the NMC Code (NMC, 2018). It is well recognised as a valuable educational tool integrating theory and nursing skills, enabling students to learn from their clinical experiences. Using it as a self-care practice strategy, nursing students can process challenging experiences, manage stress, and develop emotional resilience. Self-reflection and self-assessment activities are already incorporated into curricular programmes to encourage students to regularly reflect on their own wellbeing and coping strategies. Building upon this, students could be encouraged to keep self-care journals, reflecting upon their experiences, challenges, and successes throughout the programme in their practice assessment document.

Additionally, the RePAIR (Reducing Preregistration Attrition and Improving Retention) project (HEE, 2018) was undertaken in the UK to identify effective interventions to improve retention of nursing students, and it identified a positive relationship with nurse educators in practice as being pivotal to the success of their practice learning. Hence, it is important that students are exposed to a healthy clinical learning environment where they can observe self-care practices in action, especially as Social Learning Theory posits that learning occurs through imitation, observation, and reinforcement (Bandura, 1977). Bandura and National Institute of Mental Health (1986) Social Cognitive Theory underscores the role of observational learning and self-efficacy in behaviour change, suggesting that nursing students who witness nurse educators model self-care are more likely to adopt similar practices. Accordingly, Kolb’s (1984) Experiential Learning Theory further supports embedding self-care through reflective practice. Nurse educators in AEIs and their practice partners can shape students’ behaviours in reflective activities as positive role models of self-care practices by sharing their own experiences, including providing positive feedback for students who practice self-care. Similarly, Transformative Learning Theory (Mezirow, 1991) positions self-care as a catalyst for critical reflection on workplace norms, which can enable students to challenge unsustainable ideals like self-sacrifice, thereby mitigating perpetuating burn out cycles.

It is also important to understand how students are successfully developing self-care practices (Campoli & Cummings, 2024) and using this insight to structure and integrate self-care practices in the curricula to encourage and disseminate the continuation and enhancement of these practices. Implementation and evaluation of wellness workshops and access to regular check-ins with AEIs’ wellbeing services for students to support their self-care practices and consensually adjust their self-care plans could provide insight into effective self-care strategies.

Students could be encouraged to share their self-care initiatives in their end-of-year discussion reviews with their personal tutors. Those who effectively integrate self-care into their routines could be recognised and celebrated by sharing success stories. The use of vicarious reinforcement highlighting the benefits of self-care by their peers could inspire and motivate their peers. A wellbeing plan which incorporates a self-care plan is being trialled at the authors’ university for the current academic year. It is important to note that self-care is not a panacea for mitigating the stress and burnout exacerbated by the global nursing workforce crisis (WHO, 2024), but it can play a significant role as a whole-university approach in preparing and enabling nurses in the formative years of their career to thrive despite adversity.

5. Conclusions

There is a pressing need to address self-care at both the individual and systemic levels in the nursing profession to promote a more sustainable and supportive environment where nurses feel empowered to prioritise their wellbeing without guilt or stigma. Preregistration nursing education should serve as the first line of defence in empowering students to prioritise their health and wellbeing and develop self-care strategies. There is a pressing need to reduce the culture of vulnerability by integrating self-care in the nursing curricula to foster a culture of wellness for an inherently demanding programme. An intentional and integrated approach to fostering self-care in nursing education will lead to improved personal and professional wellbeing that sustains and empowers the nursing workforce.