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How stressful is it to be a NICU nurse?

Work-related stress is increasingly recognized in healthcare contexts. This may be especially true for healthcare specialists who deal with the survival and quality of care of at-risk patients. NICU nurses who take care of preterm babies may be exposed to high levels of stress that may arise from physical and psychological sources. Nonetheless, this stress may be partly hidden and unaware to the professionals; it may impact the functioning of neuroendocrine stress response systems with little concordance with behavioral symptoms and subjective feelings. the hypothalamic-pituitary-adrenal (HPA) axis is a major neuroendocrine system of stress regulation: it regulates the secretion of cortisol to promote adaptive reactivity to stress and also contributes to the dampening down of adrenocortical reactivity once the stress is over. Moreover, HPA axis follows a circadian rhythm that results in higher levels of cortisol in morning hours compared to the evening/night. Nonetheless, the HPA axis regulation may be impaired under chronic stress conditions and the effects can be observed in the shape of a flat cortisol secretion on a daily basis.

In a recent study, both self-report and neuroendocrine stress measures were obtained from NICU staff at the beginning and at the end of a daily work shift and they were compared with similar measures obtained from neonatal healthcare professionals working in neonatal wards (NW). NICU staff reported higher self-reported subjective indexes of work-related stress. Whereas no differences emerged in the overall cortisol secretion between the two groups, the circadian decline in salivary cortisol levels was less pronounced in NICU staff compared to NW counterpart. This study suggests that NICU nurses may experience higher levels of work-related stress compared to other neonatal healthcare professionals. Nonetheless, this may be only partly overt and there is the risk hidden effects on the daily dysregulation of the HPA axis. Dedicated resources and services should be developed and adopted to support and increase the quality of life of NICU professionals.


Fumagalli, M., Provenzi, L., Sorrentino, G., Ciceri, F., Fontana, C., Passera, S., Moncecchi, M., Plevani, L., Laquintana, D., Borgatti, R., Mosca, F., & Montirosso, R. (2021). Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals: A Repeated-Measures Observational Study. Advances in Neonatal Care, in press.

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