What is the clinical evidence from this study?

Study design: Observational. Population: Workplace stress and trauma (n=28). Intervention: Workplace events (Routine Care, Stat Care, Interpersonal) vs. Baseline (idle). Primary outcome: Change in heart rate variability (HRV) parameters (SDNN, RMSSD, HF, LF) from baseline to workplace events.

July 1, 2025Open Access

Intensive Care Unit Nursing Stress: Measuring Heart Rate Variability and Workplace Trauma

Q: What does this research mean for the field?

ICU nurses experience significant physiological stress responses to workplace activities, indicated by reductions in heart rate variability parameters (SDNN, RMSSD, and HF) during both urgent and routine care events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

ICU nurses experienced reductions in heart rate variability parameters (SDNN, RMSSD, and HF) during Stat and Routine care events, indicating significant physiological stress responses to workplace activities.

Study Design

Type

Observational (n=28)

Multicenter

Structured PICO

Do workplace events affect heart rate variability as a measure of stress in ICU nurses?

Population

30 female ICU nurses, 35 years old or younger, working day shifts at a large academic health science center in Alabama, USA.

Intervention

Real-time heart rate variability (HRV) measurement using a wearable ECG during workplace events (Routine Care, Stat Care, Interpersonal)

Comparator

Baseline HRV (idle baseline)

Outcome

Fluctuations in HRV (SDNN, RMSSD, HF, LF) associated with workplace eventssurrogate

HRV can serve as a contemporary index of workplace stress and trauma in ICU nurses, highlighting their vulnerability to physiological and psychological health issues.

Limitations

Small sample size lacking statistical power
Convenience sample
Exclusion of nurses taking antidepressant or antianxiety medications (27% of potential participants)
Single observer for data collection

Abstract

Purpose: Intensive care unit (ICU) nurses work in a demanding environment and face repeated encounters with traumatic and ethical issues, which may negatively impact their psychological and physical health, patient care, and hospitals’ bottom line. The purpose of this study was to investigate stress among ICU nurses performing workplace activities/events by measuring fluctuations in heart rate variability (HRV), a reliable indicator of stress-related physiological changes. Methods: Real-time HRV was measured using a wearable, wireless electrocardiogram for 30 ICU nurses while at work in this cross sectional, observational study. Workplace events were categorized (Routine Care, Stat (urgent) Care, and Interpersonal) and assigned numerical code labels. HRV time- and frequency-domain indices of SDNN, RMSSD, HF, and LF were calculated and accurately linked to participants’ corresponding physiological HRV responses to workplace events on an observational data collection tool, accessed on a portable electronic tablet. The association of HRV with ICU workplace events and psychological and clinical outcomes was explored. Results: Nurses’ HRV parameters of SDNN, RMSSD, and HF tended to have the greatest reduction to both Stat (urgent) and Routine care events. New nurses tended to have lower HRV than experienced nurses. We found high rates of perceived stress and peritraumatic dissociative experiences and low resilience in the ICU nurses. Conclusion: HRV can be used as a contemporary index of workplace stress and trauma in ICU nurses. Study nurses were vulnerable to potential long-term physiological and psychological health issues. Understanding stress and trauma ICU nurses face at work will allow for strategies for interventions to reduce the development of post-traumatic stress disorder, peritraumatic dissociation, and other psychological outcomes. Keywords: post-traumatic stress, PTSD, peritraumatic dissociative experiences, workplace stress

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