Healthy Nurse, Healthy Nation Challenge Five Years In

America’s 4 million registered nurses are suffering. Their health is worse than the average American in every dimension except smoking. Nurses are more likely to be overweight, have higher levels of stress, and get less sleep. Hazards such as workplace violence and stress from understaffing contribute to poorer health.

Why Is the Health of Nurses So Important?

Nurses are essential to America’s health care system. Not only are they on the front lines of prevention and care for the ill and injured; nurses are role models, educators, and advocates. Their well-being is fundamental to a healthy America. These are the people who dispense your medications; the people who run the machines that keep patients alive. Nurses are the interface between families, patients, and doctors. If the people who care for our health are exhausted, overworked, malnourished, and at-risk, all Americans who need care are in trouble. 

Leaders of the American Nurses Association recognized they were ideally positioned to address this challenge. This led to the Healthy Nurse, Healthy Nation Grand Challenge. Its mission: to engage and unite nurses, employers, and partner organizations around improving health in the areas of physical activity, quality of life, rest, nutrition, mental health, and safety.

How Is the American Nurses Association Addressing Nurses’ Health?

On May 1, 2017, ANA Enterprise launched the Healthy Nurse, Healthy Nation™ (HNHN) Grand Challenge. The campaign uses a web platform to inspire action, cultivate friendly competition, and provide health education content and resources to nurses. Participating nurses create a profile page, make a health commitment, join challenges, engage in discussions, and access information. Each participant is encouraged to take a health-risk appraisal and create an action plan for a journey to health. Over five years, the HNHN has had over 340,000 participants participating in everything from surveys to health challenges, creating content addressing nurse suicide and obesity prevention, and posting and commenting on blogs and other social media platforms.

In addition, HNHN activated a private Facebook community to reach nurses and nursing students, where they are encouraged to showcase their wellness journey in blogs, social media, and newsletter content.

The web platform gathers data about their health status and improvement via the HealthyNurse® Survey. This is a comprehensive health assessment available to all participants. The survey includes questions on work environment, physical activity, nutrition, quality of life, and safety. After completing the survey, participants receive a customized heat map of their results, showing health risks in green, yellow, and red. A HealthyNurse™ Index score between 1 and 10 is displayed, providing an overall summary of health. Participants are prompted to retake the survey periodically to assess health improvement over time.

The ANA sends aggregated reports of partner organizations’ survey results every quarter, modified to remove the identity of individuals.

My involvement began when then CEO, Marla Weston, brought me in as the project was being conceived, and I stayed involved through its startup. We were able to build relationships inside stakeholders’ networks that led to solution development.

Findings of the fifth HealthyNurse Survey in 2022, the latest for which a full report is available

  • Physical activity: about 14% report not engaging in any light to moderate aerobic activity weekly and just over half report never engaging in vigorous activity or strength training.
  • Quality of life: 70% rate their health to be good or very good with just over 5% claiming excellent health.
  • Rest: 13% had nodded off or fallen asleep while driving during the past 30 days. Non-Hispanic Black, Asian, and Pacific Islander nurses were 77% more likely to have fallen asleep at the wheel.
  • Nutrition: just under 10% of respondents eat the recommended daily five or more servings of fruits and vegetables. While over half of nurses agreed healthy food was available on site, most noted it was more expensive.
  • Mental Health: Depression Disorder and Anxiety Disorder, at 15% and 17% respectively, are the most frequently reported mental health issues among nurses. Only about 20% of respondents felt they had adequate emotional support, a figure that has decreased over time.
  • Safety: 63% identify workplace stress as the most common safety risk, about twice as prevalent as lifting/repositioning heavy objects, prolonged standing, and concerns for sticks and sharps injuries. About 42% strongly agreed with the statement, “I have been assaulted by a patient or family member of a patient in the past year. These results, based on 4585 completed survey responses reported in April, 2023, indicate the scope and severity of nurses’ health.

"Seth Kahan assisted us at the American Nurses Association as we launched our Healthy Nurse Healthy Nation Grand Challenge. His steady wisdom and insights guided us from inception through launch and implementation."

–  Marla Weston, Chief Executive Officer, American Nurses Association 2009 - 2018


The American Nurses Foundation and corporate partners have taken the lead in funding the Grand Challenge. Sodexo and Stryker signed on in the first year; since then, CeraVe, Compass One Healthcare, Humana, and Prudential have joined among others.

Healthcare organizations and Schools of Nursing support the Grand Challenge by committing to encourage participation, provide content, and report back data from their participants. ANA constituents including State Nurses Associations and professional societies are amplifying the HNHN message through conferences and communications.

Organizations were invited to participate at four levels, each with its level of commitment to financial support, participation, metrics for success, and progress reporting. Data reported by partners feed into the assessment of the Grand Challenge’s overall success.


In its first year, about 5505 nurses and nursing students took the survey and began participating in the challenge. Annual reports share the success of HNHN, drawing on reported data to chart progress toward the goal of 4 million healthy nurses. As of 2023, more than 340,000 nurses had directly participated in one way or another in the HNHN Grand Challenge.

Findings from the HealthyNurse® Survey and other nurse mental health research have shown that nurses struggle with significant stress, anxiety, and depression. In response, the ANA designated HNHN in 2019 to take on the critical issue of nurse suicide in the United States. Then came the COVID-19 pandemic. The working group pivoted to make mental health resources for nurses available, to counter the immeasurable mental and emotional health challenges nurses were experiencing. A comprehensive blog was created to help nurses in crisis. Work on more nurse suicide prevention resources continues.

Each participant’s heatmap shows at a glance where their health is most at risk.

In its fourth year, HNHN completed an extensive renewal and refresh process, examining what was working and what needed improvement. Participation in HNHN had grown from 25,000+ in the first year to 240,000+, but significant improvement in health measures has not yet been seen. The health-risk appraisal, the HealthyNurse® Survey, moved to an updated platform to provide streamlined delivery and improved data presentation. Media outreach increased, as did action to support nurses’ mental health, funders’ support, and activity in each of the five domains.

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About American Nurses Association

The American Nurses Association is a professional organization with a mission to improve patient care through supporting both individuals and organizations to advance the nursing profession. From advocating in the halls of Congress to setting the bar for credentialing worldwide, the ANA Enterprise exists to give every nurse the best chance of success.

Solving social problems is inherently SOCIAL-it happens in community. I’m looking for researchers, academicians, and those on the front lines who are battling overwhelming issues. The community will include leaders in all aspects of society: nonprofits, corporations, government agencies, independent agents, and thought leaders.

If you’re passionate about Grand Challenges or would like to be, visit my Medium account, where I am publishing on Grand Challenges. Let’s work together to address these sticky, systemic, complex, and wicked issues once and for all, for the sake of future generations of life on Earth.

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