A recent study in JONA: Journal of Nursing Administration highlights how Covid-19 exacerbated these issues among nurses nationally.1 The authors also suggest different strategies to intervene at personal, institutional, and regulatory levels to help reduce suicide rates among nurses.
Known crises within nursing
Several research teams have studied nurse suicide. Until recently, nurses were more likely to use pharmacologic poisoning as a suicide method. However, recent data points to the increased use of firearms as a method of ending one’s life. Unfortunately, information from national organizations like the Centers for Disease Control and Prevention does not specify the nurses’ specialty, work context, or level of care.
Mental health and burnout in nursing
Mental health is also closely linked to suicidal tendencies among nurses. Many individual nurses believe in upholding a “professional face”, even while suffering from specific mental health issues. Previous studies suggest that nurses have higher rates of anxiety and depression compared to the general public. These issues are often linked to occupational stress.
Additionally, burnout has been reported in up to 50% of all nurses. This emotional response usually results from chronic job stress involving emotional exhaustion, demoralization, cynicism, and feelings of inefficacy. Burnout is not the same as depression, but it does seem to be a risk for many other psychiatric problems, such as depression, anxiety, substance use, posttraumatic stress disorder (PTSD), suicidal ideation and suicide, and neurocognitive problems. Before the pandemic, up to 21% of nurses report their intent to leave the profession due to burnout.
Substance use issues in nursing
Substance use is also linked to nurse suicide. Recent studies found nurses were much more likely to have positive blood toxicology results for nearly all substances compared to the general population. However, these nurses were also less likely to have documented substance use disorder reported before suicide. This may be due to factors such as stigma, licensure issues, and limited access to treatment.
Another qualitative analysis of nurse suicides showed that nurses who did commit suicide were more likely to have had job-related issues prior to the event. These issues usually centered on three things: mental health issues that were not well controlled, uncontrolled chronic pain, and substance use disorder. More than 90% of these identified issues were linked to investigations and job loss, in most cases due to substance use disorder.
Covid-19's effect on nurses and seeking help
The novel coronavirus helped highlight the stressors nurses face daily and the psychological issues resulting from those stressors. These stressors were certainly present before the pandemic, but Covid-19 has worsened issues like nurse fatigue, declining nurse performance, and increased use of sick leave. Also, increased rates of anxiety, depression, and PTSD impact front-line healthcare workers.
Unfortunately, research suggests that nurses are less likely to engage in help-seeking behaviors for these kinds of issues. Stigma against the treatment of mental health issues, plus fear of judgment and the consequences of seeking treatment are all critical barriers to reaching out for help.
Interventions to address the needs of nurses
Meaningful change begins with evidence-based interventions targeting specific problems among the nursing workforce. The Suicide Prevention Resource provides a 6-step public health model of prevention that might be used to help identify interventions that meet the unique needs of nurses, including:
- Identifying the problem and context.
- Identifying long-term goals for specific populations, settings, and risk factors.
- Identifying key risk factors and protective factors.
- Selecting interventions have shown to lower risk factors and enhance protective factors to work toward goals and develop action plans.
- Creating an evaluation plan to monitor progress and identify data to collect.
- Implement, evaluate, and improve the plan.
The study identified several interventions that have already proven effective in preventing nurse suicide. The Healer Education Assessment and Referral (HEAR) program at UC San Diego Health has been used since 2009 to help prevent nurse suicide. The program uses a comprehensive education program, proactive screening for high distress and suicide risk, crisis intervention and critical incident debriefing, and a peer support program all provide opportunities for nurses to come together to share and discuss feelings.
Many peer support programs have also been beneficial for nurses in distress. Often structured within a healthcare system, these programs are offered as an extension of alternative to discipline programs. They may also be freestanding, or they may be available individually using telehealth and nurse coaching.
On an institutional level, evidence-based coping strategies should be taught and highlighted during training programs. They should be offered consistently throughout the professional life of each nurse. Active coping strategies have already been associated with decreased levels of burnout. These techniques may include activities like progressive muscle relaxation, biofeedback, guided imagery, and transcendental meditation.
Nurses are already in a vulnerable position with regard to mental health issues, substance use problems, and suicide. Nurse leaders must recognize these problems and renew their commitment to preventing harm and reducing the suffering of nurses nationwide.
