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Caring counts

By: Wanda Montalvo, PhD, RN, FAAN

Preventing suicide among nurses.

Deaths by suicide affect people of every profession but are especially relevant for nurses, who frequently take care of others at the risk of their own physical and mental health. In 2019, Davidson and colleagues conducted a landmark national review of nurse suicides from 2005 to 2014. They found that nurses were more likely than the general public to have reported mental health problems, history of being treated for mental illness, and history of previous suicide attempts, placing them in the high-risk category for suicide. Studies report that nurses regularly experience burnout, emotional exhaustion, and psychological distress, leading many to suffer from depression.

These studies reveal a critical need for prospective research to identify nurses at risk for suicide and to create a safety net in the workplace where we care for our own. So, what can we do better to help our nurse colleagues struggling with mental illness, depression, and known stressors for high-risk suicide?

Be aware of the signs

The first step in taking care of each other is knowing what to look for when it comes to symptoms of mental illness and distress. Everyone should feel confident in identifying warning signs in a colleague. When nurses share 12-hour shifts, they frequently spend more time together than with anyone else in their lives, making them the ideal front line in picking up on changes in behavior or mood.

Davidson’s study found that nurse anesthetists and retired nurses were at higher risk for suicide compared to other nurses. Also, we know nurses are more likely to use pharmaceutical methods for suicide, due to their access to medications. Remaining well-informed keeps everyone safe.

When in doubt, reach out

In 2018, the National Academy of Medicine released the landmark paper “Nurse suicide: Breaking the silence” (nam.edu/nurse-suicide-breaking-the-silence) as a call to action. Suicide prevention requires a combination of increased organizational commitment and continued individual effort by colleagues equipped to recognize and discuss suicide with someone at risk.

Organizations are making new strides to provide support to those in need, but in the meantime, fellow nurses who see symptoms can make an impact by reaching out, even if that person is already receiving professional help. Mental health and suicide aren’t comfortable topics, but we can’t let fear of awkwardness, social taboo, or timidity prevent conversations that can have lifesaving impact.

Take advantage of available resources

Perhaps the most important step is leaning on the many resources at our fingertips. Here are a few:

  • The Columbia Lighthouse Project: This program is designed to save lives by making the Columbia-Suicide Severity Rating Scale (C-SSRS) online training tools available.
  • Healer Education Assessment and Referral (HEAR, visit medschool.ucsd.edu/som/hear/Pages/default.aspx): This program is used by the University of California San Diego Health. During the rollout of HEAR, nurse respondents to the HEAR survey reported staggering rates of suicidal thoughts, with most at high risk but not receiving mental health treatment.
  • Zero Suicide: Sponsored by the American Psychiatric Association Learning Center, this well-established framework aims for a system-wide, organizational approach to create safer suicide care in health and behavioral healthcare systems.

By taking care of each other and holding organizations accountable for support, we can help prevent nurse suicide. Identifying colleagues at risk, starting a tough conversation, and implementing suicide prevention programs can help us write a new future.

Wanda Montalvo is the executive director of Jonas Nursing and Veterans Healthcare and a Connecticut Nurses Association member.

Depression is a treatable illness. If you or someone you know needs help, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).


Alderson M, Parent-Rocheleau X, Mishara B. Critical review on suicide among nurses. Crisis. 2015;36(2):91-101.

Brooks E. Physician suicide and support: Identify at-risk physicians and facilitate access to appropriate care. April 31, 2016. stepsforward.org/modules/preventing-physician-suicide#section-steps

Centers for Disease Control and Prevention. Vital signs: Suicide rising across the US. June 7, 2018. cdc.gov/vitalsigns/suicide/index.html

1 Comment. Leave new

  • I am a nurse who tried to commit suicide. It is difficult for me to write that sentence even after 3 years have passed since that attempt. I have tried to hide it for so long but it is the truth. I was working at a job that was dealing with a myriad of social issues including mass amounts of drug abuse, violence, and a lot of death. I tried to get through it. My fellow nurses didn’t seem to have the same problem. I kept wondering what was wrong with me. I tried to keep stuffing down the feelings and it didn’t work. I tried to talk to a couple of my close confidants and they were telling me how I was so strong and they thought I would get through this without a problem. There weren’t really any other resources at the time. It isn’t something I felt comfortable going to my supervisor about so they knew nothing about my struggles. There aren’t so many resources out there for someone with this type of issue. I was afraid to seek professional help as I kept telling myself those dark thoughts would pass. I should have been able to handle this as I was a nurse. I would know how to handle it if a patient told me of plans to commit suicide but when it came to myself, I kept trying to rationalize it and think that somehow, I would figure it out and those dark thoughts would stop.

    I ended up developing a substance abuse problem myself. I was really good at hiding it as no one knew. I would show up to work and put my game face on. I never showed up impaired to my job but the minute I would get off was time for the drinks to start. I was falling apart but still able to keep up appearances at work. I knew I needed that job to support my family but it was killing me. Literally. It was creating a situation where I kept feeling like the insults were mounting on top of each other.

    When another patient died, it became the trigger that set into motion a plan and the execution of that plan. I was almost successful. It rocked my world and shook me to my very foundations. I think that many of us don’t really talk about the emotional side of nursing. We are in life and death situations on a daily basis but rarely discuss how we feel about being in that situation mainly focusing on the facts and trying to joke our way through it. There isn’t enough discussion in nursing schools on how to handle some of these situations and that nursing can be difficult on your emotional state.
    I am still trying to weave together the pieces of my life that shattered with that one attempt. I am still working as a nurse but at a different job. I have been having a difficult time trying to figure out what to do with my life that wouldn’t be so intense but there just aren’t many jobs out there that pay like nursing does. I am the main breadwinner in my family. It is my job to take care of them. I wouldn’t be able to do it without a job that pays me as much as nursing. So, I just put on that brave face and keep showing up and putting one foot in front of the other. It is all I can do.

    I am in counseling and it is helping. But it has been a long journey to get to a point where the dark thoughts although still there have become less intrusive and I no longer want to act upon them. My confidants were right. I am strong. I will make it through this. It just isn’t the way I thought it would be. It is a huge problem with nurses and also with nursing culture. We see some of the worst things in life but there isn’t a whole lot of debriefing or counseling offered to nurses. It would be great to see that as a part of the benefits package offered to employees. It would be nice if debriefings after major events actually happened in a professional manner. It would be nice if there was a way nurses could communicate with their nursing leaders regarding their feelings when negative events occur. There needs to be a national conversation especially with nursing students to try and bring out the emotional beating that nursing can be and what to do about it. It is the only way to build up the resources needed to combat this problem.


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