Caring counts

Author(s): 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” ( 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 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.

Centers for Disease Control and Prevention. Vital signs: Suicide rising across the US. June 7, 2018.


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