A silent crisis is brewing in the halls of our healthcare institutions. Death by suicide is on the rise amongst nurses and is drawing global attention. According to Usher et al. (2023), while high suicide rates among other healthcare professionals are frequently highlighted in the media, disturbingly high suicide rates among nurses have gone unrecognized.
This is our call to action. Nurse suicide rates are alarmingly higher when compared to the general population. According to Davis et al. (2021), our country experienced a record high between 2017 and 2018, with 729 nurses in the United States dying by suicide. In 2023, Olfson et al. reported suicide rates for registered nurses rates at 16 per 100,000, the second highest in the survey. These statistics are a powerful reminder of how the nurses are impacted by their work beyond the clinical environment.
What is contributing to this increased rise in suicide amongst nurses? According to Basu et al. (2023) nurses face individual, interpersonal, and workplace factors that increase their risk of suicide. These factors include a lack of awareness of the seriousness of their own mental health issues, guiding values such as selflessness, loyalty to the communities they serve, stoicism, a strong moral code resulting in moral distress, the drive for excellence, and a tendency to underutilize mental health support resources.
Recognizing precursors for suicide can allow intervention in a potential suicide before it takes place. The most common risk factor to suicide is mental health problems. The majority of individuals who have died by suicide have a mental health diagnosis such as anxiety, depression, or bipolar disorder. Other precursors include history of chronic illnesses, substance abuse, experiencing traumatic events, emotional stress, social isolation, loneliness, and financial problems. Untreated mental health problems and work stressors may cause nurses to feel that suicide is the only way to escape the pain, suffering, and feelings of helplessness they’re experiencing. Lack of medical interventions, social support, and access to resources to address these precursors can cause feelings of despair and alienation, leading vulnerable people toward thoughts of suicide to escape their reality.
Addressing this complex challenge requires a multifaceted approach that meets the urgent needs of nurses in crisis while also implementing systemic changes to support the recovery and resilience of our nursing workforce. This requires more than policies and protocols; it necessitates cultural shifts that prioritize mental health awareness, destigmatizes seeking help, provides education about coping skills and strategies to better manage the emotional, mental, and physical impacts of nursing work, and promotes nurturing work environments where nurses feel valued and supported.
Recommendations
- Enhance Mental Health Support Systems:
- Implement comprehensive mental health programs within healthcare institutions specifically tailored to the needs of nurses.
- Encourage the development of peer support groups where nurses can share their experiences and provide mutual support.
- Promote access to confidential counseling services and Employee Assistance Programs (EAPs).
- Foster a Culture of Open Communication:
- Create a supportive work environment where nurses feel safe discussing their mental health concerns without fear of stigma or retribution.
- Train nurse leaders and managers to recognize signs of distress and provide appropriate support and referrals.
- Encourage regular check-ins and debriefing sessions to allow nurses to express their feelings and experiences.
- Implement Suicide Prevention Training:
- Integrate suicide prevention training into mandatory continuing education for nurses.
- Provide training on recognizing warning signs of suicidal ideation and how to approach and support colleagues in crisis.
- Utilize evidence-based programs and resources to educate nurses on coping strategies and resilience building.
- Advocate for Systemic Changes:
- Work with legislative bodies and professional organizations to advocate for policies that address nurse workload, staffing ratios, and working conditions.
- Support initiatives aimed at reducing workplace bullying, harassment, and incivility, which can contribute to mental health challenges.
- Promote research on nurse suicide to better understand its causes and develop effective interventions.
- Promote Self-Care and Wellness Programs:
- Encourage nurses to engage in regular self-care activities such as mindfulness, exercise, and hobbies outside of work.
- Provide resources and workshops on stress management techniques and work-life balance.
- Highlight the importance of taking breaks and utilizing vacation time to prevent burnout.
Resources
- American Nurses Association (ANA)
- Website: www.nursingworld.org
- Resources on nurse wellness, mental health, and support services.
- National Suicide Prevention Lifeline
- Website: www.suicidepreventionlifeline.org
- Phone: 1-800-273-8255
- 24/7 free and confidential support for people in distress.
- 988 Suicide & Crisis Lifeline
- Call or text 988 to be connected to a counselor from crisis centers across the country 24/7.Chat available at lifeline.org
- HowOurCallsAreRouted-InfographicsRefresh (988lifeline.org)
- The Ohio State University College of Nursing – Stress, Trauma, and Resilience (STAR) Program
- Website: www.nursing.osu.edu/offices-and-initiatives/ohio-state-health-and-wellness/STAR
- Resources and programs to support nurse mental health and resilience.
- The National Academy of Medicine – Action Collaborative on Clinician Well-Being and Resilience
- Website: nam.edu/initiatives/clinician-resilience-and-well-being
- Information and tools to promote clinician well-being.
- Nurses House, Inc.
- Website: www.nurseshouse.org
- Provides financial assistance and support to nurses in need.
- American Foundation for Suicide Prevention (AFSP)
- Website: www.afsp.org
- Resources on suicide prevention, including support for those affected by suicide.
- Nurse Suicide Prevention Resource Site
- Website: www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/suicide-prevention
- A collection of resources specifically for nurses dealing with mental health and suicide prevention.
- NAMI (National Alliance on Mental Illness) resources https://www.nami.org/?swp_form%5Bform_id%5D=1&swps=suicide
By implementing these recommendations and utilizing these resources, we can reduce the incidence of nurse suicide and improve the overall mental health and well-being of our profession. We strive to pave the way for a healthier, more compassionate healthcare system for generations to come.
Additional Articles that one might want to read:
https://www.aacn.org/blog/suicide-among-nurses-we-have-to-talk-about-it.
https://www.myamericannurse.com/risk-of-suicide-higher-among-healthcare-workers-rns-in-particular-study-finds/#:~:text=It%20found%20the%20standardized%20suicide,second%20highest%20in%20the%20survey.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0303425.
https://nursejournal.org/articles/nurse-suicide/.\
References
Usher, K. and Jackson, D. (2023), Nurses were at high risk of suicide before the COVID-19 pandemic: Is the worst still to come?. Int J Mental Health Nurs, 32: 1512-1514. https://doi.org/10.1111/inm.13241.
Lee KA, Friese CR. Deaths by Suicide Among Nurses: A Rapid Response Call. J Psychosoc Nurs Ment Health Serv. 2021 Aug;59(8):3-4. doi: 10.3928/02793695-20210625-01. Epub 2021 Aug 1. PMID: 34343054; PMCID: PMC8344804.
Davis M, Cher B, Friese C, & Bynum J. (2021). Association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry. 10.1001/jamapsychiatry.2021.0154.
Basu, N., Barinas, J., Williams, K., Clanton, C. & Smith, P.N. (2023) Understanding nurse suicide using an ideation-to-action framework: an integrative review. Journal of Advanced Nursing, 1–17. Available from: https://doi.org/10.1111/jan.15681.
