I knew how to recognize a patient in crisis. I knew the questions to ask, the precautions to take, whom to notify, and what could happen if warning signs were missed. I had spent years caring for people during some of the worst moments of their lives.

Recognizing the same danger in myself was harder.

At work, I still looked capable. I could respond to a code, care for a critically ill patient, speak with a frightened family, finish my charting, and come back for the next shift.

Privately, I was having suicidal thoughts.

That gap between how a nurse performs and how a nurse is actually doing is something our profession needs to examine more closely. We frequently expect a mental health crisis to announce itself through absences, mistakes, declining performance, or an obvious change in behavior. Sometimes it does. But sometimes the nurse in crisis is still the nurse everyone trusts when something goes wrong.

When functioning looks like wellness

I began working in healthcare at 17. Years later, I became an emergency nurse in a Level I trauma center. Overdoses, traumatic injuries, codes, and deaths became part of the rhythm of the work. Then came the next patient.

That rhythm becomes familiar. A resuscitation ends, but someone in another room still needs medication. A family receives devastating news while another patient arrives through the ambulance bay. You wash your hands, collect yourself, and walk into the next room.

For a long time, I thought my ability to keep doing that meant I was handling it. I blamed exhaustion on night shift and poor sleep on the schedule. I told myself that difficult cases were part of the job. Meanwhile, some of those cases followed me home.

I was eventually diagnosed with post-traumatic stress disorder, anxiety, and severe depression. Yet I continued working in environments where other people depended on me to remain calm.

National data underscore the seriousness of mental health risk within the nursing workforce. Olfson and colleagues examined a nationally representative cohort of approximately 1.84 million U.S. workers. They found an annual standardized suicide rate of 16 per 100,000 among RNs, compared with 12.6 among non-healthcare workers. After adjusting for demographic factors, RNs had a 64% higher risk of suicide.

Kelsey and colleagues surveyed 7,378 U.S. nurses and found that 5.5% reported suicidal ideation during the previous year. Nurses who reported suicidal thoughts also were less likely to say they would seek professional help for a serious emotional problem than nurses who didn’t report suicidal ideation.

Those findings challenge a dangerous assumption: If a nurse is still functioning, they must be okay.

Not everything is burnout

Burnout is real and deserves attention. Heavy workloads, inadequate resources, workplace violence, moral distress, and repeated exposure to suffering can take a profound toll. But burnout shouldn’t become our catch-all term for psychological distress.

Depression, post-traumatic stress disorder, and suicidal ideation require us to think beyond burnout. The distinction matters because the label can shape the response.

In a 2025 study of 501 U.S. nurses identified as having moderate-to-high risk for adverse mental health outcomes, Melnyk and colleagues found that burnout, anxiety, depression, and post-traumatic stress were each associated with increased odds of suicidal ideation. Job satisfaction and a sense of mattering in the workplace were associated with lower risk of suicidal ideation.

If we describe every form of distress as burnout, our solutions can become predictable: take time off, practice self-care, attend a wellness event, become more resilient. Those approaches may help some people, but they’re not substitutes for recognizing a mental health crisis or helping someone access professional care.

Sometimes a nurse needs rest; sometimes the work environment needs to change; and sometimes a nurse needs mental health treatment. Those needs can overlap, but they’re not interchangeable.

The phone call

Eventually, the thoughts became a plan. I knew enough about suicide risk to understand what that meant, and I also knew I should not handle it alone.

So I called the mental health line available through my employer.

That call became my first step toward treatment. Therapy followed. Medication followed. I had spent years knowing what to do when someone else was in danger. Doing it for myself was much harder.

Treatment didn’t erase what I’d seen or make every difficult memory disappear. It gave me a way to begin dealing with what I’d spent years carrying. It also changed what I considered strength.

For years, strength had meant endurance: show up, handle it, keep moving. Now I think strength can also mean saying, clearly, “I need help.”

Ask a question that leaves room for the truth

There is a question we ask constantly in healthcare: You good?

Usually, we ask it while walking past someone, after a difficult case, or halfway through the next task. The answer is almost automatic: Yeah. I’m good.

If you’re genuinely concerned about a colleague, make room for a different answer. Ask privately. Say what you’ve noticed. Listen without immediately trying to solve the problem. Don’t use attendance, clinical competence, or productivity as evidence that someone is psychologically well.

Leaders also need to remove barriers that make asking for help feel professionally risky. The National Institute for Occupational Safety and Health’s 2024 Impact Wellbeing Guide recommends that hospitals identify confidential avenues for mental health support and review credentialing questions that may discourage healthcare workers from seeking care.

Make those resources easy to find before someone reaches a crisis. Normalize their use. Explain how confidentiality works. If a nurse tells you they’re struggling, take them seriously even when their attendance is excellent, their patients are safe, and their work is getting done.

Nurses need to extend that same seriousness to ourselves. Knowing how to recognize depression or suicide risk in a patient doesn’t make us immune to either.

See the person behind the performance

I stayed in nursing. I later worked in critical care and eventually moved into nursing leadership. But I no longer look at competence the same way.

I think about the dependable nurse, the calm nurse, and the one everyone calls when a situation starts falling apart. I think about the nurse who can hold another person’s fear for 12 hours and then drive home alone with their own.

Competence can exist beside depression. Professionalism can exist beside trauma. A nurse can spend an entire shift keeping other people safe while privately struggling with suicidal thoughts.

We shouldn’t wait for suffering to become visible enough to disrupt the work. Sometimes the nurse who needs help most is still doing the job well.

We have to learn to see the person anyway.

Christopher Perkins is manager of the emergency and respiratory therapy departments at Mee Memorial Healthcare System in King City, California.

References

Kelsey EA, West CP, Cipriano PF, et al. Suicidal ideation and attitudes toward help seeking in U.S. nurses relative to the general working population. Am J Nurs. 2021;121(11):24-36. doi:10.1097/01.NAJ.0000798056.73563.fa

 Melnyk BM, Davidson JE, Tucker S, et al. Burnout, mental health, and workplace characteristics: Contributors and protective factors associated with suicidal ideation in high-risk nurses. Worldviews Evid Based Nurs.2025;22(3):e70042. doi:10.1111/wvn.70042

NIOSH [2024]. Impact Wellbeing™ Guide: Taking action to improve healthcare worker wellbeing. Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication 2024-109, (Revised 07/24) https://doi.org/10.26616/NIOSHPUB2024109revised072024

Olfson M, Cosgrove CM, Wall MM, Blanco C. Suicide risks of health care workers in the US. JAMA.2023;330(12):1161-6. doi:10.1001/jama.2023.15787