Suicide: A Dark Cloud Over Nursing
Nurses deserve better. So do their patients. As Dr. Linda Aiken explained in her essay of the same name, the COVID-19 pandemic has exposed poor working conditions and chronic nurse understaffing. And the pandemic has exacerbated another tragedy: high rates of suicide among nurses.
The nursing shortage is amplified by the psychological injury inflicted by the morbidity and mortality of patients with COVID-19. “The Future of Nursing Report 2020-2030” highlights the higher risks of suicide, psychiatric disorders and addiction for nurses. While millions have experienced COVID-19’s adversities, the nursing profession has experienced a disproportionate share. At no other time in the history of nursing have we faced such prolonged, cumulative trauma and stress.
Within the cohort of healthcare workers, more nurses than any other segment of the healthcare workforce have died during the pandemic: 1,140 nursing professionals in the first year. And living with the specter of death has contributed to their trauma. The pandemic’s global scope has intruded into every nurse’s life, leading to higher rates of anxiety, moral distress and traumatic stress, which have kindled depressive states. Isolation, withdrawal of social support and the accompanying loneliness associated with the lockdowns all contribute to their traumatic experiences.
As a culture, Americans tend to avoid dialogues focused on trauma and mental health. However, nurses are no strangers to trauma, especially the vicarious or secondary trauma associated with witnessing dire distress and death. Indeed, mitigation of trauma, distress and death are core tenets of our profession. Combine the harsh working conditions imposed by COVID-19, the frequent deaths and suffering of patients, and the stigma associated with seeking help for mental health disorders, and a perfect storm for suicide may occur.
As of 2019, the National Institute of Mental Health identified suicide as the 10th leading cause of death overall in the United States, having increased about 30% since 2007. Recent evidence supports that nurses experience higher rates of suicide than physicians or the public. Davidson and colleagues, in a longitudinal analysis of nurse suicide in the United States, found that when matched by gender, female nurses have a significantly higher rate of suicide than other U.S. women. Patrician and colleagues published an article in 2020, stating that the same is true for male nurses. Thus, an awareness of the risks of post-traumatic stress, known to increase the risk of suicide, is warranted.
As nurses, we should remind ourselves that treatments for mental health disorders work, and a focus on ourselves and our colleagues is paramount during these times. What can each of us do? Following are some evidence-based strategies to help prevent suicide:
Start a conversation with a colleague. For example: “Just checking in with you. I’m wondering how you are holding up.”
Consider sharing some of your own challenges to begin the dialogue.
Ask someone directly if they’re thinking about suicide. Most people are relieved when someone starts a conversation. Findings suggest that talking about suicidal ideations may reduce suicidal thoughts and lead to improved mental health outcomes.
State your concerns directly, if you suspect a colleague’s mood is depressed and seemingly hopeless. For example: “Have you thought of suicide in recent days?” Or “Are you thinking of harming yourself?” Asking doesn’t increase the risk that self-harm will occur.
Learn more about suicide screening. The Columbia Suicide Severity Rating Scale, is a comprehensive approach when assessing suicidal ideation in another.
Remind yourself and your colleagues that it’s OK to ask for help. Safety and freedom from harm for our patients and ourselves must be our focus.
A resource you can use or recommend to your colleagues is the Community Resilience Model (CRM), an evidence-based approach developed by Grabbe and colleagues. The CRM is a set of wellness skills delivered via three one-hour psychoeducational sessions (in Zoom or in person); the focus is increasing awareness of personal resiliency. These skills are based on a biological model that has empirical support for treating those with trauma and stress.
The CRM uses observation and knowledge of patterns of the nervous system to help participants learn to distinguish between sensations of distress and well-being via the skill of tracking (paying attention to internal sensations). By identifying internal feelings, a person can discern the differences between pleasant, neutral and distressing sensations, leading to a choice in how to respond to stress.
In addition to tracking, the skills of resourcing and grounding are taught. Resourcing involves identifying any person, place, thing, memory or part of yourself that makes you feel calm, pleasant, peaceful, strong or resilient. Learning the resourcing skill strengthens a sense of calm and overrides the attention that automatically goes to unpleasant sensations.
Finally, the skill of grounding promotes a sense of self in the present moment by direct contact of the body with something that provides support. When a person is grounded, there is a sense of relationship to present time and space, decreasing worry about past and future.
Teaching these resilience skills is not therapy; rather it is psychoeducational, which refers to providing education and information to those seeking or receiving mental health services. The skills are easily learned and promote relaxation and clear thinking. These are skills that RNs can use for themselves and teach their patients during this unprecedented time.
How are you caring for your mental health and well-being?
Teena M. McGuinness, PhD, PMHNP-BC, FAANP, FAAN Psychiatric Nurse Practitioner and Professor Emeritus, University of Alabama School of Nursing Teena is passionate about helping nurses improve their resilience and decrease post-traumatic stress.