Practice Tip of the Week | Suicide Prevention Month: Exploring the Reach of Suicide in Nursing

By: Corinne Hernandez, MS, LCDC  

TPAPN Case Manager  Nursing, a profession that has always been among the most trusted (Munday, 2023), has demonstrated an unwavering commitment to the care of others throughout history . The role of the nurse has evolved
from managing preventorium programs assuming the sole care of children afflicted with tuberculosis (Dantonio, 2010), to leadership, research, clinical innovation, and advanced practice throughout all aspects of the healthcare system.  There is
no doubt about the contribution of nurses working tireless hours throughout the pandemic (Hoedl, Bauer, and Eglseer, 2021). The integral role of nurses highlights the importance of providing support for nurses and their increased  risk for severe
mental health conditions and high suicide rates (Lee & Friese, 2021). The data indicates that rates of suicide among nurses are 18 percent more likely than the general population (Lee & Friese, 2021). To reduce this rate, it is vital to understand
the factors that contribute to this significantly higher rate of suicide as well as the urgent need for collaboration among all nurses, employers, and environmental and societal efforts in risk reduction. The reliance upon nurses highlights the importance
of investigation of societal issues to determine immediate and collective action to remedy this statistical disparity.  Potential Contributing Factors To understand why nurses die by suicide
at rates more significant than the general population, one would have to comprehend multiple aspects of nursing, including practice, work life balance, job responsibilities, and other unique stressors that include the culture of the profession. High
stress is a contributing factor due to the constant shortage in nursing, workplace violence, and psychological trauma relating to workplace conditions (Hofstetter & Mayer, 2023). Nurses may struggle with seeking support or help due to stigma,
the prevalence of bullying behavior from peers, and/or fear of potential disciplinary action. Hsiu-Fen et al. (2021), state that nurses are susceptible to depression, anxiety, and reduced job satisfaction resulting from stressful work environments,
heavy workloads, burnout, and poor sleep hygiene. The probability of developing depressive symptoms for nurses ranges from 11.0 to 32.4%, noting that 30% of nurses have depressive symptoms in contrast to 4% of the general population (Hsiu-Fen et al.,
2021).  What can we do?  Lee and Friese (2021) point out that the socio-ecological context serves as a route to help safeguard nurses who are predisposed to an increased risk of suicide.
The American Rescue Plan Act of 2021 includes $60 million to help provide mental health support for healthcare professionals (Lee & Friese, 2021). This bill is significant in recognizing and understanding the need to support the vulnerable population
of healthcare providers like nurses who are at risk of developing a severe mental health condition that could lead to suicide. Ensuring a current understanding of factors affecting mental health conditions and rates of suicide in nursing, together
with concerned individuals and fellow healthcare workers, is imperative to create programs and resources to reduce rates of suicide among nurses. Prioritizing mental health support for healthcare professionals is paramount. The Critical
Incident Stress Management (CISM) program, includes crisis prevention, neutralization of crisis events, and a continuum of care to secure ongoing recovery.  An essential component of this intervention is the use of peer counselors who are trained
and supervised by a mental health professional (Hofstetter and Mayer, 2023). Secondly, the use of suicide risk screening programs like the HEAR Program (Hofstetter and Mayer, 2023) used by physicians and adapted for nurses offers a route to early
intervention. Early interventions, such as those in CISM and HEAR can be useful in reducing the risks of suicide. Education about mental health is a launching point for stigma reduction as is normalizing that most all individuals experience a mental
health event that interferes with their lives at some point and  seeking help is not only acceptable but it is highly encouraged. As concerned individuals and fellow healthcare workers, knowledge, a proactive approach, and prioritization of early
intervention are fundamental to reducing the risks of suicide in the nursing population.  Peer support Peer support has increased social validity in reducing hospitalization and rehospitalization
and improving quality of life in the treatment of mental illness (Mental Health America, 2017).  The Texas Peer Assistance Program for Nurses provides peer support for nurses participating in the peer assistance program. This unique peer support
program allows all nurses to apply and receive training to support their fellow nurses experiencing mental health and/or substance use conditions. This relationship is peer-to-peer and confidential, fosters a supportive culture within the nursing
profession, and is vital in risk reduction. It is essential to highlight the significant role of peer support in mitigating the impact of severe mental health conditions and suicide risk reduction among nurses.  Helpful resources for suicide risk reduction and crisis intervention: 

https://988lifeline.org/ 
https://namitexas.org/crisis-info/ 
https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials 

References 

D’Antonio P, Connolly C, Wall BM, Whelan JC, Fairman J. (2010). Histories of nursing: The power and the possibilities. Nurse Outlook. 2010 Jul-Aug;58(4):207-13. doi: 10.1016/j.outlook.2010.04.005.
PMID: 20637934; PMCID: PMC2907354.  Hofstetter T., & Mayer, N. (2023). CE: Suicide Prevention: Protecting the future of nurses. AJM, American Journal of Nursing, 123(12), 30-36. https://doiorg/10, 109/01.naj.0000996556.74490.80 Hoedl M, Bauer S, Eglseer D. Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: A cross-sectional online survey. HeilberufeScience. 2021;12(3- 4):92-98. doi: 10.1007/s16024-021-00354-y.
Epub 2021 Sep 10. PMID: 34522573; PMCID: PMC8432278 Hsieh, H. F., Liu, Y., Hsu, H. T., Ma, S. C, Wang , H. H., & Ko., C. H. (2021). Relations between stress and depressive symptoms
in psychiatric nurses: The mediating effects of sleep quality and occupational burnout. International Journal of Environmental Research and Public Health, 18(14), 7327. https://doi.org/10.3390/ijerph18147327 Lee, K. A., & Friese, C. R. (2021). Deaths by suicide among nurses: A rapid response call. Journal of Psychosocial Nursing and Mental Health Service, 59(8), 3-4, https://doi.org/10.3928/02793695-20210625-01. Mental Health America. (2017, February). Evidence for peer support. https://www.mhanational.org/sites/default/files/Evidence%20for%20Peer%20Support_%20January%202017.pdf 

Munday, R. (2023, October 10). Nurses ranked most trusted
profession for the 21st year amid the nursing shortage. NurseJournal.org. https://nursejournal.org/articles/nurses-ranked-the-most-trusted-profession-2023/