Can We Talk About Nurse Suicide?

Nurse Beth, MSN

Nurse Suicide

Reports of nurse suicide are largely anecdotal.

Sometimes nurses die by suicide after they’ve made a fatal mistake. Kim Hiatt was one such nurse. Kim was a critical care RN who worked at Seattle Children’s Hospital for 24 years before the day her shift, career, and ultimately her life ended in horror.

On September 14, 2010, Kim received a verbal order to administer 140 milligrams of calcium chloride IV. The concentration was 100 milligrams per mL. The correct dose was 1.4 mLs, but Kim miscalculated and gave 10 times the ordered dose. 14 mLs. 1400 milligrams.

The fragile nine-month old baby died 5 days later. Seven months later, Kim hung herself in the basement of her Seattle home.

No statistics

Interestingly, no one knows the actual rate of nurse suicide in the United States, as no one organization tracks and reports it. There are no standardized reporting mechanisms across the states. For example, the death report may say suicide, but the space for “occupation” may be blank, or filled in simply with “nurse”, and is often hand written.

If it’s any indicator of nurse suicides stateside, the number of nurse suicides in the UK is tracked. The Office for National Statistics reported 300 nurse suicides from 2011 to 2017 with the highest number, 54, in 2014.

Fifty-four nurse suicides in one year is one nurse suicide per week.

Studies performed outside of the US found nurses have a higher rate of completed suicides than other occupations (National Academy of Medicine: Nurse Suicide: Breaking the Silence). According to the CDC, suicides in general are up. Not only up, but higher than they’ve ever been, making suicide a major national public health issue. Celebrity suicides in the last couple of years have shocked the nation, and the Joint Commission has made suicide prevention a focus of concern.

Stigma

Even in the medical field, there is pervasive stigma around mental illness. It’s one thing to get diagnosed and treated for sinusitis. It’s quite another to seek help for a psychiatric disorder.

In the nurses’ lounge you may hear “Hey, who’s a good orthopod to see for my knee?" but less often “Anybody know a good counselor for being depressed? Is Prozac a good antidepressant?”

Or when ordering out “Hold the cheese on my taco salad! Doesn’t go with the MAO inhibitor for my bipolar disorder!”

As nurses, we see ourselves as helpers, not helpees. Being a person with mental health needs makes you less than, in many people’s view. It can mean you are weak, or just can’t cope. Other people may look at you differently, treat you differently. Whisper about you behind your back, but stop talking when you walk in the lounge.

Even loving families are not always understanding or supportive when a family member is depressed, believing mental illness brings shame on the family. The family member who can barely get out of bed and shower may be told to “snap out of it”. Ironically, if that same person broke a leg they would never be told to “snap out of it” but would be treated and expected to stay off the leg for as long as it took to heal.

Blame

Friends and family often blame themselves when a loved one dies by suicide, but they also blame the loved one who ended their own life, leaving behind devastation and broken hearts.

It’s not selfish. Selfish would be if someone knew the pain it would cause, and disregarded it. The person contemplating suicide believes they are a burden to others, and that everyone would be better off without them. Their thinking and ability to rationalize is impaired.

It’s not that they don’t want to live so much as they don't want to suffer. Suicide is a solution.

Language Matters

Language matters and words have power to not only express but to shape our feelings and beliefs.

Use the words “completed suicide” instead of “successful suicide”. Much as we would not say a pt died of a “successful MI”, “successful” is not the best way to describe death by suicide. Or just say "died by suicide".
Likewise, instead of “unsuccessful attempt” say “attempted suicide”.
Instead of “committed suicide” say “died from suicide”. The word “committed” has connotations of sin or crime.

Nurse Risk

Nurses are subject to depression, mental illness and suicide like everyone else. But nurses are more likely to experience PTSD, second victim syndrome, nurse burnout, compassion fatigue, and moral distress than those in other occupations.

While nurse suicide is not tracked, it’s not much of a leap to induce that significant occupational stressors and suicide risk could be connected.

Suicide is shrouded in secrecy, but when it does occur, it should be openly talked about. Facilities should have debriefings after a staff suicide. Employee assistance programs are helpful, but colleagues need to talk among themselves to process what happened.

If you are suicidal and need emergency help, call 911 immediately or 1-800-273-8255 if in the United States.

Maybe Kim Hiatt's story would have ended differently if she'd gotten the help she needed.

National Suicide Prevention Lifeline

We can all help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. If you are in another country, find a 24/7 hotline and location of Crisis Centers worldwide at International Association for Suicide Prevention - Resources: Crisis Centers.