Can We Talk About Nurse Suicide?

Why don't we talk about suicide openly? And how can we change that?

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Can We Talk About Nurse Suicide?

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.

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Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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Did you mean 100 mg/mL?

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Specializes in CVICU.
41 minutes ago, Eveyn Leach said:

Did you mean 100 mg/mL?

I spent the first five minutes wondering the same thing.

Either way, this story is tragic. It is crazy how much stigma still surrounds mental health even to this day. We all have to support each other and work to not place the blame on the one who committed the error. Instead, we should look at what can be done to learn from the situation mentioned above.

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Specializes in ER OR LTC Code Blue Trauma Dog.

I have often consoled and been personally supportive of my peers. It's tough work and sometimes we just need one another.

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Specializes in Tele, ICU, Staff Development.
1 hour ago, Eveyn Leach said:

Did you mean 100 mg/mL?

Oh, right! Thank you. I corrected it. See how easily that can happen?

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Specializes in geriatric, home health.
4 hours ago, Nurse Beth said:

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.

This is so true!!!! I experienced moral distress while finishing up last clinical rotation at a local hospital in my ADN program. My preceptor had entered another RN's initial's as a witness for insulin administration and said "We have to just trust one another". She did not get another RN to witness nor had me to witness. She indicated this as acceptable practice due to limited time frame and high demands of the job. We were taught in nursing school and Davis' Drug Reference book also labeled insulin as requiring 2 RN witnesses.

I think nurses (or anyone) who struggle with dysthymia or depression are more prone to PTSD, second victim syndrome, burnout, compassion fatigue as well as anxiety and other emotional struggles. Unfortunately when we are depressed our ability to use our executive thinking skills decrease significantly under times of stress. We feel we have to "do it all" because otherwise we are told we're not utilizing time well or have poor time management. Often nurses do not recognize depression in fellow nurses, especially management, and the depressed nurse doesn't feel comfortable disclosing the depression because "it isn't that bad".

We may feel "different" because we aren't as "successful" as we feel we could be and lose self confidence. However a depressed or tenderhearted nurse tends to be much more empathetic and more sensitive to the patients' feelings and needs. Unfortunately "the corporate world" sees no value in employees with depression or any mental illness which slows down the employee's ability to work in a fast pace environment and quickly multi-task while making the correct decision. I can emotionally understand why Kim took her own life. She couldn't live with the emotional pain anymore and did not get the emotional support from her employer but likely lost her job, faced a lawsuit, faced a possible involuntary manslaughter charge and lost her license. She may not of had the emotional support outside of her job due to family and friends not fully feeling comfortable or knowing what to do or say. Kim likely became even more depressed and saw her life as totally ruined and no longer a respectable nurse, women (wife, mother-if she was married or had children).

Not all nurses (or anyone) who are depressed commit suicide but may feel they don't care if the Lord takes them home (have no desire to keep on living because of such a strong sense of loss. If employers, management, staff nurses and other coworkers recognized distress in an employee (nurse or any staff member) and offered ongoing help and support rather than "getting rid" of the "problem employee" this would decrease the number of suicides and other workplace violence among employees.

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Specializes in kids.

Had a nurse friend complete suicide about 10 years ago...in retrospect, there was some red flags...how terribly sad for all.

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Thank you for this commentary. We have had 2 nurse deaths by suicide in our local hospital. One is too many! As an advocate for suicide prevention , we need to do a better job at fostering a positive environment around mental health In our nursing community. Supervisors and peers should go through training where they can learn risk factors and signs and symptoms of those at risk for suicide. I’m hopeful we will get there I just wish it were sooner than later.

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After my first year out of nursing school, on a very high-acuity cardiac floor...I experienced major burnout. It got so bad, I thought about suicide. I never had a solid plan or anything, just fantasized about not being around to experience that burnout anymore. I couldn't quit my job because I had bills to pay; I'd put in multiple applications in every specialty over the prior months with no calls back.... I felt helpless.

Luckily I finally got out of the hospital setting and I'm in a much better place now.

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I definitely feel for the nurse in the story. At least I’m not in that situation.

I recently lost my job and am terribly depressed. My company fired all 4 nurses in our group. So at least I’m not alone, I have support of the other 3 nurses.

I’m interviewing, but so hard to go in with smiling face and try to act enthusiastic about another nursing job.

On a normal day I’m living paycheck to paycheck. Don’t know what I’ll do when the bills start stacking up. So worried about losing my house! Ugh...

Hopefully I can get up the energy to go to the doctor and get help before my health insurance ends in 2 weeks.

Sorry, read the story and had to vent!

Martha

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Specializes in critical care, med/surg.

We don't talk about suicide period. From Veterans who experience horrific incidents to the nurse here and Jack and Jill on the street. Depression is hidden very well by some people. Throw in some drugs and life events and...BAM!

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Specializes in Retired.

Glad the problem is being outed. Over the years I have felt that the rate is rising but had no proof since the CDC doesn't keep these statistics (only for MD's). There is a direct relationship between the expectations of taking care of increasingly sick people with less staff which sends a terrible message to nurses - we are not important enough in the eyes of our administrators to be cared for as valuable employees. Even as a CRNA, I remember in the 80's we always got a little breather between cases (even in a non-academic corporate practice) but each year the amount of cases rose, the hours got longer, lunch was usually something I ate out of my pocket (sorry OR nurses:), and if the turnover time was more than 20 minutes, we got a reminder from our supervisors - as if we could move faster than human capability. One day while working in the cataract room I was spinning so fast I tore a meniscus in my knee. And,most troubling, is that there is no answer to resolving this except to create patient ratios in every, single hospital. Most troubling, is that the ANA won't back up the staff nurses to legislate this goal. But articles like this may help us grow sensitive to fact that some of our members suffer more than others and we need to get educated and value a caring environment - actually not tolerate anything less than that......sigh.

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