Depression has numerous effects on nurses' ability to critically think and process information. The demands of the job and high patient ratios only add to the nurses' depression and lack of confidence. Too often the nurse does not receive the help and support needed.
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Reading the Article by Nurse Beth, "Can We Talk About Nurse Suicide", prompted me to share my own personal experience and perspective on depression's effect on the nurse. I personally believe that the fast paced, high work demands, and nurses' "eating their young", and corporate culture of making more money by requiring employees to do more with less staff, are major contributors to nurse burnout, depression, and other negative emotional and behavioral elements seen in many healthcare facilities and healthcare systems. This also contributes to lower morale among healthcare systems, nurses and other healthcare workers leaving healthcare and shortages within the healthcare system.
The Depressed Nurse and Stress
Unfortunately, when nurses are depressed their ability to use their executive processing skills decrease significantly under times of stress. This adversely affects nursing and critical thinking as well as processing speed. A newly hired depressed nurse may feel she/he has to "do it all" because otherwise she/he is told you're not utilizing time well or has 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" and fear of being rejected. This is further enforced by nurses who engage in bullying behaviors such as incivility (talking with an irritated tone of voice-directed to a specific nurse while talking professionally or friendly towards other nurses, criticizing the nurse, making unrealistic demands of the nurse, not communicating needed information, etc.)
The depressed nurse may feel "different" because she/he isn't as "successful" as she/he wants to be and lose self-confidence. However, a depressed or tenderhearted nurse tends to be much more empathetic and sensitive to the patients' feelings and needs. Unfortunately, "the corporate world" sees no value in employees with depression or any mental illness because the nurse does not meet the performance requirements of the job. The nurse's ability to work in a fast-paced environment and being able to quickly make the correct decision while multi-tasking is adversely affected. Much research has also shown that high levels of stress and fatigue increases errors in medication administration. Add the effects of depression on top of this, one can understand how the depressed nurse is even more prone to mistakes.
Healthcare leaders and policymakers need to understand that most nurses cannot function optimally under the high stress and demands within many healthcare systems. Creativity and employee loyalty are decreased under these conditions. Employers, management, staff nurses and other coworkers need to recognize distress in the nurse (or any staff member) and offer ongoing help and support rather than "getting rid" of the "problem employee".
All healthcare providers, leaders, managers and most nurses will agree that being thorough, advocating for the patient, and being there for the patient is the right thing to do. They will agree that having empathy, having a caring heart, and doing things the right way is good however this is considered “the ideal” but not realistic in the fast-paced hospital environment today. These are qualities that a nurse living with depression may often have. The nurse knows what it is like dealing with some type of major emotional loss and can empathize with the patient who may be struggling with a life-altering experience. The nurse with depression is aware of how one’s attitude and actions affect others and also may try to be a “people pleaser”. The nurse with depression often strives to provide the quality and type of care he/she would want to receive following the Golden Rule. This often takes extra time to accomplish, sometimes resulting in delays in completing non-essential tasks which still needs to be completed by the end of the shift.
The nurse that is fast, “efficient” and completes the “tasks” on time is the one who is often rewarded. However, the nurse with depression does not have fast information processing speed as a result of the depression or maybe even related to other underlying cognitive challenges. The nurse also takes longer to make decisions and often struggles with criticism and harsh tones often used by people under stressful conditions.
Spiraling Depression
Management and most coworkers are understanding of temporary “breakdowns” of a nurse as evidenced by crying, nervousness, or having to step off the unit for a few minutes. They may even be understanding if the nurse had a very recent personal loss. However, often times the nurse is expected to “pull it together” within a few days or may even be allowed a week to get back for full capacity. If the nurse is unable to “perform” to the corporate set expectations, management will begin focusing on mistakes made by the nurse, take a disciplinary approach, and likely look for reasons to terminate the nurse’s employment resulting in even increased depression, feelings of betrayal, decreased morale among remaining employees, and leaving the depressed nurse questioning his/her purpose as a nurse. This could even down spiral to a severe depressive episode. This then leads to Nurse Beth’s article "Can We Talk About Nurse Suicide".
What are your experiences with fellow nurses struggling with depression? What was the employer's response?
