Depression and Nursing

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by LindaGracie LindaGracie, ADN, BSN

Specializes in geriatric, home health. Has 7 years experience.

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.

The Depressed Nurse

Depression and Nursing

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? 

Linda Gracie RN, BSN has been a nurse for 4 years, which is a second career. Retired counselor from the State of SC. Was a mental health counselor and vocational rehabilitation counselor.

4 Articles   33 Posts

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21 Comment(s)

liv4nurse

liv4nurse

12 Posts

This article describes me to a "T". I went through hell. I was working an insanely busy emergency department and I was struggling to get through each shift. I couldn't think and had a hard time concentrating. I was so overwhelmed. I had to leave and go to a PACU. I hated that I had to leave the ED. I eventually went out on FMLA for 6 months and lost my job. I am still looking for work almost 9 months later. The only offer I have gotten is for behavioral health. I am afraid I will never get back to the ED. I am heart broken about all that has happened.

guest974915

guest974915

275 Posts

I unfortunately have much experience with this topic and can say that this article is accurate in describing some of the challenges that depressed nurses contend with in the workplace. I would however, like to add that the stigmatization of mental illness, although less so today, is still present and weighs heavy on those that suffer with the illness. Also, although great strides have been made in the treatment of depression, it remains poorly understood and the psychopharmacology/options available for refractory patients are less than desirable. On a personal note, I found that the side effects (significant weight gain, hair loss, sexual dysfunction, brain fog...) of almost all of the antidepressants were worse than actually being depressed

Edited by morelostthanfound

BSN-to-MSN, ADN, BSN, RN

Specializes in SCRN. Has 8 years experience. 398 Posts

I meet more nurses with anxiety than depression, because , like you explain, it might be hidden. Personally, I had a postpartum depression for nearly year and a half, self-diagnosed, did not seek any tx, and got out of it on my own by doing one thing a day that was of effective coping mechanism. I did notice a slight "drag" at work and irritability with my co-workers, sometimes that drove me nuts. I dropped all the extra things at work - like meetings, projects, initiatives, etc., and still haven't got back in, I kind of like it that way now. I got above average performance review, got certified, enrolled in BSN program, - life is better, - now, if only I can keep it this way.

Depression is a real struggle for the people that have it.

Edited by no.intervention.required

liv4nurse

liv4nurse

12 Posts

I'm so glad you have been able to stay in and perform well. I ended up out on FMLA and then losing my job. I still haven't gotten back to work. I want more then anything to get back to the ED and I don't know if that will ever happen. I keep getting turned down for ED jobs over and over even though I have ED experience in the past. I have been through the worst few years and this past year has truly been the worst in my life. I am just trying to pick up the pieces now. My depression is much better than it has been and I am ready to get back to work and make more positive changes in my life. But truly its a struggle daily. Unfortunately you are still discriminated against if you suffer from depression and I know that has happened to me in my previous employer. If I had cancer I wouldn't of been discriminated against and would of been rehired already.

hapham3693

hapham3693, BSN

Has 2 years experience. 15 Posts

Hello there,

I have been there for my friends amd mentor, so I really understand what you are going through. I understand that you love ED, but have you ever considered behavioral health? You have a gift that may help others, especially when you can connect with others. I have a friend, who was a nurse on ICU for 5 years, then she had to quit because of her depression. She decided to work for Behavioral Medicine instead, and she loved it there. Last time I saw her, she was happier than ever before. She told me she loved it there because she felt like she really can help people there. People was born certain way for a reason, and it is powerful to have depression as a nurse because of the ability to connect.

Edited by hapham3693

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience. 142 Articles; 9,977 Posts

LindaGracie, you're singing my song. Mental illness cost me my career and I had to retire at age 55, long before I'd planned to. I live on Social Security Disability with bipolar I disorder and depression/anxiety. There is still a lot of stigma around mental health diagnoses, and I lost two jobs because I made the (wrong) decision to tell my supervisors about my illness. Big mistake. Nursing has so little compassion for its members, and it's a crying shame...you'd think we would embrace those among us who are hurting.

Thank you for this article. It's well written and enlightening, even to this old war horse who's been there and done that. ?

LindaGracie, ADN, BSN

Specializes in geriatric, home health. Has 7 years experience. 4 Articles; 33 Posts

On 9/21/2019 at 4:19 AM, VivaLasViejas said:

Mental illness cost me my career and I had to retire at age 55, long before I'd planned to. I live on Social Security Disability with bipolar I disorder and depression/anxiety. There is still a lot of stigma around mental health diagnoses, and I lost two jobs because I made the (wrong) decision to tell my supervisors about my illness. Big mistake. Nursing has so little compassion for its members, and it's a crying shame...you'd think we would embrace those among us who are hurting.

It's a shame that nurses "eat their young" and many have little compassion for other nurses who are hurting. Actually I found a company doing private duty nursing who's logo is "Led by Our Hearts". They provide patient care in the patient's home (private duty). I go for orientation tomorrow. They say they are very flexible with scheduling. You can work as much or a little as you want.. They seem to have the compassion for their staff and even have high ratings on indeed and glass door. You may want to check out Bayada. I know I was contemplating applying for SSDI due to the problems I was having with my last 3 jobs since 7/2018.

choksantos

choksantos, BSN, RN

Specializes in Cardiac TCU /tele/SDU. Has 19 years experience. 68 Posts

I've been diagnosed with Major Depressive Disorder... I thought I was just tired from NOC shift and just stressed from my unit, I have no motivation to get out of bed, everything was just gray and hopeless, the final straw that made me seek help is that I was changing, I have turned into a mean and a very aggressive nurse directed to the ANMs or my fellow nurses, I came to a point where I enjoyed seeing my coworkers fail or get in trouble, that scared me, I have never been like this, I am not this. About a year now in therapy and anti-depressants, I feel better, still struggling but ways better. I hope that nurses get help and take care of themselves as much as they take care of other person, we are worth it.

liv4nurse

liv4nurse

12 Posts

I know the place that you are in and I applaud you for getting help. I wish you continued success and healing and hope that you never have to leave nurse. Never forget that you are your number one priority, no one else. Continue with therapy and medication find other things that help. My number one things were my dogs. They were my saving grace. I am finally going back to work, in a different area then I initially wanted to. I am going to try Critical Care, but I am really excited about it and I am so excited abut going back to work. My thoughts and prayers are with you.

PeachyERNurse

PeachyERNurse, BSN, RN

Has 14 years experience. 315 Posts

How'd you lose your job on FMLA? I thought that was the whole point...that with FMLA you leave, take care of your personal business, and come back to a job.

liv4nurse

liv4nurse

12 Posts

I had to go out twice in one year and because of that I was told that my position was filled. They said that I was still employed with the company. When I was released to come back I was work with this "Accommodations nurse" to help me find a job. She told me to apply for jobs that I was interested in then she would contact the manager. Then 2 days later she contacted me and offered me a night med surg position I previously told her I was not interested in and said if I didn't take it my employment would be ended. I was not a med surg nurse and I didn't trust what she was doing, so I didn't take the position. My employment was ended. I feel like what she did was dirty.