Nurse Suicide is Real: 3 Ways to Help

  1. In honor of National Suicide Prevention Week, let's discuss the lack of statistics on nurse suicide. And, a few ways you can help keep your co-workers safe.

    Nurse Suicide is Real: 3 Ways to Help

    "The Power of Connection," is the theme of the National Suicide Prevention Week, which runs from September 9th -15th. Many organizations and professionals are working diligently this week to ensure that connections are in place for patients and others who struggle with depression, anxiety, or other mental health illnesses that place them at a higher risk of suicidal ideation.

    But, for nurses, there's a different sort of connection we should be discussing. It seems in recent years, there's been anecdotal information connecting the risk of nurse suicide to burnout and job stress. The word anecdotal is used because if you search for current data on this connection, you will find limited information. Yet, you can see this data for other service-focused professionals, such as physicians, educators, and police.

    Let's discuss available statistics, anecdotal information, and a few ways nurse leaders and healthcare systems can work to prevent this deadly occurrence from happening on your unit.

    Anecdotes and Data

    According to a May 2018 Medscape Nurses article, it's estimated that one physician commits suicide each day in the United States. This statistic makes physician suicide two times higher than the general population. The Ruderman Family Foundation reported earlier this year that police and firefighters are more likely to die by suicide than in the line of duty. Post Traumatic Stress Disorder and depression rates are up to 5 times higher for these civil servants - both of which are known risk factors for suicide and other forms of self-harm.

    For nurses, the stressors of patient care, long shifts, and incredible professional demands can be much to bear. One study done conducted in England and discussed in a Nurse.org article contends that nurses are 23% more likely to commit suicide than women in general. But, it's difficult to find similar statistics about nurses in the U.S.

    You might find stories about nurses who struggled with workplace stress and bullying who turned to self-harm. One such story, recently covered in the New York Post was about Rhian Collins, a nurse who committed suicide earlier this year. Investigators determined that the decision to end her life was related to trouble with co-workers that's been classified as "bullying." And, a recent article in Oncology Nursing News further supports the claim that nurse suicide is a silent problem, even here in the U.S.

    What Can We Do To Help

    Whether you are a staff nurse, manager, or hospital administrator - you can help prevent nurse suicide. Here are three things that you can do to help the nurses in your workplace.

    Know the Risk Factors

    As nurses, we often think that we have good instincts about these types of problems. And, while you might when it comes to your patients - when you work side by side with someone, it can be easy to overlook subtle signs of impending problems. The Suicide Prevention Lifeline provides this list of risk factors. This list includes characteristics that might put someone at a higher chance of considering, attempting, or dying from suicide.

    Risk Factors for Suicide

    • Mental health diseases
      • Personality disorders
      • Mood disorders
      • Anxiety disorders
      • Schizophrenia

    • Hopelessness
    • History of abuse or trauma
    • Previous suicide attempt
    • Loss of job or finances
    • Family history of suicide
    • Major physical illnesses
    • Behaviors such as impulsivity or aggression
    • Substance abuse disorders, such as alcohol, drugs, or other substances
    • Ease of access to lethal means
    • Feelings of isolation or true lack of social support
    • Lack of access to physical and mental health services
    • Exposure to other suicide victims
    • Religious or cultural beliefs that hold suicide as a noble resolution
    • Fear or stigma related to asking for help
    • Occurrence of multiple suicides in a cluster (geography or social group)
    • Loss of relationships

    Along with risk factors, you must know the warning signs of suicide. Recognizing these signs in a co-worker would require a call to the Lifeline Suicide Hotline (number below) or other emergency services.

    Warning Signs

    • Looking for a way to kill themselves - searching online or purchasing weapons
    • Talking about unbearable pain or feeling trapped
    • Increasing the use of drugs or alcohol
    • Sleeping too much or too little
    • Exhibiting rage or attempting to seek revenge
    • Severe mood swings
    • Isolating or withdrawing themselves from others
    • Reckless behaviors, agitation, or anxiety
    • Expressing feelings of being a burden to others
    • Expressing feelings of having no reason to live or feeling hopeless
    • Talking about wanting to kill themselves or die

    Offer Screening

    As more emphasis is placed on this issue, hospitals and other facilities that employ nurses should offer screenings for suicide risks and other mental health services. Screenings should be routine and also provided after particularly stressful events, such as deaths or large tragedies. Many employers also offer employee assistance programs that allow staff to seek mental health counseling during times of need free of charge.

    Suicide that occurs after stressful events is referred to as second-victim fallout. Particular attention should be given to staff who care for patients who die after a tragedy, accidents, or due to medical errors. This can place the nurse at high risk of depression, extreme sadness, and suicidal ideation or attempts.

    As a nurse manager, having an open-door policy can help staff feel comfortable to express concerns or problems they may be experiencing from workplace stress. Remain open to how your staff feel, listen to their concerns and try not to judge or put down how someone might be feeling. If a staff member has a lot of stress going on either in their personal and professional life, offer resources such as a chaplain or employee assistance program, if available.

    Be Prepared

    With all of the violent crimes in our society these days, we rush to preparedness plans for physical safety from events. But, we must create preparedness plans for the mental health needs of our staff.

    Talk about these issues openly during meetings. Publish information on your hospital blogs or in newsletters about the support offered by your facility. And most importantly, be kind to others. If you notice a change in a co-worker or staff member's behavior that is concerning according to the risk factors or warning signs listed above - talk to them. Even if they don't want to talk at that time, let them know you are there if they need to talk later and tell them that you care about them and want them to be safe.

    If you or someone you know is struggling with suicidal thoughts, you can get help by calling the National Suicide Prevention Lifeline 27/7 at 1-800-273-TALK. You can also chat with a counselor online by visiting their website. They will help connect you with local resources.
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    20 Comments

  3. by   Truth66
    Once again a very good article.

    As I indicated in a previous thread, Nursing is one of the most abused, exploited and discriminated against of any profession/occupation that I've looked into.

    When I used to do violence prevention training I came across a shocking article that indicated the level of violence that Nurses experience is equal, if not higher in some jurisdictions, than that of Police Officers. This is scary because Police have the training and resources to deal with potentially violent situations, whereas Nurses do not.

    Let's not forget that with Nursing being a female dominated profession, Nurses are routinely conditioned to believe that violence is part of the job. One of the things that I and my fellow Nursing staff heard all too often from Nurse Managers/Administrators when they were assaulted on the job was, "what did you do to trigger the assault", or "what was your approach"? and so on.

    Because Nursing is female dominated, these ridiculous questions are quite similar to the questions of many women who are victims of sexual assault. "Why were you wearing those types of clothes", "why were you at that area of town", "what did you do to encourage him"? and so on.

    It's rare for Women/Nurses to experience a situation where the perpetrator of the assault is actually questioned as to why the assault occurred. Yet in most criminal codes, it's a chargeable offense to assault a "Police Officer". I haven't found any criminal code where it's a specific criminal offense to assault a "Nurse".

    When women are continuously blamed for the assaults and other forms of abuse that they receive, then yes this can take a heavy toll on the mental health of these Nurses. Unfortunately as a result, the support systems that these Nurses need, aren't there.

    I'm not sure how it is in the U.S., but I made an interesting observation not too long ago. Whenever a Police Officer is killed on the job, it not only makes national headlines, but the funeral(s) are often televised. Yet, whenever something tragic happens to a Nurse, society never bats an eye. So Nurses often don't feel valued as they should be, because society as a whole views them as nothing more than just a bunch of women.
  4. by   melissa.mills1117
    Truth66 - You make excellent points about the stressful, and sometimes violent nature of nursing. I was shocked to learn that there are no statistics on nurse suicide. Not that I ever really went out looking for them before, however, I found it fascinating and disheartening and wanted to share it with others. I'm a firm believer in shedding light on the issues that break your heart or infuriate your spirit.

    Thanks for your thoughts.

    ~Melissa
  5. by   NurseDiane
    Great reply.

    I have been a nurse for more than 30 years, and seen the changes in the healthcare system over that amount of time. The fact that ANYONE would tolerate a nurse being assaulted--or any staff member, for that matter--is deplorable. When a patient assaults a nurse, the nurse is told not to call police to file a complaint, the nurse is told not to say anything to anybody about it--especially the media!!!--and are questioned as if they are the reason for the assault. The questions "What did you do to escalate the situation?" and "What did you do to try to deescalate the situation?" are absurd. A nurse isn't permitted to defend themselves or fight back. And, to top it all off, the patient responsible for assaulting the nurse isn't thrown out of the hospital, is not reported to the police & continues to receive treatment. Their "mental health" is always called into question, even if they're not in the hospital with a mental health problem.

    If a person was assaulted on the street, the first thing they'd do is call the police. Why isn't that the first thing a nurse does if they are assaulted on the job? For some reason, people feel that "abuse" comes with the territory of nursing, or any other healthcare job, and if you can't handle it, find another job. The fact that administration is more concerned with keeping it quiet to limit its own liability & not have the public wonder about the safety in the facility is unacceptable.

    I can tell you one thing--I would be damned if anyone would prevent me from defending myself/fighting back, calling the police to report the assault or speaking to the media about it. If they want to fire me, go ahead---but they had better lawyer themselves up to defend against the massive lawsuit I would file against them.
  6. by   NurseDiane
    While this article is very nice, with all the risk factors & warning signs recommendations, the truth is that management/administration couldn't care less if a nurse commits suicide. The only thing management/administration care about is how much money they made & how much money they had to spend. Only when something happens does anyone come forward with their condolences and denials about a nurse's work environment contributing toward the suicide. When a nurse complains about being bullied or other issues to managers/HR/administration, their complaints are not taken seriously because managers/HR/administration do not look at them as human beings---nurses are looked at as a means to an end, a way for the place to make money to ensure the inflated salaries & bonuses of the management. There is no "stress management"---in fact, nurses are worked harder now than they have ever been, are in unsafe environments & doing their best not to make a mistake even though severe short staffing causes problems with patient safety. The whole "evidence based" practice standards are ridiculous, as many studies & research has shown that patient care and safety is far better with lower patient:nurse ratios than with the way healthcare is being conducted now. When a sentinel event occurs, the "clipboard crew" shows up in their long white lab coats, clipboards & pens to interview & "investigate" the reasons why it happened. The majority of the time, problems occur due to a shortage of nurses---but that never makes it into the "investigation". The "clipboard crew" will come up with some new policy & procedure in response to the incident, which is usually another piece of paper that has be filled in for the protection of the hospital against citations from governing agencies and to limit liability on the hospital's part in a legal proceeding. The whole environment of healthcare has gotten beyond ridiculous. It's all about money. Nothing else matters.
  7. by   melissa.mills1117
    NurseDiane - Great thoughts and comments. It just reminds me how very unsafe nursing can be. I haven't been at the bedside or even out in the field in home care for about four years, so it's easy to forget. But, you bring back several circumstances that even today bring a sense of fear to my mind and body.

    Violence is just one of the many things that might put nurses in a vulnerable state that could lead to self-harming behaviors.

    Thanks again for your comments.

    Melissa
  8. by   Daisy4RN
    Could not agree more with the OP and previous posters. Facilities do not care about nurse safety while at work or especially after work (suicide). I worked at a hospital in LA (with a union) and during orientation was told there was nothing the nurse could do if physically hit/attacked. I later asked the union rep about this who agreed with the facility, nothing the nurse could do (union dues at work there!). Outrageous!! And the question begs, why are they telling nurses this during orientation.
  9. by   brandy1017
    While it's true that nurses are the victims of violence by patients I don't think this is the main problem for stress, depression and suicide in nursing. I think it is a combination of many factors some personal and others related to the work environment of nursing, bullying plays a part in some situations as well. My most difficult days and darkest period were the result of a campaign of bullying started by one irrational, jealous LPN who was angry that I was an RN and she was not and tried to turn my coworkers against me. As the new person on the block, I felt very isolated and the only support I had came from a couple fellow new grads. My manager actually sympathized with the LPN and wanted me to be more sensitive to her feelings. I did nothing to insult her or harass her. It was totally the other way around. Add to that my own personal issues and the incredible stress of nursing itself and it was a very toxic mix!

    Things slowly turned around when her job was eliminated and she was forced to work as a HUC as LPN's were phased out from the bedside. While she left soon after, she had poisoned the waters as it were and made it difficult for me to make friends and trust my fellow coworkers.

    Bullying has a profound effect on a person, it erodes their confidence and self esteem. Cliques also have a way of excluding people and can be harmful, to a lesser extent than actual bullying.

    But the truth is we work in a generally hostile work environment where we are rushed on an assembly line pace, short staffed as the rule and overloaded with duties and responsibilities but have no real authority and are expected to pick up the slack of every other member of the health care team and blamed for every problem many that have nothing to do with us. Simply speaking nursing is a toxic environment!
    Last edit by brandy1017 on Sep 12
  10. by   melissa.mills1117
    Brandy1017 - You raise great points and your personal experiences support your thoughts and feelings. It is very unfortunate that nurses - who care for others - can be treated so poorly by their peers. And, as you stated, some nurses are dealing with other life stressors at home that further compound the issues they are faced with at work, like bullying.

    I hope you were able to lean into your network for support. Thank you so much for sharing your story.

    Melissa
  11. by   Daisy4RN
    Quote from brandy1017
    While it's true that nurses are the victims of violence by patients I don't think this is the main problem for stress, depression and suicide in nursing. I think it is a combination of many factors some personal and others related to the work environment of nursing, bullying plays a part in some situations as well. My most difficult days and darkest period were the result of a campaign of bullying started by one irrational, jealous LPN who was angry that I was an RN and she was not and tried to turn my coworkers against me. As the new person on the block, I felt very isolated and the only support I had came from a couple fellow new grads. My manager actually sympathized with the LPN and wanted me to be more sensitive to her feelings. I did nothing to insult her or harass her. It was totally the other way around. Add to that my own personal issues and the incredible stress of nursing itself and it was a very toxic mix!

    Things slowly turned around when her job was eliminated and she was forced to work as a HUC as LPN's were phased out from the bedside. While she left soon after, she had poisoned the waters as it were and made it difficult for me to make friends and trust my fellow coworkers.

    Bullying has a profound effect on a person, it erodes their confidence and self esteem. Cliques also have a way of excluding people and can be harmful, to a lesser extent than actual bullying.

    But the truth is we work in a generally hostile work environment where we are rushed on an assembly line pace, short staffed as the rule and overloaded with duties and responsibilities but have no real authority and are expected to pick up the slack of every other member of the health care team and blamed for every problem many that have nothing to do with us. Simply speaking nursing is a toxic environment!
    Sorry you had to go through that! I had a similar experience but the culprit was a senior nurse on the unit. Nursing was my second career and I was shocked to learn about the nursing culture, I had never experienced anything like it before. Even though I was a new nurse I wasn't young so had some life experience to deal with the situation. I feel bad for new, and also young nurses who maybe don't have those life experiences to know how to even begin to deal with some situations. Just sad. I really don't understand why some nurses act that way.
  12. by   Truth66
    Quote from brandy1017
    While it's true that nurses are the victims of violence by patients I don't think this is the main problem for stress, depression and suicide in nursing. I think it is a combination of many factors some personal and others related to the work environment of nursing, bullying plays a part in some situations as well. My most difficult days and darkest period were the result of a campaign of bullying started by one irrational, jealous LPN who was angry that I was an RN and she was not and tried to turn my coworkers against me. As the new person on the block, I felt very isolated and the only support I had came from a couple fellow new grads. My manager actually sympathized with the LPN and wanted me to be more sensitive to her feelings. I did nothing to insult her or harass her. It was totally the other way around. Add to that my own personal issues and the incredible stress of nursing itself and it was a very toxic mix!

    Things slowly turned around when her job was eliminated and she was forced to work as a HUC as LPN's were phased out from the bedside. While she left soon after, she had poisoned the waters as it were and made it difficult for me to make friends and trust my fellow coworkers.

    Bullying has a profound effect on a person, it erodes their confidence and self esteem. Cliques also have a way of excluding people and can be harmful, to a lesser extent than actual bullying.

    But the truth is we work in a generally hostile work environment where we are rushed on an assembly line pace, short staffed as the rule and overloaded with duties and responsibilities but have no real authority and are expected to pick up the slack of every other member of the health care team and blamed for every problem many that have nothing to do with us. Simply speaking nursing is a toxic environment!
    I completely agree that Nursing is a toxic environment and that Bullying contributes to alot of stress that Nurses endure. I also seen this in my former workplace all too often. However, there's something far worse.

    If a workplace bully is not dealt with, the bully will often target others. Then what happens is that these victims of the bully eventually ban together and collectively start targeting the bullying. This is otherwise known as mobbing. I personally seen this more than once and by the time mobbing occurs, the situation has usually spun out of control.

    The best article I ever read about mobbing is that it's bullying on steroids.

    If bullying is occuring amongst fellow Nurses, they need to recognize an important fact. This fact was told to me by one of the most intelligent Nurses I've ever had the privilage of working with. She told me that managers often create and fuel incidents of co-worker violence. She indicated that these managers absolutely love it when they see staff at each other's throats, because that means the staff are not directing their frustrations out at management.

    Nurses and other workers need to be vigilant and resist co-worker violence.
  13. by   NGONZO
    I just loved your article. During my last nursing job, I heard of only three nurses, whom I new personally, who took their own lives. They were all young, vibrant, fairly new nurses. 2 had left families with children behind. I could not phantom what the families went through, nor do I want to. I felt numb when I was told, other were like, "O well, they couldn' Take the heat', or "more overtime for me now". It amazes me how people can be so cold, so cruel over death. These were people we worked with, walked the halls with getting or giving report to. They were our co-workers, our friends, Nurses need to show respect to the dead nurses, just like we do to our patients.
    Thank you
  14. by   Truth66
    Quote from NGONZO
    I just loved your article. During my last nursing job, I heard of only three nurses, whom I new personally, who took their own lives. They were all young, vibrant, fairly new nurses. 2 had left families with children behind. I could not phantom what the families went through, nor do I want to. I felt numb when I was told, other were like, "O well, they couldn' Take the heat', or "more overtime for me now". It amazes me how people can be so cold, so cruel over death. These were people we worked with, walked the halls with getting or giving report to. They were our co-workers, our friends, Nurses need to show respect to the dead nurses, just like we do to our patients.
    Thank you
    My condolences on the loss of your co-workers. It is very sad to see the comments from your other co-workers. Unfortunately far too many Nurses become cold and calloused over time. It's their way of coping and surviving, which I do not agree with.

    This may not sound appropriate to your post, but the best way that I've learned to cope with the ongoing stresses of nursing is humor. I learned that I would rather joke around with my fellow co-workers as opposed to taking my frustrations out on them, which is not good for anyone. However, with humor (as long as it's done appropriately) benefits everyone.

    I'll be honest in stating that I would often get my self in trouble with the powers that be with my warped sense of humor. Yet my argument was always the same when I used humor with the seniors I cared for who had varying degrees of dementia. I indicated that I would rather see these residents expend their frustration and anxiety by laughing as opposed to hitting staff or other residents. In addition I would much rather administer effective humor as opposed to drugging the residents up with anti-psychotic medication.

    Nurses need to laugh a hell of a lot more than what they do and it all boils down to attitude. For example when ever I spoke to people about working on a floor with residents having varying degrees of dementia, I used to tell them that most people pay big money to see and here the kinds of things I witness all the time. Here I get paid to witness/experience it.

    Nurses can often get extremely frustrated by dealing with challenging family members as well. I'll quickly mention a true story that I posted on this site a few years ago:

    While doing my 17:00 medication pass I noticed that a family member was watching me quite closely. He eventually asked if he could ask me a question. I said sure. He asked, "How can you be a male Nurse doing this kind of job?" With out missing a beat I responded, "I tried being a female Nurse, but it didn't work." He never ever asked me another question after that.

    In short, Nurses need to try and lighten up with each other and themselves.

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