Four Steps to Reduce Nurse Suicides

Judy Davidson, DNP, RN, a nurse scientist at the University of California San Diego, discusses the new American Academy of Nursing consensus statement opens in a new tab or window she co-authored on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide.

Davidson outlines the three main drivers of nurse suicide and offers four changes that the industry can make to reduce the rates of suicide among nurses and improve their overall mental health.

She also recommended the suicide prevention resources on the American Hospital Association websiteopens in a new tab or window.

The following is a transcript of her remarks:

Hello, my name is Judy Davidson, nurse scientist at University of California San Diego. I am here today to talk to you about a call for action published recently by the American Academy of Nursing. I was a co-author on this project; JoEllen Schimmels is lead author.

The paperopens in a new tab or window is a seminal document talking about issues we have never before raised publicly in nursing — issues about inequitable treatment of nurses with mental health and substance use disorder.

We know that nurses are at a higher risk of suicide than the general population. We’ve known this now for several years. It’s not that nurse suicide is rising, but instead that nurse suicide has always been higher than the general population. This is very troubling, especially in light of the pandemic.

In the pandemic, the American Nurses Association conducted a series of studies over 3 years. They found alarmingly high rates of depression and mental health disorders disclosed by nurses to be occurring within nursing. Burnout is on the rise. Approximately 60% of the thousands of nurses who answered their survey said that they felt they had a mental health condition that warranted treatment, but many feared seeking treatment.

This is a problem. We should be treated equitably as nurses and have the freedom and safety to access mental health treatment when needed.

Suicide in nursing is known to be associated with three drivers: stigma, access to care, and job-related stressors. So what can we do?

First, we need to look at the credentialing questions in organizations. Why credentialing questions? All nurse practitioners are credentialed through the medical staff office, and these credentialing questions often have unlawful questions embedded within them related to mental health diseases and substance use disorder, asking about past history when it is not relevant to today. These same questions may be found on licensure, on initial licensure and on relicensure, or when used in disciplinary action by the state boards of nursing.

So at the individual state level and at the institution level within a healthcare system or hospital, all of the questions used for licensure and credentialing need to be examined to make sure that they are ADA [Americans with Disabilities Act] compliant.

How do we do this? A toolkitopens in a new tab or window was developed by the Lorna Breen Foundationopens in a new tab or window, easily found at their website, for you to check those questions and make sure they are not stigmatizing in nature. We know for a fact that these stigmatizing questions reduce the likelihood that healthcare professionals will seek mental health treatment when needed, and this is associated with untreated depression and can lead to suicide.

Number two: we need to rethink mandatory reporting requirements and public shaming of nurses with mental health disorders. These regulatory requirements were created with the public health interest in mind, to protect the public health when a nurse could not work due to mental health conditions or substance use disorder. However, we do know that mandatory reporting decreases the likelihood of accessing mental health treatment when needed.

So we need to rethink and retool the disciplinary process within each state board of nursing to decrease public shaming and the posting of names of nurses with mental health conditions.

The third recommendation I’m going to make today has been recommended by many, the National Academy of Nurses, the Surgeon General, and others: use the American Foundation for Suicide Prevention Interactive Screening [Program]opens in a new tab or window. This ISP is a mental health screening that’s encrypted and anonymous, and you can deploy it at the organizational level to routinely screen all employees for mental health conditions and refer them into treatment while remaining anonymous.

The anonymous encrypted nature of the program essentially bypasses mandatory reporting. No one can be reported if we do not know who you are.

Now [number four], I’m going to move onto job-related issues. It is inequitable that nurses routinely lose their job and surrender their license to receive mental health treatment for substance use disorder. Substance use disorder is a treatable disease. Mental health issues are treatable.

We posit that instead of firing a nurse when they need this treatment — instead of surrendering the license, which leaves them without the means for treatment, leads to financial ruin, and is known to be associated with suicide — consider leave of absence during acute treatment. Leave of absence during acute treatment protects the job, protects the license, protects hope, and retains the financial feasibility of doing the treatment needed to return safely to the workforce.

Our research team has read the death narrative of every nurse who has died by suicide. Those with job-related issues known prior to death are often unemployed. Many of those die during the process of being worked up for substance use disorder. The process — the regulatory process, the disciplinary process — is associated with death by suicide.

Many nurses who die by suicide while being worked up for substance use disorder became addicted originally after being prescribed narcotics for things like traumatic car accidents, fibromyalgia, musculoskeletal injuries related to work, and cancer.

We need to rethink the way this happens so that nurses can retain hope through treatment for a treatable condition.

If you or someone you know is considering suicide, call the 988 Suicide & Crisis Lifeline.

(This story originally appeared in MedPage.)