News in Nursing

Suicide in Nursing is Very Common

Suicide in Nursing is Very Common

A study published earlier this year, highlighted the fact the medical professionals are at an increased risk of suicide. But even among medical professionals, nurses, particularly female nurses, more than quadruples the suicide rate of other medical professionals and the general population. This has been an upward trend for the last few years, and it’s made many wonder what are the factors that contribute to this alarmingly high rate.

Increase in Risk Factors for Medical Professionals

Practicing medicine, particularly in high stress specialties such as Emergency Medicine, Family Medicine, Oncology (pediatric and adult) and Urology contribute to very high burnout and suicide rates. A survey of almost seven thousand physicians asking questions from the Maslach Burnout Inventory was conducted by the Mayo Clinic and the American Medical Association (AMA) in 2011. It found that roughly forty-five percent of the physicians surveyed fit the criteria for burnout. A follow-up survey done in 2014 found that the rate had increased to approximately fifty-five percent, an increase of ten percent. All of the physicians surveyed reported a lack of work-life balance that led to an overall dissatisfaction, the study did find nominal variations based on career level, age and sex.

But what about nurses? Until very recently there seemed to be no data on just how much emotional stress nurses endure. It’s been reported that every nurse suffers at least one major depressive episode during the lifetime of their careers. In England the suicide rate for nurses is twenty-three percent higher than that of the national population average. In Australia the suicide rate is much higher, with reporting on suicides of medical professionals between 20001 and 2012 at seventy-nine for physicians and two hundred and sixteen for nurses. So the issue seems to be worldwide. But what exactly are the factors that cause this increase of suicides?

In the U.S. nursing is often a low pay, high stress job. Nurses, and especially registered nurses, are considered the front lines of medicine. They often have the most contact with patients in any setting, be it an emergent one, clinics or even physician offices, and so they serve a very diverse patient population. They’re responsible for administering medications, educating patients and their families in regards to illnesses and treatment protocols, and general case management.

If working in a physician's office, clinical setting or outpatient facility the caseload will be astronomical and in most facilities in the United States, nurses are in short supply. Many facilities in the last few years have found one nurse doing the job of three or more, resulting in a distressing lack of a work life balance. One of the studies in the Medical Journal of Australia found that increases of suicides in nurses seem to be tied to traditional societal gender roles migrating over into the profession.

The idea that women are the more caring sex, forces this behavioral expectation onto female nurses bringing with it the emotional stresses often tied to being emotionally invested. Coupled with the responsibility for the very life of a patient and the overwhelming workload leaves little room for self care resulting in anxiety, depression and eventually, if left untreated, suicide. 

Making it Easier to do a Better Job

Nurses are spend many hours on their feet and are beholden to attending physicians, but they often have to make split second decisions regarding personal care for patients. An overworked, tired nurse is prone to making mistakes and when these happen, depressive episodes may ensue. One too many mistakes leading to untreated depression can cause suicide, and with being pulled in many different directions both professional and personally most nurses may not have to time to seek out professional help for depressive symptoms. It’s before it gets to this point that the facilities need to step in and implement programs to make sure that their most at risk  population is being served just as well as they serve it.

It’s not only beneficial to facilities and their staff to have employees that are emotionally balanced, but studies have shown that patient care is directly impacted by the mental and emotional stability of the provider, since nurses are not only the front line but the constant contact of patients, it behooves care facilities to create and maintain an environment that is conducive to the emotional and physical well being of their nurses.

This includes making some things easier for nurses such as being able stay on top of patient care through using mobile devices and organizing nursing stations to make it easier for nurses to attend to patients quickly and efficiently. Some hospitals running beta programs using handheld devices saw a decline in mortality rates when nurses were able to quickly call up a patient chart from a handheld device within reach. The handheld devices used in a hospital are not off the shelf devices. These come preloaded with software relevant to the hospital where they will be used and are networked so that anyone with authorization can see patient information.

With the devices, nurses can record and monitor, blood pressure, heart rate, oxygen levels and pulse. The stats are then uploaded to the networked system where it can be accessed quickly in emergency. One hospital saw a drop in fatalities of four hundred patients at the end of the first year after handhelds were introduced, the key reason is that nurses were able to quickly assess deterioration in patients and react immediately.

A drop in mortality rates have been shown to have an effect in overall provider morale not just for nurses, but across the spectrum of healthcare providers.

Creating Programs to Combat Nurse Suicides

The medical  profession can be very impersonal and cold, any patient can tell you that. Now imagine working inside of such a system where you’re expected to deal with trauma, infectious disease, death and continue on in a professional manner day in and day out while doing it twelve plus hours a day. This is the daily reality of nurses.

There needs to be support systems put in place so that nurses can safely vent or simply recuperate from the day that they have had. Programs that teach coping skills should also be targeted especially to incoming nurses to ward off early burnout and suicide. This support system needs to strive to create a balance between the home lives and work lives of nurses, while making sure to create a stable work environment where nurses aren’t exposed to violence, sixty percent of new nurses that quit their jobs in the first six months do so as a consequence of some form of violence, overwork and derision at the hands of patients or physicians.

There have been some programs implemented in the last decade that are targeted at helping physicians to cope with both the emotional and physical demands of the job that result in burnout and suicide. Slowly but surely the establishment seems to be catching on that the front line nurses also need the same care and attention. Currently in the United States, there are a few facilities such as the New York State Nurses Association that are focused on implementing programs across the state that target burnout in nurses, other individual hospital facilities are following suit. It may be slow, but at the very least it’s a start.