Despite all their medical training, professional nurses are sometimes unable to recognize symptoms of illness when it happens to them, even something as life-changing as depression. With vague symptoms like moodiness, exhaustion, distraction, weight fluctuations, and even sleep problems, nurses can easily shrug off disruptions to everyday stress.
But depression isn’t something to shrug off because it affects everything from a nurse’s daily life to the patient care he or she gives at work.
There’s no denying nurses endure enormous work stress, but depression isn’t the same thing. “This is not about situational stressors,” says Susan Letvak, PhD, RN, FAAN, chair of adult health nursing and director of undergraduate programs at the University of North Carolina at Greensboro School of Nursing. “This is truly an illness like diabetes.”
Joanne Matthews, DNP, MSN, RN, APRN-CS, a clinical assistant professor at the University of Kentucky College of Nursing agrees. “Everyone gets sad and people need to understand that,” she says. “This is more than temporary. There’s a big difference between depression and stress. Stress can be a strong contributor and can be a precursor. It’s important to recognize the symptoms of depression. Depression can be insidious in nature and can come on over time where the symptoms can creep up on you.”
What makes nurses so much more prone to depression? A nurse’s job is typically fast-paced, intense, requires being present and focused all the time, and often directly affects others. According to a 2012 study funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, of which Letvak was a lead researcher, approximately 18% of hospital-employed nurses experience depression, double the rate of the general population.
As if that weren’t alarming enough, there is also a ripple effect when a nurse is distressed. Patient care can suffer and other coworkers have to pick up the slack. “When nurses are down, everyone can sense it,” says Letvak. But few want to or are able to deal with it openly. Nurses worry that even a hint of mental health troubles could negatively impact their careers. Depression makes frequent health headlines, but many still feel the stigma and worry that someone will tag them as a less capable professional if they struggle with mental health issues. “Especially in nursing, we are supposed to be the ones who care for other people,” says Letvak.
Identifying the Symptoms
So what does typical depression look like? Lots of people recognize the traditional symptoms of being sad and feeling hopeless, but sometimes, it’s less obvious.
“Symptoms nurses should pay attention to include: difficulty concentrating, difficulty remembering, difficulty making decisions,” Matthews says. Most significantly is that the symptoms do not go away and are persistent. You might find yourself feeling guilty or hopeless, feeling fatigued or drained no matter how much sleep you get, and feeling headaches, stomachaches, and body pains for no identifiable reason. Your eating habits might change as well, and you might be overeating or not eating enough. And rather than sad, you might be more combative, and find yourself in conflicts with colleagues or family members.
As Matthews says, some symptoms are so draining that it makes it hard to sustain any kind of effort over time or to sustain a change. It makes it difficult for you to do your job or even enjoy your job—so much so that you might find yourself dreading going into work and leaving with less satisfaction than you once did.
Matthews notes that depressed nurses can show up at work and not really be there—something she calls “presenteeism.” “You are not as productive at work because of illness or injury,” she explains. Depression is a top cause of presenteeism, she says, and leads to more patient falls, more medication errors, and lackluster patient care. You aren’t at your best as a nurse, but that also means your team can’t depend on you either.
What Can You Do?
Linda Grabbe, PhD, APRN-BC, a clinical assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University, says talking about depression and the symptoms isn’t always easy in the workplace. “Nurses are just like all other people in relation to that stigma and being afraid of being labeled and afraid to get help,” she says.
If you feel any symptoms are unusual or a red flag, an appointment is in order. “The most important thing about treatment is having an appropriate diagnosis,” says Charon Burda, MS, PMHNP-BC, CARN-AP, assistant professor and director of the psychiatric mental health nurse practitioner specialty at the University of Maryland School of Nursing. Because depression symptoms overlap with symptoms of other things like chronic fatigue, burnout, thyroid disorders, or even anemia, knowing the root cause of what you are dealing with is essential.
Treatment for clinical depression involves things like medication and behavioral therapy, and those might be equally as effective in treating mild depression as well. Even if you are mildly depressed, you want to take action since untreated symptoms can escalate to clinical levels.
If you are wondering what to make of your own symptoms, Letvak recommends online depression scales, like the PHQ-9, as a valid and reliable indicator of depression as long as they are answered honestly.
“If your scores are all the way to a 10, you are clinically depressed and you are not going to shake it off,” says Letvak. “If you are clinically depressed, it’s not just going to go away on its own.” As Matthews notes, the symptoms will be persistent, but she also says they will affect all areas of your life, not just work or family.
Matthews reminds nurses that taking a tough stance won’t help. “Depression is an illness with a biological basis, but it is very curable,” she says.
Treatment helps, so don’t ignore the symptoms in hopes they will just go away. “You can’t power through depression if it’s biologically based,” she adds.
To boost your treatment plan, you can also use a computerized cognitive behavioral therapy tool, such as MoodGYM, at home. You can also try some proven methods for help managing the symptoms including yoga, exercise, eating well, getting good-quality sleep, journaling, simplifying the aspects of your life that you are able to, and making space and time to support yourself.
Managing a Depressed Nurse
What happens if you’re a manager and a nurse’s behavior raises red flags? Remember, protecting the mental health of nursing staff protects patient care quality in an organization.
“Even nurse managers may be aware that they have a nurse who might be depressed, but they don’t know how to approach it,” says Letvak. If they aren’t calling in sick every day, a nurse manager might not want to rock the boat by commenting on a nurse’s mood. But if you saw a colleague limping, you would ask about how they are doing, so part of forging a culture of openness includes talking about mental health.
If you feel comfortable, you can broach the topic in a nonjudgmental and casual way, says Letvak. Mention how her upbeat personality seems to be more down lately and ask if she wants to talk about it. “That opens the door,” says Letvak.
As Matthews notes, having an honest reason for raising your concern makes a difference, too. If you are concerned about patient care, mention that in private and in a caring manner. “Say, ‘I am worried about you and worried about the safety of the patients. I noticed you seem down and you don’t smile as much. There were two mistakes last week and that’s just not like you. Is there something you would like to talk about?’”
An Organization’s Role
Organizations play a crucial role in prioritizing mental health. Letvak suggests display boards including mental health information and resources. Consider organizing or proposing seminars. “Ask for in-services about how to achieve excellent self-care while working 12-hour shifts,” Burda suggests. “Give nurses time to talk to each other.”
And because loss and grief is such an integral part of nursing, a debriefing group or process offers huge benefits for nurses struggling to cope with losing patients. Nurses frequently experience what Letvak refers to as grief syndrome. “Nurses are constantly exposed to grief,” she says. “There is almost nothing in nursing for chronic exposure to death, dying, and sickness.”
Burda notes that an effective barrier to the kinds of stress that can lead to depression is often right in your professional circle. “A mentor, someone who is older and more experienced, can tell you how they deal with the job over time,” she says. A more experienced nurse can help you cope with the daily trauma you witness, the sadness when a patient dies, or the feeling of having little control. They can also help you refocus to manage your own personal and professional expectations about being a nurse. “Having peers to talk about the issues that bother you the most increases your resilience rather than becoming overwhelmed by what you see as stressful,” says Burda.
Depression is an important topic for the nursing profession, and if the topic is personal for you, getting help is crucial. Treating depression will make you feel better and help you continue to provide the best possible patient care.
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