Judy Davidson, DNP, RN, FCCM, FAAN, EBP, is the lead author of a recent research paper titled “Nurse Suicide: Breaking the Silence” published in the National Academy of Medicine’s Perspectives: Expert Voices in Health & Health Care.
We interviewed Davidson at length about this incredibly important topic to help raise awareness during National Suicide Prevention Month. What follows is Part 2 of our interview. (Check out Part 1 here.)
It seems like nurses—when it comes to suicide—don’t matter as much in the eyes of the health care system as other health care workers do. Why?
I don’t agree with this statement. It is our own problem that we don’t track these issues or actively address them. Believe me, when the Chief Medical Officer and CEO read the results of our pilot extending the Healer Education Assessment and Referral Program (HEAR) to nurses and hospital staff, they were right on top of it, working out a strategy for how to fund the program moving forward. We, as a profession, have to frame it as a problem with data to back up our emotional plea to move this into the public light.
I am very grateful for nurses who are now coming forward to share their stories, putting a “face” to the problem and helping to destigmatize mental health issues. When our initial data was published in the Journal of Nursing Administration on the same day “Breaking the Silence” came out, the American Foundation for Suicide Prevention changed their website from “Physician” Suicide Prevention to “Healthcare Clinicians.” The content is heavily geared towards physicians, but that is only because we haven’t studied or tested enough strategies with nurses to have more prominence on the page. As soon as we do, they will gladly market best practices for others to learn from.
Since they take the most prominent role of caregiver, do you think this is why they are being ignored? Why hasn’t more research been done? Why haven’t more programs been developed to help nurses prevent suicide and deal with its aftermath?
We are not being ignored, we have ignored ourselves. No one is to blame. We didn’t know what we didn’t know. No one thought to ask. Now that the questions are being asked, we will find the answers. We learn a great deal at an organization level by participating in the HEAR program and offering our nurses the interactive encrypted anonymous risk screening. They tell us about actionable risks that can be reduced in the workplace. Top on the list is bullying and lateral violence. Every leader has an obligation to actively reduce bullying in the workplace. It’s not just an issue of employee satisfaction and retention, workplace wellness—when you come down to it—is about saving lives.
How can nurses recognize signs in coworkers that they may be severely depressed and possibly contemplating suicide?
Burnout and compassion fatigue can lead to or coexist with depression. Recognizing those issues when they occur, and preventing them with caregiver support strategies, can go a long way. We tested a strategy for caregiver support that was originally published by Susan Scott at the University of Missouri. Peers elect peers that are naturally good at helping colleagues through rough days. These peers receive special training to become emotional first aides. They keep on the watch for people who might need help and provide comfort as the need arises. When they sense that this collegial help is not enough, they go up an emotional aide type of chain of command to get their colleague the help they need. It is a wonderful program. We are now expanding the HEAR program to include this level of caregiver support.
In addition, our HEAR counselors who become experts at workplace crisis management also provide emotional debriefings for groups and individuals after a significant clinical event. We don’t wait for them to ask for help. Risk management informs the counselors that there has been a significant event and the counselors proactively offer their services.
If they do become aware of these indicators, what’s the best way for nurses to intervene to help other nurses?
Once the HEAR program is in place, after getting into the habit of recognizing each other when there is stress or crisis, the counselors that run the screening help to triage and find people the professional help they might need.
Is there anything else that you think is important for people to know?
If you or someone you know is suffering from depression or suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255.
For more information about starting a suicide prevention program in your own organization, contact mmortali@AFSP.org.
Do not try to create a screening program on your own. The program at AFSP has been tested and works.
Suicide, in and of itself, is a tragedy for all involved. One field in which it hasn’t often been discussed is nursing. Earlier this year, that began to change when Judy Davidson, DNP, RN, FCCM, FAAN, EBP, and her colleagues published an article in Perspectives: Expert Voices in Health & Health Care titled “Nurse Suicide: Breaking the Silence” to start a conversation about nurse suicide while raising awareness.
In honor of National Suicide Prevention Month, we interviewed Davidson, who is a nurse scientist at University of California, San Diego Health, about this incredibly important topic.
What was the impetus for conducting research about suicides in the nursing community?
We began this exploration of nurse suicide after experiencing suicides in our own workforce and then finding nothing in the recent literature about nurse suicide in the U.S. International data and historic U.S. data suggested nurses were at higher risk than the general population, but before our recent work it hadn’t been studied in over 20 years. A lot has changed in the profession since then and suicide is on the rise worldwide.
What was the most surprising fact about nurse-related suicide that you discovered in your research?
What I couldn’t believe is that we do not collect gender as part of our yearly workforce data. We are struggling to do the research that is needed on suicide because of it. While the world has increased a focus on gender issues, we do not really know how many men vs. women are licensed nurses—and that is just the binary code. We should be further along on understanding this very basic demographic of our own workforce.
Why is it important with suicide? Well about four men complete suicide to every one woman in the general population. Nursing is a female-dominated profession, so you can’t just compare nurses to the general population. To do this work correctly, we need the denominators of males and females to figure out comparative proportions and relative risks. It can’t be just our work that would be enhanced by accurate gender data. There must be hundreds of research questions about nurses that would benefit from this information. And it wouldn’t be hard to do. Every year on December 31, every state reports the number of licensed nurses to the National Council of State Boards of Nursing. If gender were collected with the license renewals, within three years we would have accurate data on a national level.
Another surprise is that in the literature it often points to “access to means” as a risk for nurse suicide. This assumption is made because wherever it has been studied in the world nurses are more likely to use medications as the method of suicide. However, in our pilot looking at 10 years of nurse suicide in San Diego, we did find that nurses completed suicide more commonly with medications than other methods, but the mess were things like Benadryl and Tylenol; not drugs of diversion. We are just beginning to sift through the longitudinal NVDRS [National Violent Death Reporting System] dataset from the CDC and the 2014 Data is suggesting the same thing. It is beginning to look like knowledge about how to use medications in a lethal manner may be a more prominent factor than means.
Your research yielded so much information about how nurse suicides haven’t been recorded, dealt with, and that there is no standard best practice across the board for how to prevent them or how to help the coworkers deal with it. Why are nurses, in this way, not being taken care of? Are they expected to keep the proverbial stiff upper lip and keep going no matter how they feel? Do you think that nurses are concerned about losing their jobs by admitting that they may have mental health problems?
Since we have published “Breaking the Silence,” I have heard from many nurses who have personally had suicidal intent. They tell me that stigma plays a large part, not wanting to be treated for mental health problems, especially by the very people you work with. Untreated depression can lead to overuse of alcohol and drugs. Sadly, we often move nurses out of the profession if they are found to have this problem.
Then there is the travesty of DUIs. When untreated depression leads to problem drinking, eventually a DUI is bound to occur which is reported to the Board of Registered Nursing. When that happens, at least in the state of California, it is almost impossible to keep a position as a nurse. So, out of work and untreated, some lose hope.
I’m not saying we should excuse people who drive under the influence, but instead let’s focus on the root causes and seek and find those who need help and welcome them back to the workforce after they get the help they need.
Partnering with physicians on this research, I’ve learned a lot about how they deal with these issues. It is very different. Faculty or house staff can leave for months without penalty, license intact, and come back when they are on the mend.
The Healer Education Assessment and Referral Program (HEAR) seems like a good one. But why do you think it wasn’t extended to include nurses until seven years after its inception? It is very strange. The founders of that program shake their heads and wonder too. The most remarkable thing is that the program was “jump started” by a nurse after losing her husband, a physician, to suicide. It might have something to do with the fact that physicians have known for a long time that they are at risk. We, as nurses, are just coming to that awakening.
Another odd coincidence is that I was conducting a study on Caregiver Support at the time our local nurse suicides occurred in a luster. I mentioned it to my research partner, who’s a founding member of the HEAR program. He told me about the physician prevention program, and I was stunned. Right there, under our noses was the answer I was looking for. I’d been searching in the literature without success to find prevention measures when, in our own house, a program had been developed that the American Medical Association has recognized as a best practice in suicide prevention—but none of us nurses even knew it existed.
They gladly shared their resources, and instead of recreating a parallel program for nurses, we expanded theirs to include us. The reason we were in this cone of silence to begin with was because we operate in parallel universes. Coming together, we are really learning a lot about each other, our mutual stressors in the workplace, and creating stronger action plans for change.
For more information, check out Part 2.
While anyone who works long hours at a high-stress job is vulnerable to burnout, nurses, doctors, and other medical professionals are at an especially high risk of experiencing this phenomenon, which the Mayo Clinic defines as “a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work.”
After all, hospital employees often work 12-plus-hour shifts—and residents sometimes put in more than 28 hours straight. And in many cases, they’re treating patients who are in serious pain or whose well-being or lives are in grave jeopardy. Indeed, it’s no wonder that 70% of nurses are experiencing burnout in their current position, while more than half of physicians report at least one symptom of burnout. Even if they don’t experience complete burnout, many hospital employees experience negative emotions such as stress and anxiety on a regular basis, which can affect both their work and personal lives.
However, there are steps that medical professionals can take to reduce feelings of burnout, stress, and anxiety if they work in a high-stress hospital environment. Here are seven different ways facilities around the country are trying to help their employees de-stress, whether they’re on the job or off the clock.
1. Group Activities and Classes
Hospitals frequently host or subsidize group activities that encourage creativity, social time, and stress relief. Popular class ideas include dance, pottery, painting, knitting, and group journaling exercises. Other group activities focus more on fitness and nutrition, such as educational sessions on eating a healthy diet or coordinating group fitness classes like yoga or aerobics. While engaging in these activities on your own can reduce stress and give you a mental break from work, doing them with coworkers creates the additional physical and mental benefits of socialization.
2. Facility or Department Events
Many companies host employee appreciation events to celebrate their workers, and hospitals are no different. Department lunches, holiday parties, and award ceremonies give employees a chance to hang up their stethoscopes and socialize without the pressures of work. If their facilities don’t host such happenings regularly, hospital employees can still coordinate their own low-key events, such as cookouts, potlucks, and game nights. Even if it’s just a couple people getting together for a casual lunch, it’s still a good opportunity to de-stress with coworkers who understand the unique demands of the job.
3. Havens of Relaxation
More and more hospitals are going beyond your average break room to create calming havens for employees to relax in during breaks. Sometimes called “serenity rooms,” these areas incorporate soothing features such as dimmer lights, soft colors, comfortable chairs, relaxing music, pleasing artwork, and beverages or snacks. Such rooms give doctors and nurses a chance to take a break from patients and families to clear their minds and release some of the stress and anxiety they’ve internalized during their shift.
4. “All-Natural” Stress Relief
Hospitals and employees often turn to Mother Nature to help them de-stress while in the middle of a shift. Many of the “serenity rooms” mentioned above use indoor plants to create a welcoming space full of life or incorporate water features to provide pleasant, soothing background noise while employees relax. Other facilities have created small outdoor gardens where staff can step out and get away from the chaos of the hospital for a few minutes. And if the facility is lucky enough to be located near beautiful natural surroundings, whether that’s lush forests or towering mountains, some employees find that just looking out the window is enough to give them a quick mental break and remind them of a world beyond the hospital walls.
5. Massages, Meditation, and More
Many businesses have begun offering free or low-cost massages to employees to help them de-stress, and no one needs it more than hospital employees. Some hospitals offer massages regularly, on a weekly or monthly basis, and even just 15 minutes of massage can help employees relax and return to work refreshed without having to change out of their scrubs. Other hospitals teach classes on meditation, deep breathing, and other relaxation techniques that doctors and nurses can draw from in a stressful moment when massages aren’t an option.
6. Expert Advice
Medical professionals may experience trauma while on the job, such as when a patient dies. Staff who work in certain departments, such as the emergency room or neonatal intensive care, are exposed to even more of these profoundly affecting incidents. Hospitals may call in chaplains to talk about the stress and provide emotional support to their employees, and some doctors and nurses also benefit from talking to peers who have experienced similar situations. In certain cases, some medical professionals find it very helpful to talk to a counselor, therapist, or psychologist about mental health issues directly resulting from work, such as PTSD among nurses.
7. Fewer Extended Shifts
Working extended shifts can negatively impact the well-being of doctors and nurses, in turn leading to more employee turnover—and less desirable patient care. For example, nursing shifts commonly last 12 hours and frequently go over that limit due to patient needs and staff fluctuations. Hospitals looking to reduce anxiety, stress, and employee turnover should work to create a culture where employees don’t feel pressured to stay for “voluntary” overtime or to pick up extra shifts. After all, when hospital shifts are shorter, the rates of burnout remain lower as well. Respecting days off and vacation time so medical professionals truly get a break are also critical for helping them rest up and come back to work refreshed.
There’s no denying that doctors, nurses, and other medical professionals experience high levels of anxiety, stress, and burnout, especially if they work in a hospital. Thankfully, facilities around the country are taking more steps every day to help promote the well-being of their employees. If you work at a hospital that hasn’t tried any of these stress-relief initiatives yet, see if you can start one or independently host an event for your coworkers.
Are you thinking about going to nursing school and already have a family at home to take care of? While balancing nursing school with a family can be a big commitment, it’s definitely doable, and many nurses going to school later in life already have a family, often including multiple kids. If you have a family and are thinking about going to nursing school—or are already enrolled—here are eight tips for balancing it all and staying sane.
1. Talk about the changes with your family.
Before you start school or run out to purchase your scrubs, discuss all the coming changes with both your partner and the kids so everyone knows what is going on. If your partner is going to take on new responsibilities once you start school—such as picking up and dropping off the kids at daycare or taking them to doctor’s appointments—clarify expectations beforehand and work out a plan. Then let your kids know that you’re going to nursing school, and explain that everyone’s schedule is going to change as a result. If they’re younger, they may take time to adjust to the new routine, so be patient with them.
2. Create a master calendar.
Some people like to keep their work or school and personal calendars separate, but it will be a huge help for you and your partner if you consolidate everything into one master calendar. At the very least, the calendar should feature major events such as exams, recitals, and doctor’s appointments, and if you’d like you can get more granular and add your class schedule as well. And don’t forget to bring your partner on board and invite them to contribute to the calendar: They can add work trips and other major events from their schedule so you’ll have all the family commitments in one place.
3. Figure out your peak study periods.
Are you a morning person or a night owl? Would you rather get up at 4 a.m. and do your studying early before anyone else wakes up, or do you like to stay up late and crack the books after the kids have gone to bed? There’s no right or wrong answer, but your studying will be more efficient and you’ll retain more material if you work with rather than against your circadian rhythm. You probably already have an idea of when your most productive periods are during the day, so try to get homework done during those times whenever you can.
4. Make the most of nap time.
If you have little kids, you know the blissful quiet that (finally!) descends on the house when nap time comes around. While you may be tempted to take a nap yourself after running around after little ones all day, use this time to check some things off your to-do list: Finish that assignment, study for that exam, take care of that chore. After all, the more you get done during nap time, the less you have to get done either super early or very late in the day, when you’re less alert.
5. Determine what you’re willing to sacrifice.
You’re not a superhero. You’re only human, and you can’t do everything on top of managing your family and getting through nursing school. Before school starts, take stock of all the activities in your life and determine what you must keep and what can go. For example, you might not be able to spend as much time with extended family as you used to, or you might have to give up a time-consuming hobby such as knitting. At the same time, make sure you leave some time to take care of yourself: Maybe you give up the knitting projects, but you can continue to make time for your daily workout.
6. Schedule family and couple time each month.
Wrangling a family is difficult enough without adding nursing school to the mix. Despite the schedule chaos, do your best to block off at least one day or night a month for family time. Visit the zoo, host an at-home move night, or go out to a park together. And don’t neglect your love life either: If you’ve got a partner, aim to schedule one date a month if you can. Put away the books and stethoscope, get a babysitter, and enjoy some well-deserved time away from the kids, just the two of you.
7. Find a support system.
There’s a good chance there are other parents in your nursing program, so seek them out and make friends. They’ll understand the challenges you’re going through, and you can swap tips and babysitter recommendations. Of course, everyone in the nursing program is going through the same experience, but fellow parents will be able to sympathize with cramming during nap time and other strategies only moms and dads can understand. You may even become study buddies, as fellow parents will probably keep a schedule closer to yours, which makes it easier to find mutually available times to study together.
8. Consider a part-time program.
If going to nursing school full time isn’t feasible because of your family situation, don’t be discouraged—there are plenty of part-time nursing programs out there. Check to see if there are any part-time programs in your area; these programs will be spread over more months, but they’ll require less time of you each week. You can also look into online nursing programs, some of which provide on-demand video classes, let your work at your own pace, or otherwise offer a more flexible schedule to accommodate the demands of parenting.
There’s no denying that nursing school is challenging on its own, and having a family adds an extra layer of complexity. However, with hard work, planning, and prioritization, plenty of parents get their nursing degree each year and launch fulfilling careers in nursing. Follow these eight tips to balance your family life with nursing school.
Every time you fly in an airplane, the flight attendant explains that, in a crisis, you need to put on your own oxygen mask before helping others—because you can’t help others unless you’re taken care of first. Unfortunately, with regard to their own health, nurses don’t follow this type of example.
According to a recent survey conducted at the Medical University of South Carolina (MUSC), about 75% of MUSC nurses admitted that they put their patients’ health, wellness, and safety before their own. In fact, they put their own well-being last. And even though nurses have quite a bit of knowledge about nutrition, they eat a 30% less nutritious diet than they should be.
Like they say in the air, you need to take care of yourself before you can truly care for others.
As a result, on June 13, MUSC launched a 60-day nutrition pilot that is designed to help nurses eat better and improve their eating habits with healthier food options. At three locations at MUSC, nurses will be able to increase the amount of fruits and vegetables they eat daily by getting Simply-to-Go foods, which are healthful, fresh, seasonal, as well as locally sourced.
Andrea Coyle, MSN, MHA, RN, NE-BC, Professional Excellence and Magnet Program Director at MUSC, answered some questions about this program.
Why did MUSC decide to do this?
MUSC nurses impact the lives of their patients, colleagues, families, and neighbors every day, so when we were approached by ANA Enterprise to spearhead the first HNHN pilot, the decision to participate was easy. The opportunity to collaborate with ANA and Sodexo Healthcare to offer more quality food options on our campus and serve as a model for other organizations is truly an honor.
The ANA Enterprise and Sodexo Healthcare have partnered, at a national level, to improve the health of America’s nurses through the Healthy Nurse, Healthy Nation™ (HNHN) Grand Challenge. Sodexo made a multi-million-dollar contribution to the American Nurses Foundation in direct support of the ANA Enterprise’s HNHN Grand Challenge.
Where did the idea come from?
Sodexo has operated the foodservice at MUSC for over 30 years, so it made sense that MUSC, which is also an HNHN partner, would be selected to be the first organization to participate in a HNHN quality of life program in the United States. MUSC is the only participant site in South Carolina.
Why do you think that nurses tend to put their health on the backburner?
Nurses have one thing in common; they want to help care for other people. It’s their passion. Often helping others takes priority over helping themselves.
Why do they need to take care of themselves like they do their patients?
At MUSC, our nursing shared governance and nursing leadership has made self-care a priority. One driving strategy in our nursing strategic plan is to integrate healthy living into the nursing culture. If nurses have the tools and support to care for themselves, taking care of the patients and community we serve will reap the benefits of healthy nurses.
The biggest excuse that just about everyone has when it comes to eating better is that they don’t have time to prepare foods. What advice do you give to nurses about making up their own healthful foods/snacks?
- Plan ahead: whether it’s packing up dinner leftovers to grab on the way out or getting up 10 minutes earlier to pack a lunch, have a plan for what you will eat for the day.
- Keep better choices on hand: a mix of nuts and dried fruit, low-sodium tuna packs, nut butter, microwavable soups are all shelf-stable options. If you have access to a refrigerator, yogurt or cottage cheese, cut up veggies and hummus. Hard boiled eggs will keep for a couple days.
- 2-for-1: when you purchase a grab-and-go item, pick up a second option for the next day or take turns with a friend where one person takes time to make the food run one day and you the next.
Assuming that the pilot is a success, is this something that you will market to other health care facilities or to nurses in general?
Absolutely! It would be so exciting to share lessons learned and best practices. Promoting health and wellness is bigger than MUSC; it expands into the community we serve. At MUSC we aspire to build healthy communities.
What benefits can hospitals and other similar facilities get from using this kind of program?
The biggest benefit of the program is to increase awareness of heathy food choices. Recognizing that fruits and vegetables, smaller portion sizes, and fresh food ultimately creates a healthier workforce.
Why is this kind of program so important?
The answer is twofold: Nurses must turn their passion for caring for others inward and make caring for themselves a priority. Nurses must also be role-models for healthy living and health promotion to ensure our patients and families stay well. This program provides healthy food choices, which is one way to make a difference in the lives of nurses as well as the patients and families that depend on us for health promotion and wellness.
From ultrasound powered by artificial intelligence to image-sharing tools on the cloud, technology advancements are improving the quality of health care at an unprecedented rate. Yet, when it comes to one of the most universal and compelling health care needs – a smooth and successful pregnancy and childbirth – we still have a long way to go.
Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. The United States accounts for the highest maternal death rate in the developed world, and the number has been steadily increasing over the last two decades. What should be a moment of joy and celebration can become an unbearable tragedy.
The operative word in these troubling statistics is “preventable.” And one of the keys to avoiding these tragedies is more closely monitoring the health of the mom and baby. The idea that you can’t manage what you don’t measure rings particularly true in pregnancy and childbirth.
Fetal and maternal health monitors provide invaluable data that can support clinicians and health care providers as they need to make quick and accurate clinical assessments throughout a pregnancy and during labor and delivery. However, these health care needs are at odds with recent trends in labor preferences.
For example, increasingly, expectant mothers want to take a more active role in their birth plans, not simply turn over the reins to the care staff. A growing trend among these patients is the desire for more mobility during labor.
The ability to get out of bed, walk around and even bathe can improve their overall comfort and experience – and may help decrease the length of labor. Not only do patients feel a sense of empowerment by choosing their birthing process, increased mobility may also decrease the length of labor.
During labor, women are often entangled in a sea of cords and monitors, significantly limiting their movement. Fortunately, expectant moms now have the option for cordless monitors that replaces the traditional, cumbersome belts, cables to support the traditional transducer system.
But as with many things, there’s still a role for “traditional” practices – including, in the case of childbirth, more movement and engagement on the part of the mother. Pairing this focus on the patient with advanced technology, we can achieve the best of both worlds: safer, smoother births with lower maternal-infant mortality.