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.