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Nurses and Suicide: When Loss of Identity Leads to Loss of Life

Nurses and Suicide: When Loss of Identity Leads to Loss of Life

For nurses who commit suicide, job-related problems likely play a major role in that tragic decision.

Such is the conclusion of a study of 203 nurses known to have job problems prior to death by suicide between 2003 and 2017 published in the April 2021 issue of the Journal of Nursing Regulation.

“Nurses who lose a nursing position or leave the profession because of substance use, mental health issues, or chronic pain are at risk for nurse suicide,” the article noted.

In a previous longitudinal study of nurse suicide, “one of the things that came out pretty clearly was that nurses were more likely to have a known job-related problem prior to death,” said Judy E. Davidson, DNP, RN, MCCM, FAAN, lead author of the project. Davidson serves as nurse scientist, UC San Diego Health Sciences and research scientist, UC San Diego School of Medicine, Department of Psychiatry.

The danger zone: situations known to increase risk of nurse suicide

Of the 203 nurses studied, nearly all were out of work or in the process of losing their position as a nurse, the study notes. The researchers analyzed narratives about the 203 nurse suicides written by medical examiners and law enforcement personnel. Using natural language processing and thematic analysis, the researchers discovered three main reasons for the suicides.

“Nurses with substance use disorder are treated inequitably to others in the world. Nurses are treated differently and inequitably, and it often leads to death.”
—Judy E. Davidson, DNP, RN, MCCM, FAAN

First, a nurse could have a serious mental health issue.  “Their mental health problems were not controlled to a point where they could continue working,” said Davidson.  Largely, the nurses suffered from depression.

Second, nurses could suffer from uncontrolled chronic pain leading to them no longer being able to function as a nurse and having to leave their job. That could lead to financial ruin, a destroyed family and a sense of having no way out, noted Davidson.

“Obviously we should be able to do a much better job at controlling people’s pain,” Davidson said. “There are many different types of way you can express yourself as a nurse, and there are desk jobs that nurses could do.  The whole issue of undertreated pain is definitely actionable.”

Third, nurses who die by suicide related to job loss may suffer from the mental health issue of substance use disorder (SUD). This cause is “really problematic for the profession and this is where we have a lot of work to do,” said Davidson.

“Nurses with substance use disorder are treated inequitably to others in the world,” according to Davidson. “Nurses are treated differently and inequitably, and it often leads to death.”

If the nurse doesn’t get help prior to being found on the job impaired or prior to diverting medications, then the nurse often loses his or her job at the point of identification, Davidson noted. “What we need to do is to be able to identify these nurses earlier in the course of their disease. Substance Use Disorder is a disease that is incremental in nature; it doesn’t happen overnight. And there are points in time when these people could be identified earlier, encouraged and motivated into treatment to prevent issues such as being found impaired in the workplace.”

When states have mandatory reporting requirements, those requirements prevent this from happening and drives these issues underground, Davidson said. “Nurses end up progressing in their disease to the point where they’re so far gone by the time they’re identified that it ends up being treated as a criminal issue instead of a disease-focused issue.”

Confidential prevention programs can save lives

One method to stop the progression from mental health issues to suicide involves a program for suicide prevention tested at UCSD in partnership with the American Foundation of Suicide Prevention and replicated nationally. A nurse, physician or other hospital worker is sent a request to fill out a survey in an anonymous encrypted program. If the respondent scores moderate to high risk, a therapist, who is also anonymous, will contact the person through encryption over the computer. The healthcare worker can then have anonymous online counseling, be referred to a psychiatrist or psychologist for maintenance therapy while remaining anonymous, or break anonymity and engage in traditional counseling.

“We’ve sent hundreds of doctors, nurses and hospital workers over the years into mental health treatment without anyone in the organization knowing who they are,” Davidson said. The employee’s manager will not know the reason why they took leave to get treatment.

Through this program, UCSD refers roughly 40 to 60 nurses a year into mental health treatment, including the disease of substance use disorder (SUD), Davidson said. “It works beautifully and is very cost-effective.”

Losing one’s “identity as a nurse”

“The nurse cracks when their identity as a nurse is threatened. It just breaks them.”
—Judy E. Davidson, DNP, RN, MCCM, FAAN

In another warning about the effects of job issues on nurse suicide, a study published in the November 2021 issue of the American Journal of Nursing found that burnout – which has become rampant during the COVID pandemic – was strongly associated with suicidal ideation among nurses.  “Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it,” the report said. “Burnout contributes to the risk of suicidal ideation.”

The events leading to job loss are largely modifiable, concluded Davidson and colleagues in the Journal of Nursing Regulation article. Alternative-to-discipline (ATD)  programs, it notes, would benefit from standardization, national oversight, consistent use of non-disciplinary measures, and focus on treatment while the nurse was temporarily removed from the workplace. Removal of license could be reserved only for those who are refractory to treatment, it notes.

At a core level, suggested Davidson, these nurse suicides have to do with a loss of identity. “The nurse cracks when their identity as a nurse is threatened. It just breaks them,” Davidson said. “We break our nurses by firing them when they have the disease of substance use disorder. We discard them from the profession where we could instead be healing them. We could preserve the workforce by focusing on earlier identification, motivating nurses into treatment on leave using anonymous programs like the one tested at UCSD, instead of breaking them by taking their jobs and licenses.”


For more information  about starting an anonymous encrypted screening program at your organization, contact the American Foundation of Suicide Prevention:  https://afsp.org/interactive-screening-program