And University of California–San Diego researchers, who conducted the longitudinal study, said a pilot program at the university to help nurses at risk has proven successful and is ready to roll out nationally.
“Nurses are on the highest of the burnout scale,” said Rachael Accardi, a counselor with the university’s Healer Education Assessment and Referral (HEAR) suicide prevention program. She recalled the story of a male nurse who called her while he was on the verge of shooting himself.
“He didn’t have any support. He was going through a divorce,” she said. The demands of his high-pressure job made it more difficult to cope.
Nurses are exposed to the carnage of fatal accidents, stabbings, and shootings, and they establish relationships with patients who often die. They experience more loss and grief than most people and, as a result, are at an even greater risk of depression, Accardi said.
Nursing shortages, especially in California, have only added to workplace woes. Forty percent of nurses have burnout levels exceeding the norms for health care workers, according to a HEAR program lecture series. Job dissatisfaction among nurses is four times greater than the average for all U.S. workers, and one in five hospital nurses report they intend to leave their jobs within a year.
“He suffered from major depression, among other things,” Accardi said of the male nurse who called her. “My job was to make sure that he felt heard and he felt seen while giving him a few techniques to regulate himself, so that he didn’t think suicide was the only option.”
How HEAR Helps
HEAR has helped about 500 health workers since its inception in 2009. In 2016, it began screening nurses, trying to catch problems early.
Accardi feels the stigma around depression is lifting as a result.
“The number of nurses who continue to meet with us in the HEAR program increases every year. So, at least in my opinion, that’s an indication stigma isn’t holding them back as much.”
HEAR counselors use grounding techniques and mind exercises to help the nurses focus on what’s in front of them, rather than dwelling on painful thoughts that could drag them into a downward spiral.
The program also connects the nurses with psychiatrists for continuing therapy.
“Our promise is that we’ll bridge that gap, even if there is a waiting list to get in with a therapist,” Accardi said. “We’ll see you as many times as it takes to get you one.”
Had that male nurse not called HEAR, Accardi said, “I’m not sure what would have happened.”
“To watch him on the completely different side of it now is really remarkable,” she said.
Dr. Judy Davidson, senior author of the recent UC–San Diego study, said in a statement: “It is time to take urgent action to protect our nursing workforce. The HEAR program is ready for replication at the national level to address this newly recognized risk among nurses.”
Opioids and Firearms
“Female nurses have been at greater risk since 2005 and males since 2011,” Davidson said. “Unexpectedly, the data does not reflect a rise in suicide, but rather that nurse suicide has been unaddressed for years.”
The study, published in the journal Worldviews on Evidence Based-Nursing, found that female nurse suicide rates from 2005 to 2016 were 10 per 100,000, higher than the rate among all U.S. females of 7 per 100,000. The suicide rate among male nurses was 33 per 100,000 for the same period, compared to a rate of 27 per 100,000 among the general male population.
“Opioids and benzodiazepines were the most commonly used method of suicide in females, indicating a need to further support nurses with pain management and mental health issues,” co-author Dr. Sidney Zisook said in the release. “The use of firearms was most common in male nurses, and rising in female nurses. Given these results, suicide prevention programs are needed.”
While overall mortality rates are decreasing in the United States, the suicide rate of 13 per 100,000 people is rising, according to the study.
Accardi said typical warning signs that someone may be suicidal are mood changes, increased anxiety, depression, impulsive behavior, anger, or even rage. Other red flags include someone giving away their belongings or talking about what it would be like if they didn’t exist.
“You can see it. Their personality changes,” Accardi said. “Their whole lives change, their outlook on life becomes kind of meaningless.”
As far as she knows, nobody who has participated in the HEAR Program since screenings began has died by suicide, “because we’re so proactive, we’re catching it earlier.”