Nurse Suicide: How to Support Nurse Mental Health

Resilience in nursing is essential. However, it can no longer come at the expense of ignoring our humanity. After years of nurses persevering to meet unrealistic healthcare expectations, moral distress, moral injury, and burnout have taken their toll. The rising tide of mental health issues and suicide among nurses is sounding an alarm for change. But, as nurses, we rarely discuss nurse suicide or our mental health. Why?

As the caregivers, nurses often find nurse mental health and suicide sensitive, awkward, and even scary topics to discuss. We’re here to help you understand these topics a little better and help start normalizing the conversations. We’ll review statistics, nurse mental health stigma, suicide risk factors, and warning signs, along with resources to assist if you or a colleague are struggling.

Nursing Suicide Statistics

The nurse suicide rate is alarming. Nurses have an 18% greater suicide risk than the general public. However, female nurses in particular are at even greater risk, with almost twice the chance of death by suicide than the rest of the population.

When the American Journal of Nursing took a closer look at these statistics, they found that:

• Nurses are at higher risk for suicidal ideation compared with other U.S. workers.
• Nurses with suicidal ideation are more reluctant to seek assistance.
• Burnout contributes to the risk of nurse suicidal ideation.

Nurse Mental Health Stigma

A mental health stigma refers to a negative attitude toward people with mental illness or mental health issues. For years, nursing has utilized an unhealthy professional mindset of “survival of the fittest.” Nurses learn to compartmentalize emotions and not seek help to avoid appearing weak. It’s often difficult for nurses to be trusting and vulnerable about mental health struggles or illnesses, especially if work environments are unsupportive or judgmental.

Nurses may also be afraid of harassment, punitive action, or job loss if their employer discovers they have a mental health condition, according to Healthy Nurse, Healthy Nation (HNHN). When nurses need but don’t receive assistance, their mental health can worsen — impacting job performance and patient care, which can have the paradoxical effect of disciplinary action or termination.

HNHN reminds nurses that if they receive treatment or are recovering from a mental health condition, including previous substance abuse disorder(s), they are protected by the Americans with Disability Act (ADA). They cannot be fired, denied a job or promotion, or forced to take leave due to their mental health condition.

Nursing Suicide Risk Factors

There are multiple risk factors for nurse suicide that the American Nursing Association (ANA) identifies as integral to the profession. These risks are in addition to those factors that increase the chance of suicide among the general population:

Nursing Suicide Risk Factors

There are multiple risk factors for nurse suicide that the American Nursing Association (ANA) identifies as integral to the profession. These risks are in addition to those factors that increase the chance of suicide among the general population:

Suicide Warning Signs

Knowing the warning signs for suicide are essential for prevention. A detailed list of suicide warning signs that the American Foundation for Suicide Prevention compiled is provided below. Most people who take their lives will display at least one of these behaviors.

Consider warning sign(s) that appear as a change in behavior or new behavior in the setting of a painful event, loss, or change as particularly dangerous. Many nurses are excellent at compartmentalizing their emotions as a professional coping mechanism. So, some of these signs can be subtle. They include:

1. Talking about any of the following:

• killing themselves
• feeling hopeless
• having no reason to live
• being a burden
• feeling trapped
• unbearable pain

2. Exhibiting behaviors that may signal risk, especially if related to a painful event, loss, or change, including:

• increased alcohol or drug use
• looking for a way to end their lives, such as researching methods online
• withdrawing from activities
• isolating from family and friends
• sleeping too much or too little
• visiting or calling people to say goodbye
• giving away cherished possessions
• aggression
• fatigue

3. Experiencing or displaying one or more of the following moods:

• depression
• anxiety
• loss of interest
• irritability
• humiliation/shame
• agitation/anger
• relief or sudden improvement

Normalize Speaking About Mental Health and Suicide

It’s often said that it’s okay to not be okay, but what isn’t okay is to suffer in silence. It’s not easy to ask for assistance or respectfully broach your concern with a nurse you believe is at risk, but it’s worth it. Nurse suicide is preventable.

When someone has suicidal ideation, their mood and energy can be so dark and so low that they require a caring person to guide them to the help they need. Each nurse is worth a conversation — the crucial first step that can save their life. To facilitate nurses normalizing conversations about suicide with peers, the ANA has provided a strategy utilizing the acronym AIR (Awareness, Identify, Recognize):

1. Awareness: Be aware of the warning signs of suicide and how your team is doing.

• Know what signs to listen for and observe.
• Talk and be present with fellow nurses regularly.
• Cultivate an open, trusting, and empathetic environment.

2. Identify: Engage with coworkers to identify when someone is in crisis.

• Trust your instincts.
• Plan for safety. Use situational awareness to ensure you’re speaking in a confidential and secure space (e.g., no weapons present).
• Start the conversation. For example, ‘I notice you’ve been quieter than usual this week. Would you like to talk about it?’
• If there are no signs of suicidal ideation, plan to reconnect later.

3. Recognize: Understand the urgency to take action. The warning signs of suicide are a signal for help.

• If there are signs, ask directly if they have thoughts of suicide or a suicide plan.
• Always believe a person when they report suicidal ideations or a suicide plan.
• If they do, stay with them until they get assistance. Follow any mandatory reporting to the state.
• Immediate access to lethal methods (firearms, high-risk medications, etc) should be removed.
• If the nurse is at imminent risk of harm to themselves or is actively suicidal, call 911 if they refuse to go to the hospital.

Nurse Suicide Resources

We gathered a list of resources to assist nurses struggling with mental health issues or suicidal ideation in getting the assistance they deserve. Many of these resources also assist colleagues and family members concerned about a nurse in their lives.

Help Is Available: Talk to Someone Now

Nurse suicide is preventable. If you or someone you know is having suicidal thoughts or struggling with mental health issues, call or text 988 to connect to the National Suicide and Crisis Lifeline. The lifeline is available 24/7 to provide free and confidential help in the U.S.

Medical Disclaimer: Any medical information contained in this article is only provided as a general informational resource. It should not be relied on for diagnostic or treatment purposes. The information in this article does not create a patient-provider relationship, and should not be used as a substitute for professional medical care. Please consult with your healthcare provider for guidance about a specific medical condition and before making any healthcare decisions.