The study, published in the November 2021 issue of the American Journal of Nursing, used responses from a national survey on well-being, which included questions on burnout and depression. The authors found that 5.5 percent of nurses experienced suicidal ideation (thoughts of killing oneself), approximately 1 percent higher than other workers. After controlling for factors such as age, gender, work hours, relationship status, and burnout, it was estimated that nurses had significantly higher odds — 38 percent — of having suicidal thoughts than other workers. “Our findings indicate that nurses are experiencing a high rate of suicidal ideation, burnout, and depression,” says Liselotte Dyrbye, MD, a physician at Mayo Clinic in Rochester, Minnesota, and the study’s senior author. “Given that the data used in the study was taken before the pandemic, these findings highlight the need to really act, because nurses are now under even more stress than before.”
Life-and-Death Decisions With Little Time for Breaks
“Nursing is stressful. Part of the job can involve making big decisions that may be a matter of life or death,” says Holly Carpenter, RN, a senior policy adviser in the nursing practice and work environment department at the American Nurses Association. “There’s a lot of knowledge, technology, and best practices to keep up with,” she adds. In the early days of the pandemic, there were often daily updates on guidelines regarding patient care, according to Carpenter. Staffing is also an issue in many health systems, she says. “There are situations where some nurses might go a whole 12-hour shift without a bathroom break. They might hesitate to take a vacation or even a day off because it will cause their unit to be short staffed and everyone else will have to work that much harder,” she says. Depending on the department, some nurses have to cope with the death of a patient regularly, says Carpenter. “In any other career, if anyone dies in your workplace, you would get the day off. If you’re a nurse and one of your patients dies, you may not even get a few minutes to process that before you have to go off and take care of the next patient.”
Job Burnout Is a Risk Factor for Suicidal Thoughts in Doctors and Nurses
Although nurses are the largest group of healthcare professionals, surprisingly little is known about their risk factors for suicide, in part because suicide is difficult to study, the authors write. An alternative end point often used by researchers is suicidal ideation, which is an established precursor to suicide attempts. Another factor that researchers try to quantify is burnout, which is an independent predictor of whether a healthcare worker will have thoughts of suicide, says Dr. Dyrbye. “Most of our work has been with physicians, but we recognize that they are not the only healthcare professional that experiences this — nurses and other types of healthcare workers do, too. It’s an important question because burnout is really driven by work-related stressors,” she says. Job burnout is defined as “a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity,” according to Mayo Clinic. Previous research indicates that approximately 35 percent of U.S. nurses have experienced depressive symptoms and 35 to 45 percent have had at least one symptom of burnout, according to the study authors.
Nurses Are More Likely to Think of Suicide, and Nurses at Risk Are Less Likely to Seek Help
The study aimed to find out how many nurses think about suicide, how that compares with the regular population, and how burnout is an independent risk factor for nurses developing suicidal ideation. Investigators used data from a questionnaire sent in November 2017 (pre-pandemic) to 86,858 nurses and a sample of 5,198 general workforce members. A total of 7,378 nurses responded to the survey; the median age was 51 years old, 92.7 percent were female, and 87.4 percent were white. The survey questions were designed to help researchers look for indications of emotional exhaustion, depersonalization, a low sense of personal accomplishment — all indicators of burnout. Survey items also included questions about depression, and how likely they were to seek professional help if a serious emotional problem arose. According to Dyrbye, there were three main findings:
American nurses experience suicidal ideation in greater numbers than other general workers, with 403 (5.5 percent) reporting suicidal ideation within the past year.Nurses who experience suicide ideation were less likely to seek professional help for a serious emotional problem than nurses without suicidal ideation. “That’s concerning because that’s obviously a big barrier for getting better,” says Dyrbye.Burnout was a risk factor for nurses experiencing suicidal ideation.
Sadly, these findings don’t surprise Carpenter. “We have ongoing surveys as part of the ANA’s Healthy Nurse, Healthy Nation program, which is a health, safety, and wellness program. “We do see that many nurses struggle with stress, anxiety and depression,” she says.
The Number of People Experiencing Mental Health Issues Has Increased Since the Pandemic
“There’s quite a bit of data showing that depression, suicidal ideation, and anxiety are about two- to fourfold higher now in the general public in the United States than before the pandemic, and that figure would include our healthcare workers,” she adds. In an ANA survey that was taken in January and February 2021 (about a year in to the pandemic), 23 percent of respondents reported feeling depressed and 1 percent reported suicidal ideation within the previous 14 days. “For those healthcare workers who are on the front lines taking care of COVID-19 patients, we’re seeing more and more data to suggest those people are experiencing a high amount of post-traumatic stress disorder (PTSD), anxiety, sleep disorders, depression; there’s no doubt that they are under an enormous amount of stress, and that is most certainly affecting their well-being,” says Dyrbye.
Changes in Healthcare Contribute to Stress and Leave Less Time for Patients
Some of the changes that we’re seeing in healthcare — such as changes in payment models and the emergence of for-profit hospitals — are creating enormous work pressure on the healthcare team to generate revenue and see more and more patients, says Dyrbye. “That’s happening at the same time as workforce shortages, which have been going on for a long time and have been exacerbated by the pandemic. Nurses are leaving the profession,” she says. The increased number of people accessing care, pressure from organizations to have high levels of productivity, and a workforce shortage have combined to create a “perfect storm,” says Dyrbye. “When the demands of a job are greater than the resources you are given to do the work, you get a high amount of work stress, and that leads to burnout,” she says. Another changing aspect of healthcare is that an increased burden of administrative and clerical tasks has taken away from the face-to-face time that doctors and nurses spend with patients, says Dyrbye. “Those interactions are the really meaningful work and why many nurses chose their profession,” she says.
Burnout Is Associated With a Reduced Level of Patient Care
These findings are also concerning because burnout has been found to negatively impact the care a patient receives, says Dyrbye. “We know that the level of nurse burnout predicts how likely you are to get a hospital-associated infection. Burnout in doctors and nurses in the ICU is an independent risk factor for whether you are going to live. Doctors and nurses who are experiencing burnout are more likely to commit medical errors and have professional lapses,” she says. Access to care is also impacted by burnout because healthcare workers who are experiencing burnout are much more likely to quit or cut back on their hours, adds Dyrbye.
Improving the Work Environment for Healthcare Professionals
Both Dyrbye and Carpenter cite individual and systemic changes that could improve the well-being of nurses and other healthcare professionals.
Eliminate inefficiencies that create time-consuming extra administrative tasks and take away time from patient care. Rules and regulations from insurance companies and Medicare need to be optimized and streamlined.Adequate resources, in both staffing and supplies, are needed to make sure the workload is manageable.Work to reduce the stigma attached to mental health issues in healthcare workers. In some states, a mental health diagnosis may put a nurses’ license or job in jeopardy.Mental health screenings are vital to identify issues early on, before a person is in crisis.Nurses need to engage in self-care and take care of their mental health. That may mean seeking counseling, time off, or rotating to a different department for a while.Mental health should be accessible, affordable, and confidential for all healthcare professionals.
