Nursing is one of the fastest growing professions in the United States. According to the Bureau of Labor Statistics, employment for registered nurses is projected to grow 12% from 2018 to 2028, a rate far higher than average for an occupational field. In a healthcare setting, registered nurses (RNs) take on a variety of critical responsibilities, such as providing and coordinating patient care, educating individuals and the public about health conditions, and promoting community wellness. Yet, a recent report showed that long work hours and unprecedented rates of physical or verbal abuse are taking a toll on nursing professionals. Across the country, nurse suicide rates are on the rise, and healthcare facilities have a responsibility to address mental health concerns in the field.
In July of 2019, the University of California at San Diego conducted a study on suicide rates and nursing. Research found significantly higher rates for suicide among men and women working in nursing when compared with non-nurses, as per MedPage Today. Researchers found a suicide incidence of 11.97% per 100,000 women who are nurses, compared to 7.58% per 100,000 women in general. Even though nursing is largely dominated by women, demographically hovering around 90%, the number of male nurses is growing. The study’s findings on suicide rates were consistent for men in healthcare as well. Men who are nurses were found to have higher incidences of suicide than men in general, with researchers finding 39.8% per 100,000 men who are nurses, versus 28.2% per 100,000 men not in the field.
Judy Davidson, the study’s lead researcher and a nurse scientist, explained how the research supported local data and anecdotal evidence. “This national data confirms what we previously suspected given our local findings, that nurses are at higher risk of suicide than the general population,” she told MedPage. She also went on to explain how awareness, and institutional changes can prevent these tragedies from occurring. “Now with this whole movement towards preventing burnout, increasing joy in the workplace, increasing resiliency, this is a piece of that puzzle, sadly it took a tragic event to get the ball rolling.”
Promoting a sustainable work environment for nurses is imperative for the future of healthcare. Despite rising demand for certified RNs, caused in part by an increase in preventative care, rising rates of chronic conditions, and an aging baby-boomer demographic with increasing needs for healthcare services, nursing shortages are impacting facilities across the country. The shortage will likely be compounded by dropping enrollment in nursing colleges, as well as many in the workforce coming of retirement age, in the coming years.
Why Are Nurse Suicides On The Rise?
Every day, nurses face a variety of unique challenges and stressors. Exhausting shift cycles often leave employees physically and emotionally drained, with little time for recovery before clocking back in. Given that healthcare is a 24/7 industry, shifts are required on holidays and weekends, a reality which can also increase strain on workers. Amid nurse shortages, overtime requirements are becoming more prevalent, and each individual RN may be responsible for a large number of patients during these shifts. According to Business Insider, a few nurses have reported working 12-hour shifts with so few breaks there isn’t even time to use a bathroom.
Nursing is also an inherently stressful profession, and witnessing terrible injuries or death takes an emotional toll on workers. Davidson, who led the study, points to how little time or support nurses receive to process trauma. In other public service fields, such as law-enforcement or first response, workers often receive time off following significant trauma. In an interview with KPBS, Davidson points out time-off considerations are not often used in nursing. “A nurse can work with a patient and develop a really deep connection with that patient and the patient may not survive. And then, as soon as the patient's gone to the morgue, she's expected to pick up the next one. So there's no break at all between these big events and then the next person they need to care for."
Rates of workplace violence in healthcare also far exceed other industries. Incidents of serious workplace violence are four times more likely to occur in a healthcare setting than other private industries, according to the Occupational Safety and Health Administration. In 2018, a poll conducted by the American College of Emergency Physicians found that half of emergency room healthcare workers reported being physically assaulted while on the job, as per NPR. Over 60% reported physical assaults that occurred within the last year. Even worse, incidents of workplace violence among nurses may also be going underreported. For many, these risks may seem compulsory to the job, and many workers feel their complaint won’t be taken seriously by management.
How To Address Nursing Mental Health Crisis
Unlike other high-stress fields, nursing may not have sufficient infrastructure to support employees during or following difficult shifts. A shift toward proactive mental health programming and active efforts to dispel stigma have become common in other fields with a high physical or emotional toll, such as first response. For example, law enforcement agencies recently received a $7.6 million dollar grant to fund police suicide prevention efforts, mental health screenings, and training to identify officers who may be a suicide risk, according to PBS.
The UC San Diego HEAR program takes a similarly proactive approach to promoting mental wellness for physicians, as per KPBS. Given that doctors and nurses are known to be high-risk for mental health concerns, professionals are encouraged to take an encrypted screening once a year. Through the screening profile, the program can identify individuals who may be struggling and provide them with appropriate mental health treatment. Nurses remain anonymous throughout the process, which leads to a higher rate of success in an industry where many feel afraid to voice concerns.
Nurse labor unions are pushing for systemic changes to workplace culture in healthcare. A national effort to push OSHA to have more authority in monitoring hospital safety and addressing physical or verbal violence against employees. The “Workplace Violence Prevention for Health Care and Social Service Workers Act”, which recently passed in the House, would push healthcare facility administrators to take more responsibility for workplace safety. The legislation would hold employers accountable, through OSHA, for having an effective violence prevention plan in place.
Insufficient patient to nurse staff ratios are also an area hospitals can look toward for answers. Nursing strikes to protest for better conditions for patients and workers have become a national norm, with labor unions citing the role wait-times and insufficient care has in increasing incidents of workplace violence. One way hospital or healthcare managers can better care for the mental well-being of nurses is by ensuring these workers are not over-worked on a shift or put in a dangerous position with a patient. If nurses are unable to manage patient quotas and strike for better labor, hospital operations will inevitably be disrupted. Being proactive about nurse safety and mental health is a universally beneficial practice for sustaining a culture of health and wellness in your healthcare facility.
Technology can also be leveraged to better accommodate nurse safety. A safety app can be a powerful tool for increasing both nurse safety and addressing situations which may lead to mental distress or burn-out. The app is is available on each employees phone, and during an incident, can be used to either call 9-1-1 or seek assistance from a group of designated “guardians”. In a healthcare setting, these guardians can be co-workers, such as other nurses working on the floor or a nurse manager.
Another valuable element in an industry where nursing professionals may be hesitant to come forward about abuse, due to a hospital culture which may accept violence as normal, is an anonymous tip application. If an employee is subject to verbal or physical attack, whether from a patient and their family or bullying from a coworker, they can submit an anonymous tip to hospital managers. The app can help raise awareness of workplace safety concerns among medical professionals, and better understand the resources needed for proper response and support for nurses.
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