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The suicide crisis in nursing

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Nurses are at heightened risk of suicidal thoughts Nurses are at a heightened risk of suicidal thoughts, and may require the support of colleagues

Nursing is one of the fastest-growing professions in the UK – but, alarmingly, suicide rates among nurses are growing just as quickly as the profession itself. In just six years between 2011 and 2017, at least 307 NHS nurses took their own lives.1 These figures were released by the Office for National Statistics (ONS) in 2018 and, understandably, sparked national outrage by both the press and public.

Suicide does not discriminate, and nurses have been suffering in silence for too long. Nurses are at higher risk of suicide than the general population and are four times more likely to take their own lives than people working in any other profession in the UK.2 Furthermore, female nurses are more likely to commit suicide than their male counterparts. Previous research by the ONS found that female nurses are 23% more likely to take their own lives than the rest of the female population.3

Support systems are increasingly being put in place for doctors after national concerns about burnout in this profession. As a result, suicide rates have been declining in doctors.4 The same cannot be said for nurses, making it critical to dig deeper into the factors that contribute to this crisis and work out how you might be able to help yourself or a struggling colleague.

What factors contribute to such high suicide rates in nursing?

It can be problematic to directly assign suicide causality to external factors because the main risk factor for suicide is the presence of mental illness,5 and we need a lot more research to be able to understand occupation-specific risk factors.6 That being said, external factors that are pushing some nurses over the edge largely relate to the nature of the healthcare industry and the workplace environment. Many of today’s healthcare professionals are working in environments that are a breeding ground for stress and workplace trauma. For nurses, they are also confronted by dangerous working conditions, gender imbalances, inconsistent work schedules, and long shifts.7

The key occupational factors implicated in nurse suicide

Self-sacrifice

Nurses are regularly caught between the demands of the system and those of their patients. Caring for patients means having to deal with devastating diseases, upsetting situations, and everything in-between. Sometimes, nurses end up having to do more than their job requirements, effectively becoming the entire keystone of their patients’ care – not being able to care for themselves as a result. According to Gail Kinman, an occupational health psychologist, and Visiting Professor at Birkbeck University of London. ‘A culture of self-sacrifice is prevalent in healthcare, which means that nurses often don’t develop the self-care strategies and self-compassion needed to thrive under demanding conditions – they are more concerned with the well-being of patients than their own.’

Bullying

It might be difficult to envisage bullying occurring within a caring profession, but the nursing environment can be cut-throat at times. In a 2016 survey, 42.18% of UK nursing students reported having faced some form of bullying or harassment in the past year, and 19.6% of all such incidents involved a qualified nurse.8 To top this off, ‘a bullying culture in healthcare and fears about speaking out can mean that nurses suffer in silence,’ says Kinman.

Pressure to toughen up

It varies from institution to institution, but it is not uncommon for nurses to be encouraged to suppress feelings in order to display ‘professionalism’. You may have found that if you have ever, for instance, cried about a patient during your shift or even on your break, you were made to feel as though you weren’t ‘tough enough’ for the job. It isn’t news that suppressing emotions can have long-term health affects – and yet some workplaces either explicitly or implicitly encourage this.

Long hours due to staff shortage

Despite nursing being one of the fastest-growing professions in the UK, staff shortages remain a huge problem as demand for healthcare rises. This demand, along with the high turnover from nurses leaving their jobs because of stress, mean that those nurses who choose to stay must work longer hours with little rest and not nearly enough compensation. According to Kinman, ‘Long working hours and overwork are contributing factors for poor mental health. Staffing levels are inadequate and nurses often feel obliged to work longer hours. Twelve-hour shifts are very common nowadays among nurses, especially those with young families or a long commute. This can lead to exhaustion and low mood.’

Workplace violence and abuse

In 2018, 14.5% of the NHS staff reported experiencing some form of physical violence at the hands of their patients or their patients’ visitors.9 For example, patients with Alzheimer’s disease or dementia, through no fault of their own, have been known to abuse nurses – from cursing to hitting. Visitors can also take their anger out on nurses during what may be an emotionally difficult time for them. Nurses working in the emergency room or on evening shifts are more likely to be exposed to violence because these are the times when they are most often in contact with patients under the influence of drugs or alcohol.10 Many cases of abuse go unreported and are seen as part of the job.

How can I spot suicide risk?

Warning signs are not always present or reliable. When they are present, they can be difficult to detect. ‘People are often very good at hiding that they are really struggling,’ says Kinman. ‘A heavy workload and fast pace of work often mean that colleagues are just too busy or preoccupied to pick up the early warning signs.’

However, there are still some red flags that you can look out for in yourself and your colleagues:11,12

  • Having thoughts about ending your life; or hearing a colleague make statements about ending their life
  • Acting more aggressively than usual, or lashing out
  • Acting very happy after a long period of depression
  • Not showing up for shifts, or simply not being as productive as usual
  • Being noticeably tired and speaking about feeling like a burden
  • Isolating behaviour that is uncharacteristic
  • Lack of simple self-care, such eating badly or not caring about appearance
  • Having lack of purpose, or a ‘what’s the point?’ attitude.
  • Signs like these could simply signal deteriorating mental health rather than risk of suicide, but attention is still needed to prevent escalation.

What action can you take if you are having suicidal thoughts?

According to NHS guidance, the first step is to talk to someone you trust. Start a conversation with family and friends, and they may be able to offer support and help keep you safe. You can also speak to your GP, contact your mental health crises team, or call 111. In the meantime, you can also take the following steps13,14

  • Focus on one day at a time
  • Stay where you feel safe
  • Avoid drugs and alcohol
  • Engage in activities you enjoy, such as spending time with your pet, friends and family
  • Remind yourself that this is a feeling – and feelings come and go.

What action can you take to help colleagues?

Pete Clark, Head of Corporate and Service Sector Development at Health and Case Management Ltd (HCML) has a 12-point manual for how you can help a colleague who seems to be going through a crisis.15 The first step is communication – simply mentioning that they seem a little quiet or down. If this prompts them to open up, listen and empathise without judgment. Gently nudge your colleague towards calling helplines, their GP, friends, or family.

If your colleague doesn’t want to reach out for help, be patient. You cannot force them to talk to you. Instead, let them know how and where to seek help when they are ready.16 In extreme cases, you may need to contact your own manager or occupational health to assess if more urgent action is needed.

What action can organisations take to better protect nurses?

Healthcare organisations need to do their absolute best to ensure a positive workplace environment, and an organisational culture that encourages seeking help and reaching out to those who may need it. ‘Employers should ensure that working conditions support good [mental and physical] health by providing access to support such as occupational health, counselling, and drop-in centres for emergency support,’ advises Kinman. ‘Employers should also be aware of the risks of caring for others, often under challenging conditions.’

Some measures that organisations can take include designing programs specifically for employee assistance and counselling, ensuring human resource departments are always ready to intervene where needed, and providing employee training on suicide awareness and prevention.17

Mental health needs to be simultaneously prioritised and promoted, not only through awareness, but through paid mental health holidays and benefits that include mental health services in the same capacity as physical health services. There also needs to be serious consequences for employees found to be bullying and safe ways for victims to report the people bullying them.

Nicola Davies is a freelance medical writer

References

1. Suicide deaths among nurses aged 20 to 64 years, deaths registered in England and Wales between 2011 and 2017. Office for National Statistics. Available from: https://www.ons.gov.uk

2. ‘Suicide risk’ for doctors and nurses. BBC News [online]. Available from: http://news.bbc.co.uk/2/hi/health/944503.stm [Accessed 23 January 2020].

3. Suicide by occupation, England. Office for National Statistics. Available from: https://www.ons.gov.uk/peoplepopulationandcommunit... [Accessed 23 January 2020].

4. Siddique H. Drop in suicide rate in Britain linked to prevention work in England. The Guardian [online]. Available from: https://www.theguardian.com/society/2017/sep/07/dr... [Accessed 23 January 2020].

5. Pandey G. Biological basis of suicide and suicidal behaviour. Bipolar Disorders. 2013;15(5):524-541.

6. Tiesman H, Konda S, Hartley D, Menéndez C, Ridenour M, Hendricks S. Suicide in U.S. workplaces, 2003–2010. American Journal of Preventive Medicine. 2015;48(6):674-682.

7. Peterson C, Stone DM, Marsh SM, Schumacher PK, Tiesman HM, McIntosh WL, Lokey CN, Trudeau AT, Bartholow B, Luo F. Suicide rates by major occupational group - 17 States, 2012 and 2015. MMWR Morb Mortal Wkly Rep. 2018;67(45):1253-1260.

8. Tee S, Üzar Özçetin Y, Russell-Westhead M. Workplace violence experienced by nursing students: A UK survey. Nurse Education Today. 2016;41:30-35.

9. NHS Staff Surveys - 2018 Results. NHS Staff Surveys. Available from: https://www.nhsstaffsurveys.com/Page/1064/Latest-R... [Accessed 23 January 2020].

10. Johnson S. Violence in the NHS: staff face routine assault and intimidation. The Guardian [online]. Available from: https://www.theguardian.com/society/2019/sep/04/vi... [Accessed 23 January 2020].

11. Warning Signs. American Association of Suicidology. Available from: http://www.suicidology.org/resources/warning-signs [Accessed 23 January 2020].

12. Search and Rescue: Supporting a colleague with a mental health problem. Mind Blue Light Programme. Available from: https://www.mind.org.uk/media/16772366/supporting-... [Accessed 23 January 2020].

13. Help for suicidal thoughts. NHS. Available from: https://www.nhs.uk/conditions/suicide/ [Accessed 23 January 2020].

14. Are You Feeling Suicidal? HelpGuide. Available from: https://www.helpguide.org/articles/suicide-prevent... [Accessed 23 January 2020].

15. How to help a suicidal colleague. People Management [online]. Available from: https://www.peoplemanagement.co.uk/voices/comment/... [Accessed 23 January 2020].

16. Search and Rescue: Supporting a colleague with a mental health problem. Mind Blue Light Programme. Available from: https://www.mind.org.uk/media/16772366/supporting-... [Accessed 23 January 2020].

17. Bolster C, Holliday C, Oneal G, Shaw M. Suicide assessment and nurses: What does the evidence show? Online Journal of Issues in Nursing. 2015;20(1):2.

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