Supporting Nurses with Addictions and Mental Health Issues

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According to previous research, nurses are at an increased risk of death by suicide. Links between suicide, substance use, mental health problems and employment problems have been identified. However, nurses struggling with these issues still face stigma, inaccessibility of resources, and regulatory and legal issues.

A recent study in JONA: Journal of Nursing Administration highlights how Covid-19 has exacerbated these issues among nurses nationwide.1 The authors also suggest different intervention strategies at the personal, institutional and regulatory levels to help reduce suicide rates among nurses.

Known Crises in Nursing

Several research teams have studied nurse suicide. Until recently, nurses were more likely to use pharmacological poisoning as a method of suicide. However, recent data indicates an increased use of firearms as a means of ending one’s life. Unfortunately, information from national organizations such as the Centers for Disease Control and Prevention does not specify nurses’ specialty, work setting, or level of care.

Mental Health and Burnout in Nursing

Mental health is also closely linked to suicidal tendencies among nurses. Many individual nurses believe it is important to maintain a “professional face”, even when suffering from specific mental health issues. Previous studies suggest that nurses have higher rates of anxiety and depression than the general public. These problems are often related to work stress.

Additionally, burnout has been reported in up to 50% of all nurses. This emotional response typically results from chronic job stress involving emotional exhaustion, demoralization, cynicism, and feelings of ineffectiveness. Burnout is not the same as depression, but it appears to be a risk for many other psychiatric conditions, such as depression, anxiety, substance use, post-traumatic stress disorder ( PTSD), suicidal ideation and suicide, and neurocognitive problems. Prior to the pandemic, up to 21% of nurses reported intent to leave the profession due to burnout.

Substance use issues in nursing

Substance use is also linked to nurse suicide. Recent studies found that nurses were much more likely to have positive blood toxicology results for almost any substance compared to the general population. However, these nurses were also less likely to have a documented substance use disorder reported before the suicide. This may be due to factors such as stigma, licensing issues, and limited access to treatment.

Another qualitative analysis of nurse suicides showed that nurses who committed suicide were more likely to have had work-related problems before the event. These problems generally centered on three elements: mental health problems that were not well controlled, uncontrolled chronic pain, and substance use disorders. Over 90% of these identified issues were related to investigations and loss of employment, in most cases due to a substance use disorder.

The effect of Covid-19 on nurses and seeking help

The novel coronavirus has helped highlight the stressors that nurses face on a daily basis and the psychological issues resulting from these stressors. These stressors were certainly present before the pandemic, but Covid-19 has compounded issues such as nurse fatigue, declining nurse performance and increased use of sick leave. Additionally, increased rates of anxiety, depression and PTSD are impacting frontline healthcare workers.

Unfortunately, research suggests that nurses are less likely to engage in help-seeking behaviors for these types of issues. Stigma against treatment for mental health issues, as well as fear of judgment and the consequences of seeking treatment are all key barriers to seeking help.

Interventions to meet the needs of nurses

Meaningful change begins with evidence-based interventions targeting specific issues within the nursing workforce. The Suicide Prevention Resource provides a 6-step public health prevention model that could be used to help identify interventions that meet the unique needs of nurses, including:

  1. Identification of the problem and the context.
  2. Identify long-term goals for specific populations, settings and risk factors.
  3. Identify key risk factors and protective factors.
  4. Selection of interventions has been shown to reduce risk factors and enhance protective factors to achieve goals and develop action plans.
  5. Create an evaluation plan to track progress and identify data to collect.
  6. Implement, evaluate and improve the plan.

The study identified several interventions that have already been shown to be effective in preventing suicide among nurses. UC San Diego Health’s Healer Education Assessment and Referral (HEAR) program has been used since 2009 to help prevent nurse suicide. The program uses a comprehensive education program, proactive screening for high distress and suicide risk, crisis intervention and critical incident reporting, and a peer support program, all provide opportunities for nurses to come together to share and discuss their feelings.

Many peer support programs have also been beneficial for nurses in distress. Often structured within a health care system, these programs are offered as an extension of alternative programs to disciplinary programs. They can also be self-directed, or they can be available individually using telehealth and nursing coaching.

At the institutional level, evidence-based coping strategies should be taught and highlighted during training programs. They should be offered consistently throughout every nurse’s working life. Active coping strategies have already been associated with decreased levels of burnout. These techniques can include activities such as progressive muscle relaxation, biofeedback, guided imagery, and transcendental meditation.

Nurses are already in a vulnerable position when it comes to mental health issues, substance abuse issues and suicide. Nurse leaders must recognize these issues and renew their commitment to preventing harm and reducing suffering for nurses nationwide.

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