Nurses have a higher rate of suicide than the general population and often go without mental health treatment due to stigma and regulatory requirements, Judy Davidson, DNP, RN, a nurse scientist at the University of California San Diego, said in a May 3 article on MedPage Today.
Dr. Davidson is a co-author of a new American Academy of Nursing consensus statement, which hopes to improve policies around mental health, substance use disorders and nurse suicide. Her comments were transcribed from a video on MedPage Today's site.
"Many nurses who die by suicide while being worked up for substance use disorder became addicted originally after being prescribed narcotics for things like traumatic car accidents, fibromyalgia, musculoskeletal injuries related to work and cancer," Dr. Davidson said. "We need to rethink the way this happens so that nurses can retain hope through treatment for a treatable condition."
Recent surveys conducted by the American Nurses Association found an "alarmingly high rate of depression and mental health disorders disclosed by nurses." Approximately 60 percent of nurses said they had a mental health condition that warranted treatment but feared seeking help.
Dr. Davidson suggested four policy changes that could make it easier for nurses to seek the help they need:
- Rework the credentialing questions: "All nurse practitioners are credentialed through the medical staff office, and these credentialing questions often have unlawful questions embedded within them related to mental health diseases and substance use disorder, asking about past history when it is not relevant to today," she said "These same questions may be found on licensure, on initial licensure and on relicensure, or when used in disciplinary action by the state boards of nursing … all of the questions used for licensure and credentialing need to be examined to make sure that they are ADA compliant."
- Rethink mandatory reporting requirements and public shaming of nurses: "These regulatory requirements were created with the public health interest in mind, to protect the public health when a nurse could not work due to mental health conditions or substance use disorder," Dr. Davidson said. "However, we do know that mandatory reporting decreases the likelihood of accessing mental health treatment when needed."
- Implement the American Foundation of Suicide Prevention Interactive Screening program: "This ISP is a mental health screening that's encrypted and anonymous, and you can deploy it at the organizational level to routinely screen all employees for mental health conditions and refer them into treatment while remaining anonymous," she said. "The anonymous encrypted nature of the program essentially bypasses mandatory reporting. No one can be reported if we do not know who you are."
- Consider a leave of absence instead of firing nurses: "It is inequitable that nurses routinely lose their job and surrender their license to receive mental health treatment for substance use disorder," Dr. Davidson said. "Substance use disorder is a treatable disease. Mental health issues are treatable. Consider a leave of absence during acute treatment. Leave of absence during acute treatment protects the job, protects the license, protects hope, and retains the financial feasibility of doing the treatment needed to return safely to the workforce. Our research team has read the death narrative of every nurse who has died by suicide. Those with job-related issues known prior to death are often unemployed. Many of those die during the process of being worked up for substance use disorder. The process — the regulatory process, the disciplinary process — is associated with death by suicide."