Working as a nurse in the emergency department, I had shifts that could be long and hard. Often, however, the time at home was harder. There were times when I could not sleep, having anxiety over what I had done right or wrong while on shift, and sometimes I fell into deep depressions. I loved my job, but it was frequently not good for me. I thought I was alone with these feelings, but the data show otherwise.
Critical care nurses have been found to have higher rates of depression and anxiety than the general public.1 In a study evaluating the mental health of nurses working during the COVID-19 pandemic, investigators found that one-third of nurses surveyed displayed psychological symptoms such as anxiety and depression.2 This finding was consistent with other study results that showed that health care staff working during the pandemic had significant prevalences of mental health issues such as depression, anxiety, and posttraumatic stress disorder.3 Davidson et al4 found that nurses were 18% more likely to die by suicide compared with the general population. Female nurses were found to have twice the risk of dying by suicide compared with the general population.4
The workplace can have a significant impact on nurses’ mental health and well-being. Health care occupations are stressful due to various factors, including long hours; heavy mental and physical workloads; rotating and alternative shift schedules; exposure to frequent human suffering; and challenging engagements with colleagues, patients, and their loved ones.5,6 Health care professionals also are at significant risk of experiencing workplace violence.7 Nurses regularly report experiencing discrimination, verbal and physical abuse, and sexual harassment while on shift.8 Health care organizations and systems can and should make changes that can improve nurses’ well-being. By improving the work environment, nurses can experience improved psychological wellness.9,10
Reduce the Stigma
The stigma associated with mental illness and suicide is pervasive. This stigma promotes barriers to discussing mental illness and suicide as well as help-seeking behaviors, especially in health care communities,11,12 which can cause individuals experiencing mental illness to be avoided and feel isolated.13,14 The stigma related to mental illness may also be a risk factor for suicide.15
Strategies to reduce stigma around mental illness and suicide in health care environments should focus on behavior and culture change.16 Recommended strategies include teaching clinicians skills that support them in knowing “what to say” and “what to do” during conversations with individuals experiencing mental illness or suicidal ideation and offering opportunities for individuals experiencing mental illness or suicidal ideation to hear personal testimonies from trained speakers with lived experiences with mental illness.11,16 Additionally, actions such as engaging in combating misinformation and unconscious bias surrounding mental illness and suicide and providing emphasis on recovery in support programs are supported by research.11,16
Prioritize Nurse Well-being
In the American Association of Critical-Care Nurses (AACN) 2021 survey of nurses’ work environments, only 50% of respondents agreed with the statement “My organization values my health and safety.”8 An organizational culture that values health care workers’ health and well-being has been found to improve their well-being and safety.11,18 Furthermore, psychologically safe work environments have been associated with better worker well-being.5 The National Academy of Medicine19 calls for health care workers’ well-being to be a long-term organizational value. National nursing workforce groups have recommended that clinician physical and psychological safety be elevated to the same level of importance as patient safety.20,21
Decrease Occupational Stressors
Job stress impacts mental health, especially nurses’ mental health.9 In the 2021 Work and Well-being Survey, the American Psychological Association found that nearly 3 of every 5 employees reported experiencing negative work stress the previous month.22 For nurses, that negative occupational stress may include being unable to provide quality patient care or having insufficient staffing or supply shortages.23
Organizations can significantly influence health care professionals’ mental health by optimizing the work environment, providing adequate resources such as appropriate staffing and supplies, investing in technology that decreases the administrative burden, and ensuring that nurses can provide quality care to their patients.10,19
Create and Sustain Healthy Work Environments
The National Academy of Medicine recommends that all health care organizations create and sustain positive work environments.19 The 6 standards of a healthy work environment from AACN can be used to support nurses in providing quality patient care, improving patient and safety outcomes, and decreasing reports of moral distress.8 Organizations can employ the AACN Healthy Work Environment Assessment Tool to measure the health of their workplace and consider the utility of healthy work environment framework implementation.24
Improve Workplace Safety
Workplace violence is a unique and substantial job stressor for nurses and other health care professionals. Nurses have a high exposure to violence and report not feeling prepared to react to violence or abuse.25,26 Having zero-tolerance policies for violence and abuse, offering employee education and training, implementing meaningful workplace violence data collection systems, fostering innovation and collaboration with interprofessional partners, and creating safety programs to address violence and abuse in the workplace are recommended methods for organizations to ensure the physical and psychological safety of their nursing staff.10,18,27
Apply an Equity Lens
It is essential to recognize that all nurses do not face the same workplace stressors. The 2022 US Surgeon General’s Advisory on Building a Thriving Health Workforce discusses how long-standing structural inequities have affected groups of health care workers’ health and well-being differently.18 Health care organizations should ensure that an equity lens is applied to the individual needs of nurses and potential improvement interventions when reviewing the work environment.
Organizations and leaders can offer support to nursing staff by fostering pathways for recruiting and retaining a diverse workforce; combating bias and discrimination in the workplace; and promoting diversity, equity, inclusivity, and accessibility initiatives to support health care workers’ well-being.10,18,19
Increase Access to Care
Increasing access to appropriate mental health care and support is critical to improving mental health and preventing suicide among nurses.18,19 Health care organizations are recommended to develop mental health support services tailored to the needs of employees; ensure the incorporation of evidence-based strategies for suicide prevention; encourage the use of employee assistance programs for short-term counseling, staff education, and referrals for treatment; and decrease barriers to the use of employee assistance programs and other employer-provided mental health services.18,28 New mental health support entities and programs are being established to offer expanded services for nurses and other health care professionals.29–31 Health care facilities should consider sharing these resources as well as suicide prevention programs with their nurses to offer increased access to mental health support.32,33
Let’s Get to Work
Nurses need change. Although health care workers’ well-being has been recognized as a national priority, nurses continue to suffer and die by suicide.19 Nurses, leaders, and organizations have the power to positively influence nurses’ mental health and wellness by improving work environments. Let’s get started!
References
Footnotes
To purchase electronic or print reprints, contact the American Association of Critical-Care Nurses, 27071 Aliso Creek Rd, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected].
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