You Can Help Prevent Nurse Suicides

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“Just recognizing that somebody is having a bad day is a suicide prevention technique” explained Judy Davidson, a nurse researcher involved in a three-pronged suicide prevention program at the University of California San Diego (UCSD).

A recent report released in the UK showed that 300 nurses died by suicides during the last seven years. Similar data for the US are not available and researchers concluded that nurse suicide in that country was “shrouded in silence, avoidance, and denial”.

Nurses at high risk of suicide

Nurses work exhausting hours, often short-staffed, at duties that are complex and with an ever-present possibility of errors. There is also the emotional toll of tensions between co-workers, bullying, and violence from patients.

Furthermore, nurses experience emotional stress from deaths and trauma almost on a daily basis. They’re expected to just carry on with their work, without the debriefing offered to those in other occupations such as police and firefighters.

These circumstances put nursing staff at a high-risk burn-out, caregiver fatigue, and depression – all of which could trigger the worst case scenario of suicide.

Let’s take a look at the suicide prevention strategies used at UCSD which consists of three interlinked programs: Code Lavender, a Caregiver Support Team, and the Healer Education Assessment and Referral (HEAR) program. 

Code Lavender

Code Lavender involves simply reaching out to a coworker, acknowledging that one is aware that they’re going through a rough patch – either personally or after a particularly bad workplace experience. Code Lavender doesnt prevent burnout or stress but is rather akin to psychological first aid.

Sample Code Lavender Kit
Code Lavender kit contents. Image via: researchgate.net

One is often at a loss for words of support when you want to reach out to a stressed-out colleague. Code Lavender consists of a packet with a comforting message, a bar of chocolate, lavender essential oil, and a referral card for employee assistance. There’s also a starfish sticker that the nurse can put on their uniform to show that they’re feeling fragile.   

A coworker gives this token a colleague to show that they’ve noticed and care – and to possibly nudge them to seek professional help if they need it. Even this small act of kindness can help to prevent suicide.

After the pilot project with Code Lavender, Davidson and her colleagues found that there was an improvement in self-reports of feeling cared for. All those who had received the Code Lavender intervention reported that they had found it helpful and 84% recommended its wider use. 

You can read more about Code Lavender here and here.

Caregiver Support Team

The introduction of the Caregiver Support Team initiative was an extension of the Code Lavender project. While team members don’t give professional counseling, it’s described as providing emotional first-aid in the workplace.

A survey was conducted to identify persons whom staff felt they would turn to for emotional support at times of stress. These nominees were invited to become peer supporters. They had eight hours of training by a psychologist, which included how to recognize the signs of burnout, depression, and risks for suicide. They were then encouraged to actively identify and reach out to staff in crisis.

At the end of the pilot project, 40% of the respondents had received intervention by a member of the Caregiver Support Team and all reported that it had been helpful and that they would recommend it to others.

At least one suicide had definitely been prevented after a peer supporter had reached out and was able to set a process in motion which concluded in a professional intervention. Staff had also started to proactively contact peer supporters for emotional debriefings. 

HEAR program

The Healer Education Assessment and Referral Program (HEAR) had been running for seven years for medical practitioners at UCSD when a number of nurse suicides prompted its extension to nursing staff in 2016. The aim of this program is to get those who need it into mental health treatment.

The program has two components. Firstly, educational presentations are provided to create greater awareness about depression, burnout, and suicide among healthcare staff, and to emphasize that it’s okay to seek treatment for mental health issues. 

The second part is a digital survey tool which is sent at least once a year to all healthcare staff.  The questionnaire is used to identify at-risk individuals and to help them connect to mental health services. Respondents can choose to remain anonymous until they themselves choose to connect to the counselor for a referral.

The counselors also arrange appointments to avoid the possibility of delayed treatment or that the person gives up when they can’t get an appointment with a therapist after a number of unsuccessful few phone calls. 

A culture of caring and action

According to Davidson, the success of these programs is that they are pro-active. It reaches out to people as opposed to employee assistance programs that wait for staff to contact them.

Susan Scott, who developed a similar peer support program in Missouri, explained that the peer-initiated intervention eventually changed staff attitude towards work stresses. “What we’ve seen now in 10 years,” she said, “Is that we now have this culture of supportive presence for staff.”

If you, or someone you know, is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255. You can also call 911.  If you’re in another country you can find a crisis center on the website of the International Association for Suicide Prevention.

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Frieda Paton, M.Cur, RN
Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

4 COMMENTS

  1. Funny how earlier today I asked for a “miracle” and then encountered this article 🙏🏼 Ive never felt so utterly trapped, alone, and lost as I have recently 😔 Despite my “verbal” expression of feeling like “death is my best option”… not one single person in my life identified this as a need to inquire further. Why would they, I’M the “strong one” I’M the Nurse!!! Thank you for this 😇

    • Good Day
      I have been speaking of the need for psychological support for our staff here in our institution especially considering our challenging situation …where we have been housed in a stadium for the past 10 years due to a fire destroying our original structure. Our staff have no support yet the administration of the institution expects maximum delivery of care.
      I see nurses exhibiting characteristics associated to physical and psychological drainage and nothing is being done to help and assess these issues despite the fact that nurses make the foundation of the institution.
      I always encourage nurses to do some self reflection and understand that they too are human beings and need just as much care as their patients. We all have a right to take time for ourselves and though many institutions preach that patients come first …if we are truly honest we will recognize that doing such makes us more incompetent.
      My solution is developing a trusting relationship with at least one person to help me cope with some of my challenges.

  2. Nicole,
    Some of the strongest people I’ve watched in life seem to have an outrageous courage and sense of humor. I have neither.
    Walked to the door by a supervisor a few weeks ago bcz a family member of patient let out a torrent of pent up rage onto me. (He appeared violent enough to call police) They never asked my side, just that they would telephone me tomorrow. Once outside, I shoved my badge & keys at her so quickly, I could see she was surprised… It was a job closer to home but $8/hr less.
    I am not sure what it “takes” to be a nurse, or if it is actually even humanly possible.
    I wish I could say that I care to learn, I don’t see the use. The Lord has a plan for your life and he has a plan for my life. His plans are good. They are never abusive, degrading, demeaning. He tells us, “Be anxious for nothing”. Being IN God’s plans will never leave us feeling suicidal, indeed, not even ‘stressed’.
    ‘Nurse’ Leslie

  3. Hi Nicole, thank you for sharing your struggles. Please do consider reaching out to a trusted friend, or to an “Employee Assistance Program” should your organization have one. Absent that, a community mental health professional may help you process your feelings.
    Ours is an extraordinarily difficult profession which can take a huge emotional toll. It took great strength for you to post what did;
    it will help lots of nurses.

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