Let’s rewind to three years ago. The COVID-19 pandemic swarmed the United States, bringing life to a halt. Frontline healthcare workers, hailed as heroes, began or ended their shifts to rounds of applause or lights and sirens from thankful citizens. But now, the healthcare system itself may feel like kryptonite to some of those previously declared superheroes.
Nurses bear the burden of this highly demanding job — balancing safe patient care and high expectations with staffing shortages, patient load, bullying, and workplace violence or abuse. But nursing is more than just a stressful job.
Nurses’ struggles with stress and anxiety have led to increased mental health issues and statistics on suicide that cannot be ignored.
One study found that nurses were 18% more likely to die from suicide than the general population. Female nurses were twice as likely to lose their life to suicide than the general population.
What can you do to help yourself? What are the signs of distress in coworkers?
Emotional support for nurses is critical
Several recent surveys by the American Nurses Foundation, American Hospital Association, ConnectRN, and other studies have revealed staggering statistics among nurses:
- 65% reported inadequate staffing.
- Nine out of 10 nurses believe staffing shortages impact safe patient care.
- 42% have had traumatic COVID-19 encounters.
- 26% have experienced workplace bullying.
- 10% of nurses who have been bullied suffer from PTSD.
- 44% have reported physical violence from patients or family members.
- 68% have reported verbal abuse from patients or family members.
More than half of all nurses surveyed by the foundation have expressed feelings of frustration, exhaustion, being overwhelmed, anxiety, feeling overworked, and undervalued. Nearly half of the nurses considering leaving their position cite negative impacts on their well-being.
How to help yourself
You have eight patients needing around-the-clock pain management and numerous antibiotics to hang. You're monitoring labs and vital signs, updating care plans, and keeping up with your documentation. Your unit is short-staffed and overworked. There's a code blue at shift change. Now you’re way behind.
Despite the heavy workload, it’s important to recognize when you or one of your fellow nurses are in trouble.
Signs of mental health struggle
Some signs can include:
- Feelings of worry, fear, sadness, and hopelessness
- Extreme mood variations
- Changes in eating or exercise habits
- Difficulty sleeping
- Substance overuse or abuse
- Physical complaints such as headaches or stomach upset
Tips for nursing self-care
Nurses shouldn’t rely on others to take responsibility for or protect their mental well-being. Some tips for nurses to have more agency over managing their own stress and anxiety include:
- Take charge of your physical health with adequate nutrition, movement, and sleep to assist your body in coping with your mental health struggles.
- Recognize your triggers, personal and work-related, so that you can address them or develop coping strategies.
- Reevaluate your time management plan and seek out other coworkers who may have helpful advice to offer.
- Reexamine your task delegation — perhaps a supportive staff member can help.
- Take adequate and assigned breaks off the unit, if able.
- Develop an “in-the-moment” discreet stress coping mechanism for when you cannot break away, whether it's breath work, meditating, or praying.
How to ask for help
First, take responsibility for your well-being by learning all you can about mental illness. Asking for help can be difficult, but building a network of support is imperative.
It can feel challenging to reveal your struggles to your coworkers. If you seek colleagues' insights, however, you'll allow them to help when they're able, offer advice when needed, delegate tasks to others, and be mindful of more worrisome signs of mental illness.
Nurses must strive to be consistent in their self-care and stress-coping strategies in a healthcare system that often struggles to support its workforce. Excelling in self-care and being authentic about your mental health will give you the tenacity to watch over your coworkers.
The National Alliance for Mental Illness (NAMI) is an excellent resource for helping with this process.
Distress in coworkers — or yourself
People experiencing mental health issues can often mask signs and symptoms from observers. Nurses can be extremely proud of their work, and identifying or acknowledging difficulties may be challenging.
Additionally, no nurse wants to be perceived as weak or incompetent. This is where coworkers come in.
Signs of nursing distress
Many nurses are familiar with the general signs of anxiety and depression. How does this show up in the nursing environment? Below are some signs you may recognize in your coworkers (or in yourself) who may be struggling with mental illness.
- Highly unpredictable moods
- Extra emotional response regarding patient scenarios or situations
- Slow reaction time during a crisis
- Struggling with multitasking
- Difficulty calculating dosages and medication errors
- Time management and priority-setting troubles
- Stressed interactions with colleagues and management
How to talk to those in distress
How do you speak to a struggling colleague and not put them on the defensive when you believe they are in distress? Communication like this is rarely discussed during formal nursing training or facility in-servicing. Its necessary inclusion is becoming more apparent.
The Canadian Centre for Addiction and Mental Health (CAMH) offers some guidance.
- Be direct: Studies have shown that speaking about suicide does not increase the chances of suicide. Speaking plainly is likely to make those struggling feel less isolated, scared, and alone.
- Words matter: Mental illness does not define anyone or consume their identity as a person or a nurse. Mind your phrasing. For example, say, Jen has experienced suicidal thoughts instead of saying that Jen is suicidal. Or stating, people with mental illness instead of the mentally ill.
- Be hopeful: Recovery is possible with the proper support.
- Be encouraging: It is essential to motivate your coworker to seek help.
A nurse’s parting words
Nursing culture can be intense, unforgiving, and intimidating, which makes a caregiver less likely to ask for care. However, caring for yourself becomes your personal and professional duty as a nurse. Arguably, compassion is a tenet of nursing — watching over our comrades is a duty worth providing.
The words of Tristan Kate Smith, a nurse who tragically lost her life to suicide, echo in the minds of nurses as their struggles continue.
Smith wrote a letter months before she died, in which she addressed the U.S. healthcare system directly, stating, “I so desperately want to continue to help people, but I cannot stay in this abusive relationship…I’m only sorry to my patients and colleagues. You deserve so much better, but my abusive partner is relentless.”
Advocate for yourselves, be watchful over others, and protect one another.
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