In search of the danger of burnout, depression and suicide

As nurses, we spend long hours on our feet performing direct care, writing budgets, coping with staff, traveling to see patients at home, or teaching the following generation of nurses. We know the way diverse our roles might be! In my case, this implies spending hours at the pc, conducting conference calls and traveling away from home and family to conferences. After work, we also cope with household chores, the family calendar, and possibly 2^II work or school. When will we exercise? When will we rest? How to find time for preparing and maintaining a healthy diet food?

Did that nurses are more likely than the final population to be obese, more stressed, and sleep less (Lee et al., 2011; Melnyk et al., 2013; Thacker et al., 2016; Eanes, 2015)? We are the most important and most trusted occupation in health care and are critical to the health of the nation, and yet in terms of taking good care of ourselves, we frequently rank last on our to-do list.

It is essential that we listen to the mental health risks to ourselves and our nursing colleagues. First, let’s make clear the terminology:

• it’s “a syndrome understood to result from chronic workplace stress that has not been effectively managed” (WHO, 2019), when it’s something that you’ll feel in all areas of your life.
• it’s a sort of burnout that affects nurses’ emotional bond with patients and causes them to lose commitment.
• It occurs when nurses experience trauma from unexpected events, equivalent to the death of a patient or a medical error. Secondary traumatic stress can result in depression.

Burnout syndrome (BOS)

In April 2019, the World Health Organization added BOS as a diagnosis to the eleventh century^vol edition of the International Classification of Diseases (ICD-11). BOS is characterised by three dimensions:

• Feeling exhausted or depleted of energy
• Increased psychological distance from work or feelings of negativity or cynicism about work
• Decreased skilled effectiveness

Jones et al. (2017) took a more in-depth have a look at the predictors and effects of burnout. Their study focused on clinical pharmacists, but I feel lots of us can relate to those aspects and consider these predictors and outcomes applicable to most, if not all, clinicians.

(Jones et al., 2017):

• Too many non-clinical responsibilities
• Difficult colleagues
• Feeling that one’s contribution is undervalued

(Jones et al., 2017):

• Decreased quality of care
• Lower patient satisfaction
• Increased variety of medical errors
• Higher rates of healthcare-associated infections
• Higher 30-day patient mortality rates

Depression

Registered nurses suffer from depression at almost twice the speed of nurses working in other professions (Letvak et al., 2012). A 2016 review of 36 articles assessed the present state of the science regarding depression in registered nurses. This summary of results shows each predictive and protective aspects related to depression (Brandford and Reed, 2016).

Recognize these signs of depression as warning signs – in yourself and others (Healthy Nurse, Healthy Nation, 2017):

• Sleep disorders
• Changes in appetite
• Feeling hopeless
• Irritability
• Feeling less engaged in activities you previously enjoyed
• Feeling isolated
• Not finding joy in life
• Less energy at work and when working with patients

Risk of suicide

In August 2019, Davidson et al. published This retrospective correlational evaluation of the 2014 National Violent Death Reporting System (NVDRS) database includes 14,774 suicides in 18 states, of which 205 were nurses. Both nurse suicides and male suicides were significantly higher than in the final population of ladies and men. Other notable results include:

• Benzodiazepines and opioids were probably the most common substances utilized in nurse suicides.
• Nurses were significantly more likely than the final population to report mental health problems, a history of treatment for mental illness, a history of previous suicide attempts, leaving a suicide note, and physical health problems.
• Compared with the final population, nurses were much less more likely to have had a recent crime or alcohol problem.

There are many competing priorities for attention and time. Our lives are busier and more organized than ever before. However, we must do not forget that taking good care of ourselves is just not selfish. We have the ability to ask for help and make a change.

Brandford, A., and Reed, D. (2016). Depression in registered nurses: State of the science. (10):488-511. doi: 10.1177/2165079916653415

Davidson, J., Proudfoot, J., Lee, K., and Zisook, S. (2019). Nurse suicide within the United States: An evaluation of the Centers for Disease Control’s 2014 National Violent Death Reporting System dataset. doi: https://doi.org/10.1016/j.apnu.2019.04.006

Eanes, L. (2015). The potential impact of sleep loss on a nurse’s health. (4), 34-40. doi: 10.1097/01.NAJ.0000463025.42388.10

Healthy Nurse Healthy Nation (2017). Are you depressed? Get to know the Signs. Downloaded from https://engage.healthynursehealthynation.org/blogs/8/40

Jones, G., Roe, N., Louden, L., and Tubbs, C. (2017). Factors related to burnout amongst U.S. hospital clinical pharmacy physicians: Results from a nationwide pilot study (11). doi: 10.1177/0018578717732339

Lee W. Tsai, S., Tsai, C., & Lee, C. (2011). A study on work stress, stress coping strategies, and health-promoting lifestyles amongst district hospital nurses in Taiwan. (5), 377–383.

Melnyk, B., Hrabe, D., and Szalacha, L. (2013). Associations between job stress, job satisfaction, mental health, and healthy lifestyle behaviors in newly graduated nurses participating in a nurse-athlete program: A call to motion for nursing leaders. (4), 278-285. doi: 10.1097/NAQ.0b013e3182a2f963

Thacker, K., Haas, D., Brancato, V., Flay, C., & Greenawald, D. (2016). Health Promoting Lifestyle Practices Among RNs Study(4), 24-30. doi: 10.1097/01.NAJ.0000482141.42919.b7

World Health ORganisation. (2019). ICD-11 for mortality and morbidity statistics. Downloaded from https://icd.who.int/browse11/lm/en#/http://id.who.int/icd/entity/129180281