Nurse Suicide THE ELEPHANT IN THE ROOM - Christopher Wojnar, BSN, RN
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Nurse Suicide
THE ELEPHANT IN THE ROOM
Christopher Wojnar, BSN, RN
Introduction to presenter – Who is this guy?
Discuss incidence of nurse suicide – Why nurses?
Objectives Analyze prevention strategies
Identify warning signs
Approach to Crisis Intervention
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Introduction
Christopher Wojnar, BSN, RN
◦ Advocate Aurora St. Luke’s Medical
Center
◦ Critical Care Nurse - Neurological Intensive Care
Unit
◦ Froedtert Hospital
◦ Circulating Nurse - Surgical Services
Trigger alert
This is a sensitive topic.
Feelings and emotions may surface.
You are NOT alone.
Talk to a friend, family member, leader, peer,
or physician.
If available, reach out to your Employee
Assistance Program.
24/7 Crisis Hotline: 1-800-273-TALK (8255)
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Suicide in
Wisconsin
https://afsp.org/state-fact-sheets
Nurse suicide incidence
Judy Davidson, DNP, RN – Nurse Scientist at UC San
Diego
Female nurse suicides (11.97/100,000) “significantly
higher” than in the female population (7.58/100,000) 2
Male nurse suicides (39.8/100,000) higher than general
male population (28.2/100,000) 2
Pharmacological poisoning most common method
Limitations due to lack of standardized reporting of
nurse death by suicide
https://nam.edu/nurse-suicide-breaking-the-silence/
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Nurse suicide incidence –
why nurses?
Repeated requests for
Repeated exposure to trauma Long shift-work
overtime
Workplace violence, incivility,
Lack of self-care Financial stressors
bullying
Continuously high stress
Work/life balance Lack of support
environment
Access/knowledge of lethal
Depression/anxiety Second victimization
substances
Mindset stigmatizing asking for Isolation from friends/family Fear of causing harm to patient
help (ex. Quarantine) or family
https://nam.edu/nurse-suicide-breaking-the-silence/3
“An ounce of prevention is
worth a pound of cure.”
- Benjamin Franklin
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Organizational Prevention
Create awareness around the incidence of nurse suicide
Implement suicide prevention programs like Zero Suicide Initiatives
Lead, Train, Identify, Engage, Treat, Transition, Improve
Encourage and promote self-care programs
(ex. Healthy Nurse, Healthy Nation)
Collaboration between Human Resources, Employee Assistance Program(s), administration
UC San Diego’s Healer Education Assessment and Referral Program (HEAR)
Organizational Prevention
Leadership competency in the awareness of risk factors
Creation of a collaborative and appropriate process for crisis intervention
For example, recommendations for leaders when a team member discloses suicidal ideation
Identify vulnerable groups
Young/novice nurses
High workplace stress
Ex. ICU, Emergency Department
Personal stressors
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Individual
Prevention
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Alligator or squirrel: Musically induced
fear reveals threat in ambiguous figures
Prinz, J., & Seidel, A. (2012). Alligator or Squirrel:
Musically Induced Fear Reveals Threat in Ambiguous
Figures. Perception, 41(12), 1535–
1539. https://doi.org/10.1068/p7290
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Signs of excessive stress
Self
Feelings: Physical Reactions: Changes in routines and habits:
• Tired or worn down • Difficulty concentrating • Dreading going to work
• Increased irritability • Skin rashes • Lack of motivation
• Numb • Stomach problems • Change in energy level
• Disconnected • Difficulty sleeping • Increased alcohol, tobacco, or
• Isolated • Nightmares other drugs
• Intrusive thoughts • Headaches • Reduced self-care
• Increasing aches/pains • Change in activity level
According to Rosiek et al., “Stress is a well-known contributor to mood, mental disorders, and suicide risk” (2016).
Signs of excessive stress
Others
Change in appearance: Change in work Changes in interactions: Signs of distress:
engagements:
• Disheveled • Isolation or • Increased use of
• Appearance of being • Calling in to work withdrawal distractions at work
upset or concerned more often • Shorter fuse or getting • Noticeable or self-
more often • Decreased irritated easily reported increase in
• Change in hygiene productivity • Other team members un-healthy behaviors
• Increase in mistakes noticing changes • Increased alcohol,
• Reduced nicotine, caffeine use.
participation
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Risk factors for suicide
Previous suicide attempt(s) or self-
Mental/emotional disorders
inflicted injury
Serious illness or physical/chronic
Alcohol and/or drug abuse
pain
Recent discharge from inpatient
Access to lethal means
psychiatric care
Social isolation or a pattern of
History of trauma or loss
aggressive or antisocial behavior
The Joint Commission (2016, February 24). Sentinel Event Alert: Detecting and treating suicide ideation is all settings. Retrieved from http://www.jointcommission.org/sea_issue)56
Warning Signs
Loss of purpose Anxiety/insomnia Hopelessness
Withdrawal from
Reckless behavior Mood changes
friends/family
Feeling
Giving away Talking about
trapped/no way
possessions death/dying
out
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2021 Healthy Nurses for Wisconsin Conference
Nurse Suicide - The Elephant in the Room
Warning Signs – IS PATH WARM
• I = Ideation
• S = Substance Abuse
• P = Purposelessness • W = Withdrawal
• A = Anxiety • A = Anger
• T = Trapped • R = Recklessness
• H = Hopelessness • M = Mood Changes
Crisis Intervention
Things to consider: Align with the person and show
sincere willingness to help
Tunnel-vision
Share that there are other options; as
Loneliness difficult as it may be for the person to
see
Feeling like they do not belong
Asking about their situation is
Desperation
essential to understanding
https://u.osu.edu/cliniciansindistress/resources/
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Nurse Suicide - The Elephant in the Room
Crisis Intervention Cont.
Express care and concern, ask an open-ended question:
“I notice that something is wrong, and it seems like you’re struggling. What’s going on?”
Express empathy/acknowledge pain/validate:
“I’m so sorry to hear that. Tell me a little bit more…” or “You don’t seem yourself; you seem really
down right now.”
Do more listening than talking – stay calm.
Rephrase and/or summarize to show understanding
https://u.osu.edu/cliniciansindistress/resources/
Crisis Intervention Cont.
Assessing harm risk with no judgement
“Have you thought about hurting yourself or ending your life?”
“Have you thought about how you would harm yourself or end your life?”
Express worry and concern while acknowledging aloneness
Push towards resources
“I want to make sure that we work together to get the help that you need.”
Doing the best that you can do is what matters.
https://u.osu.edu/cliniciansindistress/resources/
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Nurse Suicide - The Elephant in the Room
Crisis Intervention: Suggestions
for Communication
Be cognizant of your own unconscious bias
Be present with the intent on collaborating with the individual
Display empathy and avoid confrontation
Goal is to reduce the sense of isolation
Align with the person
Example - "You may feel alone and that there is no one in the world who can help you. During this time,
I'm sure all you can see is pain and every solution possible seems fade."
https://u.osu.edu/cliniciansindistress/resources/
Crisis Intervention: Suggestions
for Communication
Once aligned with the person, bring up things to consider:
Options to cope
Discussing the impact on loved ones left behind
The possibility that their perspective is impacted by the emotional pain
Example - "I hear that you are in deep pain and that you feel there is no other solution. Every person may
reach a point where one says, "I cannot handle anymore. This is too much". Even if that happens, I
believe that there are different view on things that deserve some consideration."
https://u.osu.edu/cliniciansindistress/resources/
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Nurse Suicide - The Elephant in the Room
Crisis Intervention: Suggestions
for Communication
Never attempt to manage suicide risk alone
Speak with a supervisor, leader, or the Employee Assistance Program (if available).
Take responsible action(s)
Say, “I’m going to get you some help.” or “Let’s get some help together.”
The worst-case scenario is far worse than damaging a relationship with a friend or peer.
Emergency department, Intake Department, Crisis Hotline
https://u.osu.edu/cliniciansindistress/resources/
In the workplace…
Example 1:
Julie is a nurse in an Intensive Care Unit at a major hospital. She has been a nurse for less than 10 years and
recently took on the challenge of joining the ICU after being on a Medical Surgical Floor.
Julie has been dating on/off with people her parents have looked at as “bad for her”, going out multiple times
a week for drinks, trouble paying her bills, and feeling lost in life, personally and professionally.
She has a history of depression and anxiety which has gotten more significant with the stress of being in a
new department, dating, providing care to critically-ill COVID and non-COVID patients, and a decrease in the
things she previously loved doing for self-care (exercising at the gym, in-person Yoga classes, music concerts,
and going to the movies).
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Nurse Suicide - The Elephant in the Room
In the workplace…cont.
Example 1:
Julie has experienced a lot of trauma since the pandemic started in March of 2020, which she has been doing
the best she can to take things day-by-day. She has not been sleeping well and uses wine to help relax.
She has always looked at being a nurse as a calling, has relied on saving people’s lives, and helping others, for
personal gratification.
For some time, Julie has seen a lot of her patients receive an unfortunate prognosis or have passed. Due to
visitor restrictions, she has felt lonely and unsupported in the workplace while she uses an iPad to allow her
patient’s family members the opportunity to see their loved one before they pass.
Julie has done her best to keep her feelings to herself and continue to come to work…with the hope of feeling
like she has a purpose in life.
In the workplace…cont.
Example 1:
Julie’s family – mom, dad, and her older brother, have always belittled her anxiety and depression.
Additionally, she has never felt like she can talk to anyone outside of work about the things that happen at
work. Plus, who would understand anyway?
Since she is newer to the ICU, she is still getting to know people and the culture in the department is not the
most psychologically safe place – lateral violence, incivility, lack of support from leadership.
There has been a lack of debriefing after patient deaths and many barriers to utilizing her hospital’s Employee
Assistance Program – “It’s not confidential.”, “My co-workers will find out.”, “I’ll lose my job or my license”.
After excess amounts of stress experienced, Julie’s previous suicidal ideation has been gradually increasing in
frequency.
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Nurse Suicide - The Elephant in the Room
In the workplace…cont.
Example 1:
As a nurse, Julie feels like she is not allowed to feel the things she is feeling while at work. She feels
like she must put the uncomfortable and negatives things aside to remain focused on keeping her
patients alive.
Meanwhile, things continue to unravel for Julie. She has been calling in to work more frequently, more
irritable with her family and co-workers, feeling “numb”, a decrease in patience while providing care,
and looking forward to drinking wine when she gets home until she passes out…it’s Tuesday during the
middle of the week.
In the workplace…cont.
Example 1:
Some of Julie’s co-workers have noticed a change in her behavior but they just don’t know what to say,
or what to do.
A few of her co-workers ask her if she’s doing okay and Julie replies, “Yes, I’m fine.”
Julie’s leader(s) have noticed that she has been absent to work or tardy, so, they initiate corrective
action.
After Julie receives the corrective action, she no longer feels that nursing is her “calling”. The stresses
in her personal life mixed with the stresses at work are simply too much to handle.
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Nurse Suicide - The Elephant in the Room
In the workplace…cont.
She did not feel supported during the meeting with her leader(s) and felt so numb that she did not
say much in response. She thought, “Wow…they don’t care about what I’m going through at all”.
Julie leaves work that evening and has multiple glasses of wine…
The following day, Julie is scheduled to work a 12-hour shift, but she is not in the department. The
charge nurse notifies the department leader(s) who are worried about the no-call-no-show.
They attempt to contact Julie on her cell phone and her father answers the phone…”Julie passed
away last night, she killed herself.”
Synopsis
What signs of excess stress did Julie show? What are some things that you can do…
Collaborate with your leadership
What warning signs did Julie show?
HR, EAP
What could have been done?
Promote a culture of support and safety
Exhibit courage
Practice emotional intelligence
Offer appropriate support
Check in with yourself, you peers, and your team(s)
Simply ask, “How are you?”
Lead by example
Push towards resources
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Nurse Suicide - The Elephant in the Room
https://wellness.osu.edu/chief-wellness-officer/covid-19-resources
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Nurse Suicide - The Elephant in the Room
Resources
• On-site
• Employee Assistance Program
• Employee Health
• Leader(s)
• Human Resources
• Peers
• Off-site
• Lifeline – 1-800-273-8255
• HOPELINE Text Service – text HOPELINE to 741741
• Veterans Crisis Line – 1-800-273-8255 (Option 1)
• LGBTQ+ Crisis Line – 1-866-488-7386
• Life Threatening Emergency - 911
References
1. American Nurses Association. (2021). Nurse Suicide Prevention/Resilience. Retrieved from
https://www.nursingworld.org/practice-policy/nurse-suicide-prevention/
2. American Foundation for Suicide Prevention (2021), State Fact Sheets. Retrieved from
https://afsp.org/state-fact-sheets.
3. ANA Enterprise Healthy Nurse Healthy Nation. https://www.healthynursehealthynation.org/
4. Davidson et al. (2019) Nurse suicide in the United States: Analysis of the Center for Disease
Control 2014 National Violent Death Reporting System dataset. Archives of Psychiatric Nursing,
Volume 33, Issue 5, 2019, Pages 16-21, ISSN 0883-9417
https://doi.org/10.1016/j.apnu.2019.04.006.
5. Davidson et al. (2018). Nurse Suicide: Breaking the Silence. Retrieved from
https://nam.edu/nurse-suicide-breaking-the-silence/
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Nurse Suicide - The Elephant in the Room
References
6. Hrabe, H., Teall, A., Tucker, S., Warren, B. (2021). Suicide Prevention and Intervention Resources
for Clinicians in Distress. Retrieved from https://u.osu.edu/cliniciansindistress/resources/
7. Rosiek, A., Rosiek-Kryszewska, A., Leksowski, Ł., & Leksowski, K. (2016). Chronic Stress and
Suicidal Thinking Among Medical Students. International journal of environmental research and
public health, 13(2), 212. https://doi.org/10.3390/ijerph13020212
8. UC San Diego Healer Education Assessment and Referral Program (HEAR).
https://medschool.ucsd.edu/som/hear/Pages/default.aspx
9. The Joint Commission (2016, February 24). Sentinel Event Alert: Detecting and treating suicide
ideation is all settings. Retrieved from http://www.jointcommission.org/sea_issue)56
10. Zero Suicide. https://zerosuicide.edc.org/
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