With the observance of National Suicide Prevention Week, Sarah Wells of the American Association of Critical-Care Nurses talks about self-care, getting help and how hospitals can help their staff.
Nurses, doctors and other healthcare workers have long struggled with their mental health, and now those challenges are gaining more attention.
While clinicians aren’t facing the constant chaos when COVID-19 hospitalizations peaked, healthcare workers are struggling amidst staffing shortages, workplace violence, and the stress of seeing sick and dying people on a daily basis.
Healthcare workers are at higher risk for suicide. A 2020 study at the University of California San Diego School of Medicine found nurses have a higher risk of dying by suicide than the general population. Doctors, particularly women physicians, also are at higher risk of death by suicide, a 2019 study found.
Sarah Wells, a clinical practice specialist with the American Association of Critical-Care Nurses, understands these difficulties from her years of experience and her own mental health struggles.
With the observance of National Suicide Prevention Week, Wells spoke with Chief Healthcare Executive® about the need for self-care, the importance of seeking help when necessary, and how hospitals and health systems can take steps to help their staff.
“You're not alone,” Wells says. “If you're having any sort of mental health struggle, if your staff or colleagues are showing signs of mental health struggle, they're not unique. There's so many of us out there who are dealing with this.”
(See part of our conversation with Sarah Wells in this video. The story continues below.)
Wells worked as an emergency department nurse for 11 years.
During her career, she says she struggled with the stress of work, along with feelings of isolation. She says she could go days without seeing her partner on night shifts, and she suffered from poor sleep.
She has received assistance. She sees a therapist regularly and takes medication.
“I am doing ongoing maintenance treatment for my mental wellness,” she says. “Sometimes it's really good. And sometimes it's really bad. And so I can get quote, unquote, ‘sick’ with my mental wellness. And so sometimes I need some time to heal. Sometimes I can't do my work, because I'm depressed or anxious.”
But she says she has learned that her mental health struggles aren’t a sign of weakness or a personal defect. Wells says it’s vital to perceive mental health in the same manner as physical illnesses.
“I just have a chronic condition like anyone else who has diabetes, or high blood pressure, any of those things,” she says. “It's nothing I did wrong. There's no moral association with my mental wellness. It's just, I am who I am. And that's just part of who I am.”
“And I think really, I'm a better nurse for it because I'm a lot more empathetic and attuned, often to my patients’ mental health crisis and issues,” Wells adds. “And so I think there's a lot of pieces that come out of my own mental health journey that made me a much better nurse.”
The need for self-care
Even though nurses aren’t dealing with the crisis mentality of the peak waves of the COVID-19 pandemic, Wells suggests nurses aren’t under any less stress.
“The staffing crisis, I think, has gotten much more intensified in a lot of areas,” Wells says. “So I would say it's as pervasive as it has been in the last few years, and if not worse, because I think a lot of people are finally addressing some of the traumas and stress they just didn't have time to kind of address and process the last few years.”
Wells and other nursing leaders and advocates have pointed to the need for nurses to do more to take care of themselves, including taking days off when the stress is mounting.
At the same time, nursing leaders also have pointed out that some nurses are reluctant to take personal days due to staffing shortages, because they don’t want to add to the burdens of their colleagues.
Even though nurses work in the healthcare industry, many don’t seek assistance even if they are struggling. Some say they wrongly perceive getting help as a sign of weakness, and still some fear, incorrectly, that they could hurt their careers if they are seeing a mental health professional or getting treatment, Wells says.
“There was a point in time … where if a healthcare worker talks about having a mental health diagnosis, or taking medicine or needing more support or feeling in crisis, that they could be at risk of losing their job,” Wells says. “And so while that's very rare now, we have that stigma, I think, it still carried and people have a lot of shame, and don't want to be perceived as weak or ineffective in their role.
“We have to overcome that stigma,” she adds. “And the best way to do that is just with conversation. Something that any nurse or any person can do is check in with each other and help foster, really just normalizing conversations around mental health.”
Some advocates, including the Dr. Lorna Breen Heroes Foundation, are working to change applications for state medical licenses and end the practice of asking if applicants have been treated for mental health conditions. Those groups are also urging health systems to revise such questions as well.
Even nurses who are seeking assistance aren’t always having an easy time, due to the shortage of mental health clinicians.
“Nurses have had to kind of get in line with the rest of the community to get access,” Wells says.
After long shifts, some doctors and nurses don’t feel as if they have the energy to be with other people. Some also perceive they don’t want to burden others with their troubles.
Wells can understand those sentiments.
“When you're really struggling with thoughts of self-harm, or suicidal ideation, I've been there,” she says. “So I can speak to that as a direct care nurse who has had those issues. I often wanted to just isolate myself because my thoughts of self-worth were so low …. I wasn't worth anything. And so why would anyone want to be around me? It's so hard to overcome that negative internal narrative.”
But she also urges nurses and other healthcare workers who are struggling to reach out to friends and loved ones.
She recounted her experiences when she publicly disclosed her own struggles in her writing.
“As soon as I started sharing those experiences of having depression, anxiety, dark darks, mental health spaces, I was overwhelmed with people reaching out to me saying,
‘I thought I was by myself. I thought I was the only one. I can't believe someone else feels like I feel,’” Wells says. “So often we're suffering alone, but we're suffering with problems that people are struggling with all around us.”
“If you feel like no one else feels like this, you are not alone,” she says. “People are out there who love and care for you.”
What hospitals can do
Many nurses cite staffing shortages as a key factor contributing to their stress.
While hospitals and health systems have cited staff retention as one of their most persistent difficulties, they run the risk of losing talented staff if shortages aren’t addressed. Wellness experts note that people will leave hospitals for other organizations, or they’ll mentally check out, if hospitals don’t improve their work environments.
Wells also points out that the AACN has developed a tool - the Healthy Work Environment Assessment Tool - to help hospital units evaluate their own workplaces and units.
Hospital and health system leaders must stress that staff should feel comfortable seeking counseling and mental health services.
“It's really going to take not just individuals advocating for change, but also leaders, making systems changes,” Wells says. “Because an individual can do everything they can at any given time. But they only have the sphere of their influence, which is sometimes more limited than leaders. And leaders can really make a huge impact on the wellness of their staff, sometimes just by making little changes.”
Most importantly, Wells stresses that anyone who is struggling shouldn’t feel as if there is no one available to help them. People need to understand that they matter and are important, Wells says.
That’s a message that needs to be integrated into the workplace, and society as a whole, she adds.
“If you're struggling, you are loved and appreciated and needed,” Wells says. “And there is help out there for you.”
988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.
The American Foundation for Suicide Prevention offers resources for healthcare professionals.
NAMI: The National Alliance for Mental Illness offers “frontline wellness” resources for healthcare workers and public safety employees.