Kentucky: Suicide Prevention, 2 unitsPage 5 of 10

4. The Impact of Stress

There are many factors to consider when addressing suicide risk for nurses and other health professionals. The nursing profession can be stressful, and nurses are exposed to human suffering on a daily basis. This can lead to chronic stress and secondary traumatic stress, potentially increasing the risk of suicidal ideation and behaviors.

Prior to a completed suicide, nurses have reported more job-related concerns than non-nurses. This includes problems related to disciplinary action, diversion, inability to work due to chronic pain, and physical and mental illness (James et al., 2023).

The impact of ongoing stress can increase the risk of suicidal ideation and behaviors. Despite the known risks related to stress, suicide among nurses is more common than generally acknowledged. It is often shrouded in silence, at least in part due to stigma related to mental health and its treatment (Davidson, Mendis et al., 2018a).

Chronic and Secondary Stress

Chronic toxic stress occurs when an individual is exposed to prolonged or repeated traumatic events, such as violence, abuse, or neglect. Over time, this can lead to changes in the brain and body that can increase the risk of mental health problems such as depression, anxiety, post-traumatic stress disorder, and burnout. Secondary traumatic stress occurs when an individual is exposed to the trauma of others. Both can have a significant impact on an individual's ability to cope.

In today’s complex healthcare environment, nurses have a great deal of responsibility and accountability. They deliver care that is highly regulated, and they are under constant pressure to provide the required care within strict time limits. While burnout is common and painful in its own right, it also leads to suboptimal performance and patient safety issues, and is intimately associated with depression, a known precursor to suicide (Davidson, Mendis et al., 2018b).

Many nurses point to ethics-related stress, perceive limited respect for their work, and express increased dissatisfaction with their work situations. Stress can accumulate over time, related to inadequate equipment, insufficient labor resources, blame, potentially inappropriate treatments, violence, medical errors, and moral distress (Davidson, Mendis et al., 2018b).

During the COVID pandemic, high workloads and unprecedented levels of burnout stressed the U.S. nursing workforce, particularly younger, less experienced RNs. These factors have already resulted in high levels of turnover with the potential for further declines. This is exacerbated by disruptions to prelicensure nursing education and comparable declines among nursing support staff (Martin et al., 2023).

Stress Related to Workplace Violence

Nurses and other healthcare workers can be exposed to violence, harassment, abuse, or intimidation in the workplace. Exposure to violence is associated with increased risk of depression, post-traumatic stress disorder, anxiety, suicide attempts, and suicide (CDC, 2022).

Nurses are the frontline workers who spend more time with patients than other healthcare providers, increasing the potential for violent encounters. Factors that can increase the risk of violence in healthcare settings include workplace stress, novice nurses, shift jobs, and understaffing (Kafle et al., 2022).

These situations can lead to delayed care for patients, who may interpret delays as negligence on the part of an individual nurse. Patients assign certain roles to nurses and violence can occur when a nurse does not perform according to the wishes or expectations of a patient. Nurses may also be the recipient of abuse from visitors, coworkers, supervisors, or administrators (Kafle et al., 2022).

Workplace violence can be physical or psychological, and can include racial abuse, bullying, and verbal abuse. It can be directly related to increased job stress, decreased job satisfaction, absenteeism, burnout, disordered sleep, fatigue, post-traumatic stress disorder, fear, and suicide (Kafle et al., 2022).

Violence against frontline healthcare workers increased dramatically during the COVID pandemic. The attacks have increased occupational stress and the physical and mental health risks of individual healthcare workers. The violence has spilled over to social media and the private sphere and created new forms of hate crimes and harassment. Physical aggression, primarily known from war and conflict settings, now occurs in ordinary workplace settings (Kuhlmann et al., 2023).

Women account for the vast majority of the healthcare workforce. Gender-based and sexual violence is widespread and most often affects women. Unfortunately, there is a severe lack of data, research, and knowledge and a scarcity of political will and policymaking that address this issue (Kuhlmann et al., 2023).