Nursing Students Are at Heightened Suicide Risk: What to Know and How to Help
Editor & Writer
Reviewer & Writer
Editor & Writer
Reviewer & Writer
If you or someone you know is considering suicide, please contact the 988 Suicide & Crisis Lifeline at 988 or 1-800-273-TALK (8255), available 24 hours a day, seven days a week. All calls are confidential, and anyone can use this service. (This service was formerly known as The National Suicide Prevention Lifeline.
- Nurses are almost twice as likely to die by suicide compared with the general population.
- Approximately half of all nursing students may be at risk for suicide and experience higher rates of mental health disorders than non-nursing students.
- Solutions to nursing suicide include personalized self-care techniques, crisis intervention knowledge for oneself and others, and a cultural emphasis on the psychological safety of employees and students.
Suicide rates are on the rise across the country, with the number of suicide deaths in 2022 being the highest ever recorded. The issue is even more dire within the nursing community, considering registered nurses (RNs) are almost twice as likely to die from suicide than the general population.
The problem only grew more acute during the COVID-19 pandemic, with nurses experiencing much higher rates of poor mental health compared to other health professions.
Nursing students also are at risk, since suicide deaths in this population far outpace those of non-nursing students. They need and deserve effective and accessible mental health resources.
September is Suicide Prevention Month, and nurses are on the front lines of this problem in multiple ways. This article offers meaningful guidance that nurses and nursing students can utilize to help themselves and their peers.
Nurse Suicide: A Growing Problem
A 2021 study reported that, from 2017-2018, approximately 729 nurses died by suicide in the United States. This is the highest reported number on record, but it is reasonable to assume that number has been exceeded at some point since the COVID-19 pandemic.
Many nurses have experienced psychological trauma at the bedside and it has been determined that "psychological suffering" is the root cause of approximately 90% of suicides globally. However, due to the complex nature of compiling national suicide estimates, official post-pandemic data has not been released.
Depression and suicidal ideation are not just affecting nurses, but also nursing students.
A recent study found that more than half of nursing students had a risk of suicide, and more than 20% of them were considered high risk, based on their answers to a suicide risk assessment tool. A 2016 study also revealed that nursing students experience mental health conditions at higher rates than their non-nursing counterparts.
This all begs a sad but indispensable question: Why are nurses and nursing students at such a higher risk for suicide?
Caring for the sick and injured has never been easy. However, nurses are experiencing unparalleled levels of stress and psychological trauma as they attempt to care for patients in understaffed and unsafe workplaces.
Over time, persistent exposure to physically, mentally, and emotionally exhausting work can contribute to burnout, moral injury, and psychological distress. In the most severe cases of psychological distress, some nurses may experience suicidal thoughts.
Existing research has indicated that drivers for nurse suicide tend to fall into three main categories:
- Negative stigma regarding mental health treatment
- Job-related stress
- A lack of access to mental health treatment
The Mental Health Stigma
In a 2014 study of nurses with mental health disorders participants expressed fear of not being taken seriously as a professional if their peers or managers found out about their mental health condition. Nurses interviewed for the study also reported a need to maintain secrecy about their mental health condition due to fear of discrimination.
The high expectations placed on nurses in terms of the care they provide has fueled what many in the profession view as an unfair assumption that nurses with mental health disorders are dangerous or ill-equipped to safely care for their patients.
The Stress of the Job
Previous research revealed that nurses who experience severe depressive symptoms also tend to experience high levels of work stress.
This confirms that depression (and, by correlation, suicide risk) can and often is directly influenced by work-related factors. Nurses are faced with a host of unhealthy working conditions on a daily basis, including inadequate staffing, unsafe nurse-to-patient ratios, bullying, and more.
Lack of Mental Health Treatment
There are significant barriers for nurses and nursing students (mirrored in the general public) in accessing mental health treatment.
Mental health treatment is not covered by many employee-sponsored insurance plans, forcing nurses to pay out of pocket for care.
One potentially ideal fix to the problem would likely rely on complex policy and practice changes at the local, state, and federal levels. Although this level of sweeping change is unlikely, nurses have the capability to deal with their health needs head-on — when provided with the appropriate tools.
A Focus on Self-Care
There is no doubt that consistent self-care is an irreplaceable part of nurse suicide prevention. Nurses are often so focused on caring for others (and often doing so in unsafe conditions), they rarely give themselves the attention they desperately need. Self-care activities are ideally done on a routine basis as a means to improve or sustain one's mental health.
Here are some self-care strategies that have been proven to promote the well-being of nurses:
- Cognitive-behavioral strategies
- Proper nutrition
- Adequate sleep
Mindfulness involves a set of practices that encourage intentionally and non-judgmentally observing the present moment. Among nurses, mindfulness has been shown to reduce anxiety and depression and improve the regulation of emotions during stressful situations.
Examples of mindfulness exercises include deep breathing, meditation, and guided imagery. Mindfulness techniques are a practical choice for nurses because they can be done from practically anywhere and can take as little as five minutes to complete.
Cognitive behavioral therapy (CBT) focuses on the idea that thoughts, behaviors, and emotions are all interconnected. This means that by changing your thoughts or behaviors, you can thus change how you feel.
For nurses, this could include setting realistic goals for physical activity, addressing work-related stress, and improving work-life balance. Cognitive-behavioral strategies are often coupled with mindfulness techniques to greater effect.
Exercise and Proper Nutrition
Finding time to exercise and eat healthy is a struggle for many nurses. Four main barriers have been identified by researchers: time, shift work, work environment, and work culture.
These barriers certainly require determination and commitment to overcome, but the benefits of regular exercise and proper nutrition for nurses have been well-documented. One strategy to improve healthy eating habits at work is through meal prepping. Nurses who take the time to prepare their food for work tend to consume much healthier food than those who don’t.
Consistently sleeping 6-8 hours per night provides a host of health benefits, including improving cognitive function, memory, hormone levels, appetite, immunity, and stress response. Many nurses find it hard to get enough sleep, but implementing mindfulness and CBT techniques can be beneficial.
Self-care looks different to everyone. It is not one-size-fits-all, and to assume generalized self-care activities are the key to preventing nurse suicide is short-sighted. Self-care must be tailored to the individual, and this is often best accomplished with the assistance of a trained counselor or therapist, especially when someone is facing an impending mental health crisis.
How to Recognize Suicide Risk
A key factor to suicide prevention is a commitment from nurses and nursing students to recognizing suicide risk in themselves and others. One of the easiest ways to engage in crisis intervention is through the AIR acronym:
Awareness involves the knowledge of suicide risk factors and signs of a mental health crisis. Understanding these signs can help nurses identify when they or a colleague are in danger.
Some nurse suicide risk factors include:
- Chronic pain
- Evaluation for substance use disorder at work
- Fear for one's safety or the safety of others
- Feeling out of place
- Feeling unprepared for the nursing role
- Feeling unsupported in the nursing role
- Financial stress
- Inadequate self-care habits
- Isolation from family and friends
- Job loss
- Long, consecutive shifts without breaks
- Management conflicts
- Repeated requests for overtime
- Repeated trauma exposure
- Risky substance use and substance misuse
- Work/home role conflict
- Workplace stress
- Workplace violence, incivility, and/or bullying
It is important to understand that while nurse suicide risk factors are serious, they do not always mean that the nurse’s life is in immediate danger. However, if a nurse is showing signs of crisis, this could indicate that the nurse’s risk of suicidal thoughts is at its peak.
Here are some the most common signs of crisis to watch for:
- Acting anxious, agitated, or unusually angry
- Erratic or unusual behavior
- Extreme mood swings
- Giving away personal possessions
- Increased use of alcohol or drugs
- Researching suicide methods
- Rumination (repeated negative thoughts)
- Self-injury behaviors
- Sleeping too much or too little
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or being a burden to others
- Talking about unbearable physical or psychological pain
- Talking, writing, or creating art about death or suicide
- Withdrawal or isolation
Once you are aware of the risk factors for nurse suicide and the signs of crisis, you can then prepare to start a conversation. Empathy is a powerful connection builder that can ease the loneliness many nurses who are experiencing suicidal thoughts feel.
Here are some tips for having a conversation with a colleague who has demonstrated warning signs of suicide:
- Start the conversation open-endedly, without judgment or accusation. For example, "Just wanted to check in with you. How are you holding up?"
- Consider sharing some of your own challenges. This fosters trust and connection.
- State your concerns directly. "I've been worried about you because I noticed [insert specific signs here]. Are you thinking about hurting yourself?" Asking someone directly does not increase their risk of suicide.
- Offer to help them find mental health resources that can help. This can help ease the burden and legwork, making them more likely to comply. If they are showing signs of crisis or admit they are experiencing suicidal thoughts, stay with them and either call 911 or offer to take them to the hospital for voluntary treatment.
Recognize the urgent need to intervene if someone is demonstrating risk factors or signs of crisis. Don’t assume someone else has noticed and will talk to the person. Speaking up shows you care — and could be the key to saving their life.
Changing the System
When self-care alone is not enough, it is imperative that nurses have crisis intervention strategies they can implement easily, as well as affordable and accessible mental health care.
This would ideally include accessible mental health care provided by the school and/or employer, crisis training for self and others, and holding workplaces accountable for ensuring the psychological safety of their employees.
For nursing students, some of their most important advocates are faculty. Nursing instructors have a responsibility to their students to assess for warning signs and risk factors of suicide (as highlighted above), and to know how to recommend resources for at-risk students. Nursing students should also learn how to talk to their peers about their depression and/or suicidal ideations.
Colleges with nursing programs should consider implementing easily accessible mental health resources on campus. Campus-based chapters of the National Alliance on Mental Illness and Active Minds are two options that can provide valuable peer support. Another option is Mental Health First Aid, an eight-hour course that trains students and faculty how to respond to someone experiencing a mental health crisis.
Nursing organizations and federal agencies are taking steps to address the mental health crisis among nurses. The American Nurses Association has created the Well-Being Initiative, a digital mental health resource for nurses.The American Rescue Plan Act of 2021 includes $60 million to specifically support the mental health of healthcare professionals, but it is unclear when and in what capacity that money will be dispersed to those who need it.
Nurse suicide is a serious problem that deserves more recognition. Nurses are in crisis, but the right resources and interventions can help prevent tragedy and improve the safety and well-being of those who need it most.
Mental Health Resources
If you or someone you know is experiencing an emergent mental health crisis:
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Suicide Prevention Lifeline
- Call or text 988 immediately to speak with a trained crisis counselor.
- You can also utilize the chat feature at 988lifeline.org.
Additional free or low-cost mental health resources for nurses and nursing students:
- The Well-Being Initiative
- For the Frontlines
- National Alliance on Mental Illness
- Don't Clock Out
- Therapy Aid Coalition
- The Emotional PPE Project
Page last reviewed September 21, 2023