American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide

Highlights

• Rates of suicide, substance use disorder, and mental health issues have increased in nursing.

• The Surgeon General, National Academy of Medicine, and American Nurses Association among others have stressed the importance of nurse and health care worker well-being, and the importance of the mental health of health care workers.

• Expert Panels of the American Academy of Nursing recommend actions to address risks to mental health and the factors contributing to nurse suicide to inform policy, education, research and clinical practice.

Abstract

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses’ risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses’ health and well-being are provided.

Introduction

The COVID-19 pandemic exacerbated an existing but rarely acknowledged mental health crisis in the nursing profession: an epidemic of deaths of despair from suicide, drug overdose, and depression. Nurses experience problematic rates of depression, anxiety, substance use disorders, post-traumatic stress disorder, and burnout (Maqbali et al., 2021; Choflet et al., 2021 ; Melnyk et al., 2020; National Academies of Sciences, Engineering, and Medicine. (NASEM) 2019; Pappa et al., 2020 Schuster & Dwyer, 2020; Strobbe & Crowley, 2017). The problem of inequitable recognition and treatment of mental health issues among nurses exists despite an emphasis on personal health and well-being as central to professional life in the American Association of Colleges of Nursing's (AACN) The Essentials: Core Competencies for Professional Nursing Education (American Association of Colleges of Nursing 2021) and Code of Ethics for Nurses from both the International Council for Nurses (ICN) (2021) (International Council of Nurses 2021) and American Nurses Association (ANA) (2021). Indeed, nurse self-reported burnout has increased 350% since the summer of 2020 (American Nurses Foundation, 2021). An American Nurses Foundation (ANF) survey of 4912 nurses reported 35% of nurses who said they were not emotionally healthy and 42% indicate they have experienced some form of trauma. Similarly, the National Plan for Health Workforce Well-Being (National Academy of Medicine, 2022) recognizes burnout as a barrier to health care worker professional well-being. The deterioration of mental health of the nursing workforce with the pandemic is disturbing given that nurses were previously found to be at greater risk of suicide than the general population prior to the pandemic (Choflet et al., 2021 ; Davidson et al., 2020; Davis et al., 2021; Patrician et al., 2020).

The purpose of this paper is to examine the background for increased mental health concerns among nurses and provide recommendations among clinical, policy leaders, and scholars from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and the factors contributing to nurse suicide. Drawing from the Centers for Disease Control and Prevention (CDC) Suicide Prevention Resource for Action Framework (2022), recommendations are aligned with the seven strategies for action at the individual, health system, and national levels.