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
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.
Section snippets
Background
Nursing requires physically and emotionally exhausting work which varies over time and across settings. Persistent levels of energy expenditure at work contribute to burnout, moral distress, and a host of serious psychological consequences (ANF, 2021; Dall’Ora, Ball, Reinius, & Griffiths, 2020). In 2017, National Academies of Sciences, Engineering, and Medicine (NASEM) identified clinician well-being as a significant problem, noting an epidemic of nurse and physician suicide (Dyrbye et al., 2017
Drivers of Suicide in Nursing
Research suggests drivers of nurse and health care worker suicide fall into three main categories: (a) stigma associated with asking for and receiving treatment to support mental health, (b) job-related stressors, and (c) access to mental health treatment (American Hospital Association, 2022; Davidson et al., 2021). In a longitudinal investigation of nurse suicide, Davidson et al. (2021) identified that suicide occurred in nurses with known job-related problems, almost all of whom were
Recommendations
Federal policy changes are needed in addition to resources for the individual nurse. Mitigating the psychological harm experienced by nurses requires a bundled approach as suggested by the National Academy of Medicine's National Plan for Health Workforce Well-being (2022). Such an approach includes creating and sustaining a positive work environment; investing in measuring, assessing, and research to improve well-being; supporting mental health and reducing stigma; investing in effective
Academy's Position
The psychological safety for all nurses is vital and the Academy is committed to a positive organizational culture that supports nurse health, mental health, substance use disorder care, and suicide prevention. Substantive change needs to occur in our health care environments where nurses are at the center of a host of potentially traumatic and psychologically demanding situations leading to burnout. This cascade of events can lead to depression, addiction, and increased risk for suicide while
Conclusion
There is a tension between our obligation to safeguard the public by ensuring nurses are safe in their practice and our obligation to care for nurses who face mental health challenges. The recommendations laid out in this paper represent opportunities for significant legislative and programmatic changes in the absence of national standards. Advancing health equity and championing well-being requires that nurse leaders and health care organizations work to promote programs that support mental
Authors' Contributions
JoEllen Schimmels (Conceptualization, Writing Original Draft, Writing Review & Editing), Deborah Finnell (Conceptualization, Writing Review & Editing), Judy E. Davidson (Conceptualization, Writing Original Draft, Writing Review & Editing, Supervision), Lucia Wocial (Writing Original Draft, Writing Review & Editing), Michael Neft (Writing Original Draft, Writing Review & Editing), Carla Groh, (Writing Original Draft, Writing Review & Editing), Cara Young, (Writing Original Draft, Writing Review
Conflict of Interest Statement
The authors have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Acknowledgements
This consensus paper represents the partnering of five American Academy of Nursing Expert Panels: Psychiatric Mental Health and Substance Use; Bioethics; Environmental and Public Health; Military and Veterans Health; and Quality Health Care. We gratefully acknowledge the review, editing, and expertise of Elizabeth Bonham, PhD, RN, PMHCNS-BC, FAAN; Deborah S. Finnell, PhD, RN, CARN-AP, FAAN; Teena McGuinness, PhD, PMHNP-BC, FAANP, FAAN; Madeline A. Naegle, PhD, CNS-PMC, BC, FAAN; Elizabeth Pace,
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