What's Killing Our Nurses and Doctors? Depression, Denial and PSTD

As a nurse myself, I’ve been following with interest the ongoing conversation about a critical issue that has gone too long unaddressed; the crisis-level suicide rates of our nurses (and doctors, too).

A recent article on the MedPage website, Nurse Suicide: Under the Radar, used as an example the suicide of Dana, a bright, energetic and hard-working ER nurse. As bad as the heartbreak experienced by her colleagues was, even more damaging was the way in which their institution handled the emotional aftermath of this woman’s death. One section of that story struck me in particular:

“The department held a debriefing after Dana's death -- a meeting to allow hospital staff to discuss a critical event -- but it was only open to those who had directly cared for Dana as a patient….

Simpson broke down crying in the nurse's lounge when she was told she could not go. She had worked during Dana's memorial service and regretted not being able to say her goodbyes. There were people much closer to Dana, but "it was hard for me to lose her," Simpson said.

That day, she badly wanted to go home, but instead she was sent to triage.

"I had to straighten up. I had to get my act together ... I had to do what we do: Forget about my own problems and take on other people's problems," Simpson said.

When a colleague is upset, Kelley said, "The thing that you need to hear from your co-worker is, 'Go take a minute, I got you.'" Instead, she said, the feeling from management was, "Wipe your eyes. Get to work."

This, to me, says it all. The stigma attached to mental illness – to depression – that hangs over the healthcare world is like a slow-acting poison to those who work in it. It begins within us as we see or otherwise absorb the mostly unspoken message; if you can’t take the heat, stay out of the kitchen. If you can’t handle the emotional stress, or the physical demands, or the daily dangers of working in healthcare, you probably aren’t fit for the job. Better just to stifle your feelings, shut down the conversation, and move on. “Wipe your eyes. Get to work.”

And we wonder why so many gifted and passionate nurses and doctors leave the profession – either by simply walking out, or by self-harm.

Here’s my take: we have to start giving as much compassion to our healthcare workers as we do to our patients, without stigmatizing them when they stumble or show human weakness. Physical exhaustion is a daily reality for most nurses and doctors; so is burnout. As hard as we try to draw a clear, bright line between our work life and our personal life, inevitably there’s emotional overlap, and we’re every bit as apt to experience crippling PSTD as are military or law enforcement personnel. When that happens – when depression washes over us, sapping our joy and energy – we’ve got to feel safe asking for help.

That’s half of it. The other half falls on leadership. We must commit to becoming more proactive – not only in spotting the signs of burnout before it reaches critical mass, but in addressing these issues ahead of need, encouraging and modeling openness about them, and offering resources to all of our people to help them take better care of themselves and of each other. This has to become an ongoing effort, not a one-time thing but a part of our institutional culture.

Compassion is our mission, but that caring support and acceptance needs to flow in all directions. If we lose our caregivers, the mission goes with them.