As nurses, we work long hours whether on our feet doing direct care, writing budgets, dealing with staffing, traveling to see patients at home, or teaching the next generation of nurses. We know how varied our roles can be! For me, it’s spending hours on my computer, conference calls, and traveling away from home and my family to conferences. After work, we also juggle household responsibilities, the family calendar, or maybe a 2^nd job or school. When do we exercise? When do we rest? How do we fit in time to prepare and eat healthy food?

Did you know that nurses are more likely to be overweight, have higher levels of stress, and get less sleep than the general population (Lee et al., 2011; Melnyk et al., 2013; Thacker et al., 2016; Eanes, 2015)? We are the largest and most trusted health care profession and are critical to the health of the nation, yet when it comes to taking care of ourselves, we are often last on our own to-do list.

It’s important that we pay attention to the mental health risks in ourselves and our nursing colleagues. First, let’s clarify terminology:

• Burnout is “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” (WHO, 2019), while depression is something that you will feel in all areas of your life.
• Compassion fatigue is a type of burnout that impacts the emotional connection nurses have with their patients and causes them to disengage.
• Secondary traumatic stress occurs when nurses become traumatized by unanticipated events such as a patient’s death or a medical error. Secondary traumatic stress can lead to depression.

Burnout Syndrome (BOS)

In April of 2019, the World Health Organization added BOS as a diagnosis in the 11^th edition of the International Classification of Diseases (ICD-11). BOS is characterized by three dimensions: 

• Feelings of energy depletion or exhaustion
• Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
• Reduced professional efficacy

Jones et al. (2017) took a deeper look at predictors and effects of burnout. Their research focused on clinical pharmacists, however I think many of us can relate and would consider these predictors and effects applicable to most, if not all clinicians.
 
Predictors of burnout (Jones et al., 2017):

• Too many nonclinical duties
• Difficult colleagues
• Feeling that one’s contributions are underappreciated

Effects of burnout (Jones et al., 2017):

• Reduced quality of care
• Lower patient satisfaction
• Increased numbers of medical errors
• Higher rates of healthcare-associated infections
• Higher 30-day patient mortality rates

Depression

Registered nurses suffer from depression at almost twice the rate of those in other professions (Letvak et al, 2012). A 2016 review of 36 articles assessed the current state of the science related to depression in registered nurses. This summary of the results demonstrates both the predictive and protective factors related to depression (Brandford & Reed, 2016).
 

Predictors of depression for RNs	Protective factors for depression in RNs
Females	Older age
Younger age	Married
Single and/or divorced	More years of work experience
Fewer years of work experience	Positive evaluations and expectations toward self and others
Work setting	Higher job satisfaction
Unit acuity	Self-efficacy
Shift work	Optimism
Workplace violence or trauma	Learned resourcefulness
Job strain	Positive ideation
Role overload
Role insufficiency
Diminished role boundaries
Lack of supervisor support
Job insecurity
Lack of reward
Lower job satisfaction

Are you depressed?
Recognize these signs of depression as red flags – in yourself and others (Healthy Nurse Healthy Nation, 2017):

• Sleep disturbance
• Changes in appetite
• Feeling hopeless
• Irritability
• Feeling less engaged in activities you used to enjoy
• Feeling isolated
• Not finding joy in life
• Bringing less energy to work and with patients

Suicide Risk

In August 2019, Davidson et al. published Nurse suicide in the United States: Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset. This retrospective correlational analysis of the National Violent Death Reporting System (NVDRS) database for the year 2014 looks at 14,774 suicides in 18 states, 205 of which were nurses. Both female nurse suicides and male nurse suicides were significantly higher than in the general female and male population. Other notable results include:

• Benzodiazepines and opioids were the most commonly used substances utilized in nurse suicide.
• Nurses were significantly more likely to have reported mental health problems, history of a treatment of mental illness, history of previous suicide attempt, leaving a suicide note and physical health problems than the general population.
• Nurses were significantly less likely to have a recent criminal problem or alcohol problem than the general population.

There are many competing priorities for attention and time. Our lives are busier and more structured than ever  before. However, we must remember that self-care is not selfish. We have the power to ask for help and make a change.

References:
Brandford, A. & Reed, D. (2016). Depression in registered nurses: a state of the science. Workplace Health & Safety, 64(10):488-511. doi: 10.1177/2165079916653415

Davidson, J., Proudfoot, J., Lee, K., & Zisook, S. (2019). Nurse suicide in the United States: Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset. Archives of Psychiatric Nursing. doi: https://doi.org/10.1016/j.apnu.2019.04.006

Eanes, L. (2015). The potential effects of sleep loss on a nurse’s health. American Journal of Nursing, 115(4), 34-40. doi: 10.1097/01.NAJ.0000463025.42388.10

Healthy Nurse Healthy Nation (2017). Are You Depressed? Know The Signs. Retrieved from https://engage.healthynursehealthynation.org/blogs/8/40

Jones, G., Roe, N., Louden, L., & Tubbs, C. (2017). Factors associated with burnout among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey. Hospital Pharmacy, 52(11). doi:  10.1177/0018578717732339

Lee W. Tsai, S., Tsai, C. & Lee, C. (2011). A study on work stress, stress coping strategies and health promoting lifestyle among district hospital nurses in Taiwan. Journal of Occupational Health, 53(5), 377–383.

Melnyk, B., Hrabe, D., & Szalacha, L. (2013). Relationships among work stress, job satisfaction, mental health, and healthy lifestyle behaviors in new graduate nurses attending the nurse athlete program: a call to action for nursing leaders. Nursing Administration Quarterly, 37(4), 278-285. doi: 10.1097/NAQ.0b013e3182a2f963

Thacker, K., Haas, D., Brancato, V., Flay, C., & Greenawald, D. (2016). An Investigation into the Health-Promoting Lifestyle Practices of RNs. American Journal of Nursing, 116(4), 24-30. doi: 10.1097/01.NAJ.0000482141.42919.b7

World Health Organization. (2019). ICD-11 for Mortality and Morbidity Statistics. Retrieved from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281