1. Reid Ponte, Patricia DNSc, RN, FAAN, NEA-BC


This month's column is an interview with Dr Judy Davidson, nurse scientist, University of California, San Diego Health Sciences Center. Dr Davidson has devoted a large part of her research to the reporting and prevention of nurse suicide.


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Dr Reid Ponte: I am aware of the important work of the American Nurses Association on nurse suicide, and I recently learned of your leadership in this area. Before we start into that topic, can you describe what brought you to a career as a nurse clinician, nurse scientist, and policy advocate?

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Dr Davidson: I worked as an intensive care unit (ICU) nurse for many years before attaining my master's degree as a critical care clinical nurse specialist (CNS) at San Diego State. With outstanding mentorship from Dr Barbara Riegal, I began a career-long journey of conducting nursing research. I found myself routinely asking and answering clinical questions using the scientific process. My initial work was small and unfunded studies since I was not in an academic center and not eligible for federal funding. One of my 1st studies investigated the use of peripheral nerve stimulation to prevent excess dosing of neuromuscular-blocking agents in the ICU. After presenting my work at the Society of Critical Care Medicine meeting, I was asked to coauthor the 1st neuromuscular blockade and sedation national guidelines in the early 1990s.


Dr Reid Ponte: I understand you developed guidelines advancing patient- and family-centered care, which resulted in the movement to open family presence in ICUs through your involvement with the Society of Critical Care Medicine. What was that experience like?


Dr Davidson: The most profound attribute of that experience was that I worked so closely with international, interdisciplinary colleagues. Each guideline writing team [neuromuscular blockade, pain agitation, and delirium] or led [family-centered care] required at least 3 years of communication with authors from all disciplines who have performed research to advance practice. The network you build and the collegiality are really joyful. Years ago, Dr Karen Kirkoff and I established the 1st family-centered care award through the society, which served to drive innovation in practice. That experience was seminal for me encouraging through competition the advancement of new ideas to support patients and families in the ICU. In the 1st year, we analyzed abstracts identifying 300 expressions of excellence, beyond what our guidelines were advocating.


Dr Reid Ponte: As I reviewed your CV, I realized you did so much of your scholarly work as a master's degree-prepared CNS before attaining your DNP [doctor of nursing practice] in 2008. What is your philosophy related to research and educational preparation?


Dr Davidson: I became a researcher before obtaining my master's degree. When I had a clinical question, I found ways to use the scientific process to answer them. Then as a CNS, I worked in organizations that supported me. They included Sharp Memorial, UC San Diego Health, and Scripps Health, none of which are associated with a school of nursing. I knew that my focus would always be in the clinical setting, and so when I decided to pursue my doctoral degree, the DNP degree was the one I chose. I continue to conduct research just as in my earlier roles. Gaining the competencies to conduct research can be accomplished in many ways, not only through a PhD degree. However, I do realize now that a PhD would have been the more appropriate degree for the work I do now as a nurse scientist. I do my best to make up for the formal research courses that I have missed through vigorous self-study, learning from good mentors and building research teams with members who possess the skills that are my weaknesses.


Dr Reid Ponte: One such initiative or, rather, program of research, evidence-based practice, and policy development is your recent work: suicide incidence and prevention in the nursing workforce. What drew you to this?


Dr Davidson: About 5 years ago, 3 nurses in the practice setting I worked in completed suicide. I was curious about the incidence of suicide in nursing. I was aware of the national work for suicide prevention in veterans and physicians. I found it disturbing that nothing about suicide in nurses had been written since 1984 in the United States. I led a team to explore the medical examiner suicide data in my own region and then the Centers for Disease Control suicide national data to find that, disturbingly, nurses have been at a higher risk of suicide than the general population for many years.2,3 We were at risk for all of the years that the data had been collected, but no one asked the research question. Recently, we conducted a study using the same data to demonstrate that firearm deaths in nurses who complete suicide have been rising, pointing to the need for better firearm safety among nurses. Sadly, we have also focused a study on job-related issues leading to death by suicide in nurses. We discovered that the time around a job loss is a very vulnerable time. We need better strategies to transition nurses out of the workplace when they can no longer work. Losing a job due to substance use disorder can lead to death. Our Alternative to Discipline programs need to be coupled with efforts at suicide prevention. Since the completion of our 1st study, I have been working with colleagues across the nation to create programs to educate nurses and healthcare organization leaders about effective means for supporting the mental health of employees. Several key articles based on our work on suicide and suicide prevention are now in the literature.1-3


Dr Reid Ponte: Given the trauma and distress of working over the past year during the pandemic, I am sure there is even more concern about nurse suicide. What knowledge would you share with JONA readers about suicide prevention, risk detection, and mental health treatment for nurses?


Dr Davidson: Our research has resulted in a new understanding of programs that need to be adopted by healthcare organizations. The Tricouncil of Nursing endorsed a national effort led by the American Nurses Association to collate suicide prevention resources now available to all nurses []. I encourage JONA readers to become informed about how to support nurses through employee programs that proactively reach out to nurses. It is not enough to hope that nurses will use their mental health benefits. We have found that it takes someone to reach out for a nurse to take action. The annual employee survey my colleagues at UCSD [University of California San Diego] developed to measure suicide risk and depression and refer high-risk nurses into treatment is now considered best practice, "The Healer Education and Referral Program" (HEAR).2 HEAR is an easily implemented program in which organizations can actively reach out to nurses and ask them to take an anonymous risk screening. The 2 elements of being proactive and anonymous are essential. It is paramount that nurse executives and managers are informed about suicide risk and prevention and that they are supporting programs to improve the mental health of our workforce.




1. Davidson JE, Proudfoot J, Lee K, Zisook S. Nurse suicide in the United States: analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset. Arch Psychiatr Nurs. 2019;33:16-21. doi: [Context Link]


2. Davidson J, Zisook S, Kirby D, DeMichele J, Norcross W. Suicide prevention: a healer and education program for nurses. JONA. 2018;46(3):1-8. [Context Link]


3. Davidson JE, Stuck AR, Zisook S, Proudfoot J. A testing strategy to identify incidence on nursing suicide in the United States. J Nurs Adm. 2018;48:259-265. [Context Link]