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Debi Fischer is a nurse at the University of Miami surgical oncology step down unit. Prior to that she worked in orthopedics and neurology for many years. In addition to her nursing experience, she has earned a master’s degree in social work. Becoming a Licensed Clinical Social Worker was a lon-sought-after goal which she finally attained. She is a caregiver for her family and her dogs as well.

Preventing Nurse Suicides

One health system in California is working on a solution to the problem of nurse suicide.
PUBLISHED: 3:34 PM, FRI JULY 6, 2018
Recently, the topic of conversation in nurse’s stations across America has turned to suicide in light of two recent high-profile deaths: fashion designer Kate Spade and celebrity chef Anthony Bourdain. Suicide is the 10th leading cause of death in the United States, and, globally, the World Health Organization reports that one person commits suicide every 40 seconds.1 

Health care professionals are singled out as being at high risk for suicide. Stressful clinical areas include oncology, psychology, the emergency department, the intensive care unit, and the operating room. This has been an overlooked topic in the current nursing literature. Twenty-eight-year-old data, the last available research available on occupational risk, revealed that the risk of suicide was 1.58 times greater in the nurse population than in non-nurses.1 On an international level, Australia has a higher rate of nurse suicide compared to non-nurses.1

Risk factors attributed to suicide include being too caring, having access to drugs and their use, and being perfectionists or “super nurses.” Other issues that push nurses to suicide are hospital culture, which can include inadequate staffing, bullying by coworkers, as well as simultaneous emergencies without adequate time to decompress.1

A Possible Solution

One health system in California is working on a solution to the problem of nurse suicide. The Healer Education, Assessment, and Referral (HEAR) program is being called the first and only nurse suicide prevention program in the US.1 The program, originally geared toward physicians in 2008, has been extended to nurses at UC San Diego Health.1 Originally, HEAR was a collaborative effort with the American Foundation for Suicide Prevention (AFSP).

Key statistics showed that one doctor per year¾including either a medical student, resident, or faculty member¾was committing suicide at the institution, and that there are 400 physician suicides annually in this country.1 Since the inception of the physician program, there has only been one suicide in 6 years at UC San Diego Health.1

Components of HEAR

The HEAR program involves teaching the nurse about mental health topics such as suicide, depression, and nurse burnout.1 Different modalities were used to reach the 2475 employed nurses at this facility such as education during grand rounds and dedicated 1-hour sessions. A graduate of HEAR, a nurse who completed the program, was also a speaker. The huddle format, wherein information is delivered by nurse managers and charge nurses, was also developed and given to nurses in a fact sheet over a 2-week period.1 The chief nursing officer (CNO) was part of the effort and took the pitch to the masses with a call for screening all nurses in the facility.1 HEAR wants to break the stigma surrounding nurses seeking out mental health treatment.

The Result

Seven percent of nurses that were approached had responded to the mass outreach efforts. Once a nurse decides to participate, they begin an Interactive Survey Program (ISP), where an internet-based screening and assessment tool identifies those who may be at risk for depression and consequent suicide.1 The tool is confidential and the answers to the questions are encrypted. There are 3 tiers that rank current suicidal ideation from high to moderate and low risk.1 Participants log into the website and link up with mental health professionals.  In a crisis, they are directed to an emergency room; otherwise they are referred for counseling. 

Originally, 172 out of 2475 employed nurses working at UC San Diego Health completed the assessment tool. Out of the original 172, 44% of the nurses received counseling either on the phone or face-to-face. Records show that 17 nurses took the next step and sought more follow-up counseling. Another route for referral was during what could be called stressful or emotional clinical  situations.2 Program counselors also recruited potential clients at these settings.1 Examples of clinical situations range from everyday occurrences, like medication errors, to patient deaths that caught the staff off guard, to rarer events like a patient-nurse attack.2

If you are having thoughts of suicide call the National Suicide Hotline at 1-800-273-TALK (8255).  
  1. Davidson JE, Zisook S, Kirby B, DeMichele G, Norcross W. Suicide prevention: A healer education and referral program for nurses J Nurs Adm. 2018;48(2):85-92 doi: 10.1097/NNA.0000000000000582.
  2. Thew J.  Nurse suicide is real. Don’t ignore it. Health Leaders Media website. Published June 2018. Accessed July 1, 2018.



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