A friend on social media shared a recent article regarding the rate of nurse suicides in the UK. 300 nurses in 7 years, 23% higher than the UK national average.
Problem is, the US does not track nurse suicides. We track veterans, active duty military, police, doctors, air traffic controllers, firefighters and teachers. Not nurses.
I’m in my 25th year of nursing since graduation. I can tell you that nursing in the US is one of the most stressful careers you can imagine. As in other countries, we have the stresses of long hours, departmental politics and holding human lives in our hands.
Make a mistake or fail to identify a mistake in most careers, not much really happens. Maybe money is lost. You may lose your job but not your ability to work in your profession. Police shoot an unarmed civilian, they will have the backing of their department. They may get time off with pay. Not so with nursing. In nursing, if you make a mistake you are the lowest person on the totem pole in a system designed less to prevent mistakes than to assign blame. If a doctor writes an inappropriate order which harms a patient, if the nurse carries the order out, the nurse will be responsible. If the nurse refuses to carry out the same order, often they can be written up or fired. I have personally been written up on multiple occasions for doing what was the correct medical decision. I once had accusations against me claiming I killed a patient with my decisions. That claim was by a non-medical staffing administrator who had the power to blackball me from working at a facility. Even though every doctor and nurse administrator involved said my decisions were correct. Yet I was never allowed to work there again.
Here’s a real conversation I once had:
We’ve had complaints about you.
Me: About what?
I can’t tell you that.
Me: When did the complaints occur?
I can’t tell you that.
Me: Who made the complaints?
I can’t tell you that. Now, how do you respond to these complaints?
Me: I have no idea. I can’t respond without knowing what this is about.
That’s confrontational and unprofessional. I’m afraid we can’t let you work here any more.
The following month, the shift and unit I worked on saw an increase in cardiac events by 700%. I had had the habit of always watching the cardiac monitors and seeing changes before they became critical. The hospital never changed their position. They lost so many nurses they closed one of two cardiac units for several months. Turned out they were eliminating travel and agency nurses, of which I was one.
The above is an illustration of one thing. The influence of money on our system. Agency nurses cost considerably more than staff nurses. With liability, if you can blame a nurse for an incident, the facility and the doctor are not at fault. This is all in addition to the hierarchic structure, often patriarchal structure, which remains present in the medical field. Nurses provide direct patient care, yet fall under the purview of the administration, the medical director, the nursing director, the immediate doctor, the nurse manager and probably a charge nurse. In addition to nurse practice acts for each individual state. You can follow every rule, every medical standard, ask questions and stand your ground. Then by doing so, be considered unprofessional and confrontational. (I’ll take that. Better than someone getting sick or dying because I did not. It also will not lose my license.)
The profit motive in medicine is a huge problem. If a hospital or clinic has slow business, hours can be reduced or the facility may close down. That may not even have to do with business flow but simple profit margin. I’ve written before that hospitals in the US have been closing at a rate of 35 hospitals per year for many years. Under current conditions, I would assume this rate is accelerating, though reporting runs at least two years behind.
Nursing is also stressful because of the social and professional judgments inherent in our system. As illustrated by my own experience, that judgment does not have to be accurate or in any way truthful. Newer or less experienced nurses entering a new field can often be judged incompetent for asking questions. Such judgment can often be imposed for having personal or family illness which interferes with their schedule. In short, the medical field is highly political and nurses have the least support from professional organizations or administrations of all medical professions except nurses aids. Honestly, housekeeping has more administrative support.
It is fairly common knowledge, though generally unspoken, that nurses have a high percentage of substance abuse. From alcohol to prescription drug dependency. I’d say that most nurses I know take some form of antidepressant or anxiety medication.
The stress for nurses doesn’t stop with professional circumstances.
It used to be common that nurses had outpatient medical coverage, typically at no cost, from the facility they worked for. If we had insurance, we paid some of the lowest premiums and deductibles of any profession. Some facilities even provided inpatient care at low or no cost to nurses when it was needed. None of this is true any longer. We pay as much as anyone else and are bound by the profit-driven health plans dictated by our employers. Many nurses decline coverage at all.
Pay for nurses has remained static for many years now. In some areas, it has declined. I have worked in multiple cities where all the hospitals formed an agreement to reduce and limit pay for nurses. At one facility where I was a travel nurse, I worked three consecutive contracts. My contract was up for renewal and I had no intention or signing another, which I had not told them. They called me in and offered me another contract. At 1/3 less pay than I had been receiving. I declined. So did all the other agency nurses. The whole city had to close down entire units because of that decision. And that was the second time I saw such an occurrence but not the last by any means.
Another problem is that many newer nurses entering nursing do so for money. A high percentage (by no means all) of newer nurses for decades have an apathetic attitude which causes more stress for experienced nurses. You’ve likely seen the apathy I refer to if you have been a patient at any level. If that apathy reaches a high enough concentration, that coupled with the administrative and political conditions already described will drive the older, experienced nurses to transfer jobs or leave the profession. Which sadly exacerbates the situation.
The fact is that many older, experienced nurses are retiring if they are financially able. In contrast to popular belief, you will not get rich as a nurse. Younger nurses often leave the field once they pay off student loans. So much so that the shortage is likely to continue for many years. Schools and facility closings cannot keep up with the flow of people leaving the profession entirely.
That’s not all. Nurses experience a lot of emotional stress in our social lives. We are far more likely to be the ones listening to the ailments and anxieties of our friends and partners, while our own illnesses and emotions are dismissed. Often like they don’t exist or are not as bad as for someone not in the medical field. People often treat nurses like we have no role in life but to care for others and have no needs of our own.
People wonder why the nursing shortage continues. There are more schools pumping out more nurse graduates than ever. Hospitals are closing, meaning there are fewer clinical positions to fill. While there are more non-clinical nursing jobs than ever, there remains a shortage of qualified nurses to fill those positions. They also tend to pay less, have fewer benefits and can sometimes be socially isolating, working independently or from home.
All these stresses add up over time. With nurses feeling overworked, over-stressed, under staffed, professionally, socially and personally isolated, this leads to the continued nursing shortage, anxiety, depression, substance dependency/abuse and a high suicide rate. While other professions are given consideration, nursing in this respect is ignored.
The worst part is that we know this is not likely to change any time soon. Not until someone comes up with a way to turn it into a profit motive at our expense, leading to worse financial stress, which will probably make the situation even worse than it is now.
This is one of the conditions that would be greatly improved by universal healthcare. It would reduce the profit motive inherent in our system which leads to some of the above problems. It would also offer access to mental health care services without causing extraordinary financial stress. Universal adult education could potentially increase the number of competent graduate nurses entering the field while reducing stress from student loan debt. What is absolutely certain is that the situation will continue to get worse under our current system.