I recently read among women, nurses have a higher rate on suicide than the general population. JAMA Psychiatry published this on April 14, 2021 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2778209 and it is based on data from 2007 – 2018. Can you imagine if the year was 2020? It has been a hard year for nursing and I suspect, 2021 will continue to be difficult with the pandemic. Occupational and environmental nurses, whether staffing hospitals, clinics,, or industry need to know the potential signs of someone contemplating suicide. This is why I asked Judy A. Jobe, RN, BSN, a NISOH ERC master’s student to write this blog as credit for her MSN program:
“The suicide death of a coworker is considered a psychiatric emergency for nurse managers and coworkers left to process the feelings associated with this type of grief. The occupational health nurse (OHN) can assist nurse managers and coworkers in the grieving process. It is critical for the occupational health nurse to understand the psychological, social, and emotional implications for coworkers (suicide survivors) left to grieve the loss. Appropriate support and guidance immediately following the suicide death of a coworker will assist individuals through the normal grieving process and avoid suppressed emotions that may lead to personal and departmental dysfunction.” (Lynn, C., 2008)
- Suicide is the 10th leading cause of death in the United States. It was responsible for more than 47,500 deaths in 2019. (CDC, 2021)
- In 2019, 12 million American adults seriously thought about suicide, 3.5 million made a planned suicide attempt, and 1.4 million attempted suicide. (CDC, 2021)
- The suicide rate is expected to increase by 8.4% in 2020-2021 (McIntyre, R. & Lee, Y., 2020) due to increased social isolation and depression related to COVID.
These are sobering statistics in a time where a pandemic rules our lives: social distancing, masking, not being able to see people’s faces, not being able to hug or show we care by simple hand holding. As OHN’s, we continually evaluate our employee’s mental health and physical health. Healthcare professionals are stressed. COVID leaves no one untouched, and OHNs have been taught to look for signs of depression and possible suicidal ideation. We educate ourselves and our employees on suicide prevention, offer EAP services, make getting help easy and anonymous. Suicide prevention programs are everywhere, in every business environment, and most employees can tell you all about prevention and the resources available.
But what happens when one of your employees commits suicide? What can you, as the OHN, do for your employees at this time? How do you help your employees?
The unexpected and sudden death of a coworker often leaves fellow employees shocked and confused, lost in grief and despair, completely disrupting the “normal” workplace environment. Elisabeth Kubler-Ross originally defined 5 Stages of Grief®– denial, anger, bargaining, depression, and acceptance (EKRFoundation.org, 2021). Since her original publication in 1969, two additional stages have been added: shock at the onset and hope at the end, which have been suggested to help round out the model. The Stages of Grief are fluid, and one may go back and forth between them.. Individuals vary in their grief responses. It is essential to be supportive and accepting on where individuals are in their grief process. This is especially true when hospital staff, a team, lose a member. The daily stressors, both work and personal, make it challenging to work through grief. Suicides are more like sudden accidents; family and friends do not have time to adjust. Complicating the grieving process is the reality of the death and regrets for what may have or have not been said. Initially, co-workers may also feel a heightened sense of responsibility and guilt. They may keep asking themselves “What did I miss? What could I have done differently?” They tell themselves they somehow could have prevented it.
As the OHN, the suicide of a coworker is a traumatic crisis requiring intervention. Often referred to as suicide postvention, it can be defined as the “efforts made by individuals, organizations, and the local, state/tribal, and federal governments to assist those who have been impacted by suicide, and to reduce the harmful effects of exposure to suicide (Jordan, J., 2017)”. In 2015, the National Action Alliance for Suicide Prevention published a document titled Responding to Grief, Trauma, and Distress after Suicide: U.S. National Guidelines (Cook, F., 2017).These guidelines call for the development of postvention programs. To this date, the most recognized and widely used model is the U.S. military’s TAPS (Tragedy Assistance Program for Survivors) Suicide Postvention Model™ (Ruocco, K. et al., 2021). Still, all models encourage primary postvention resources (Andriessen, K. et al., 2019). The following guidelines are taken from Cynthia W. Lynn’s 2008 article in Workplace Health & Safety When a Coworker Completes Suicide:
Support and Education
- The OHN plays an essential role in communication with the employees, establishing immediate, on-site resources such as chaplaincy services, critical incident stress management (CISM) teams, counselors, and crisis intervention support teams (CIST).
- Being a visible, available presence for the employees. Making frequent rounds in all areas, all shifts.
- Posting available resources
- Hold survivor support meetings with the aid of the EAP
- Acknowledge the feelings-Anger, guilt, fear, confusion. Many times the survivor will focus on what could have been done to prevent the suicide. These feelings are normal, but the focus should be on healing and moving forward. Focusing on the life of the victim can help survivors understand they are not responsible for others’ actions.
- Allow coworkers and employees to express their grief in the way they feel comfortable. Not everyone grieves outwardly, and each person grieves on their own timeline. This is where providing resources such as EAP contacts can benefit these employees.
- The OHN, as always, should be an active listener and be prepared to make appropriate referrals for those experiencing suicidal ideations, dysfunctional grieving, depression, PTSD symptoms, etc.
Here are some resources available to help your employees and coworkers:
American Foundation for Suicide Prevention
Suicide Prevention Resource Center
https://sprc.org/resources-programs/resources-suicide-postvention-planning
https://sprc.org/sites/default/files/resource program/Spotlight_Postvention_ResourceSheetv03.pdf
Survivors of Suicide Loss
Thrive_At_Life: Working Solutions 