Here's a startling statistic: 18% of hospital-employed nurses experience depressive symptoms; that's twice the rate of the general public.
But according to researchers at the Robert Wood Johnson Foundation, nurse leaders are in a unique position to help the nurses on their units identify their depressive symptoms and offer resources for dealing with the condition.
"They're the group that really needs to hear this," says one of the researchers, Susan Letvak, PhD, RN, associate professor of nursing, the University of North Carolina at Greensboro, School of Nursing. She tells HealthLeaders Media that nurse managers have an obligation to ensure a healthy, productive staff. However, she thinks there's a "little bit of denial" about depression among nurses; they might chalk up their feelings to a bad day or a stressful job.
"I think nurses managers always have to address a problem," she says, no matter what the problems is.
And when as many as two out of every ten nurses on a unit could have depression that definitely qualifies as a problem.
In fact, it's a big, expensive problem. The Interdisciplinary Nursing Quality Research Initiative study cites other research showing that "almost two-thirds of the estimated $83 billion that depression cost the United States in the year 2000 resulted from lowered productivity and workplace absenteeism."
Moreover, depressed people often exhibit low mood, have trouble concentrating, are more accident prone, and have worse time management skills; symptoms that would no doubt harm patient care.
The trouble is nurses often don't recognize depression in themselves.
"People assume because we're nurses that we take care of ourselves," Letvak says. "We don't want to ever consider ourselves as not the cheerful happy nurse going into work every day."
For the Robert Wood Johnson study, researchers analyzed surveys from 1,171 hospital nurses in North Carolina to determine the prevalence of depression, as well as the individual and workplace characteristics associated with the illness.
They used the PHQ-9, a nine-item self-reporting tool developed for use in primary care. In addition to identifying the prevalence of depression, the researchers also found that factors such as body mass index, job satisfaction, and having other of health problems had a significant relationship to a higher total depression score.
Although Letvak knows that nursing is a tough job (she says her role as a nurse manager was "the most difficult job I ever had"), she was still "really surprised" by the study results.
But she and her fellow researchers also say that depression screening and early treatment can help—in fact, Letvak told me that even filling out the screening questionnaire caused some nurses to recognize depression symptoms in themselves. Moreover, advanced practice nurses and other nurse leaders can help raise awareness and encourage nurses to get help.
Although Letvak doesn't recommend that nurse leaders just walk up to a nurse and say "you seem depressed," there are steps they can take to help. First, be on the lookout for certain behaviors, like mistakes with patient care or the presence of other health problems that cause them to struggle just to get through the day. Managers don't like to do it, but consider sending the nurse to talk with HR—that's what HR is there for, Letvak says.
The problem should also be addressed on a unit level. Letvak recommends talking about depression during staff meetings, handing out a depression scale, and recommending resources for confidential, free diagnostic treatment. She points to Web-based tools such as MoodGYM, which provides evidence-based cognitive screening and therapy for depression.
An even better way to work depression discussions into meetings is to make nurse health a standing agenda item; Letvak says one meeting might invite a physical therapist to talk about nursing and back pain; another might address depression symptoms and resources. Hospitals should also consider sponsoring workshops to teach skills that are shown to help with depression, such as mediation and reflective journaling.
Although depression continues to carry a societal stigma, Letvak says nurses and nurse leaders should give the condition as much credence as physical ailments.
"We all knew about our back problems, but I don't think we ever look at the mental health component," she says. "There are some solutions though…problems don't go away when they're ignored."
Alexandra Wilson Pecci is an editor for HealthLeaders.