Nurses are at a high risk for death by suicide, but there are ways nurse leaders can help.
Nursing is an incredibly difficult profession.
Nurses face new challenges, including high stress emergency situations, workplace violence incidents, and death, on a daily basis with patients and families. All of those events can take a major toll on a nurse's mental health, which can lead to more serious problems.
September is Suicide Prevention Month, and CNOs need to be aware of the risks and warning signs among their workforce and provide mental health resources and programs.
Nurses are at risk
According to a 2023 study from JAMA Network, from 2008 to 2019, the risk of suicide was higher for healthcare workers, specifically registered nurses, healthcare support workers, and health technicians, compared to non-healthcare workers.
Another 2021 article published in the Journal of Psychosocial Nursing reported that the available data from the CDC's National Violent Death Reporting System showed nurses were 18% more likely to die from suicide than the general population between 2007 and 2018. The risk of death by suicide for female nurses was twice as high than the general population, and 70% more than female physicians.
According to the American Association of Critical-Care Nurses (AACN), the suicide risks are higher for nurses because of several different reasons, including high levels of stress, hectic schedules, exposure to trauma, workplace violence, and a lack of healthy work environments. Other factors include feeling a lack of support and preparation for the job, leadership concerns, depression, and financial issues.
How CNOs can help
While the numbers are startling, nurse leaders can make an impact. It's critical that CNOs take steps to address the underlying issues that contribute to suicide risks to improve the work environment to keep their nurses safe and healthy.
According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, the CNOs at the health system support the whole person by offering flexible work hours so that nurses can choose how and when they work.
"Mental health and well-being are important for both an individual's personal life and work life," Rocchio said. "Flexible hours and environments support the needs of our nurses and ultimately provide the space for our nurses to deliver compassionate, quality patient care."
Additionally, Mercy has programs in place that support whole health, Rocchio explained, including a robust employee assistance program with an abundance of mental health resources.
"People flourish when we support them as a whole person," Rocchio said, "by tending to their physical, mental, emotional, and social well-being."
According to Deana Sievert, chief nursing officer at Ohio State Wexner University and Ross Heart Hospitals, and HealthLeaders Exchange member, there are two areas that CNOs should focus on: staff support structures and nursing workflows.
"By dividing into these two categories, the CNO can assure a broad focus on structures and supports," Sievert said, "but also a zoomed in view that looks at the day-to-day frustrations that can gather and increase stress and dissatisfaction which thereby impacts mental health and wellbeing."
Sievert also recommended implementing an employee assistance program and a strong-structured shared governance model, but Sievert also emphasized the need for a more proactive approach.
"There are some in the nursing community that I have heard are doing a simple screening of the nursing team, through very brief individual surveys," Sievert said, "to help identify those subtle red flags that could lead to reactions such as depression, anxiety, or even suicide.
Sievert is hopeful that this strategy will become more widely used throughout the nursing industry.
"I applaud those organizations and CNOs that have moved here," Sievert said, "and I am hopeful that this becomes a best practice that many of us adopt."
Advice for nurses and leaders
Rocchio also emphasized the important role that CNOs and other nurse leaders play in creating a sustainable work environment where nurses feel supported.
"It's of the utmost importance for our nursing leaders and teams to have a close professional relationship so they can help and support each other," Rocchio said. "Changing the care delivery model to meet workforce needs, designed and supported by nurse leaders, is the key to a healthy workforce, healthy work environment, and a workflow that supports the best patient care possible."
As a note to nurses who might be struggling with their mental health, Rocchio offered some words of wisdom.
"Mental health is critical. As nurses, we tend to set aside our own needs and take care of others first. We must remember that before we can take care of others, we must first take care of ourselves. It's imperative because our families, friends and patients need caregivers who are mentally, physically and emotionally healthy. Supporting our team and paying attention to their needs supports a healthy workforce and environment. Healthcare and nursing put patients and caregivers at the center of our care model because people matter!"
Sievert also had some words of encouragement for nurses.
"First and most importantly, ask for help. We are all here and hope that there is comfort in being able to reach out. Then I would encourage reaching out to your nursing leaders. I assure you we do care about you. We want to help, and we want to support you. Please do not let the stigma that often still exists stop you from asking for help. You are too important to us!"
The 988 Suicide and Crisis Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a trained listener, call 988. Visit 988lifeline.org for crisis chat services or for more information.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
There are many benefits to nurse staffing ratios, for nurses, patients, and health systems, says this CNO.
One proposed solution for ensuring proper staffing is staffing ratios.
Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.
"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."
The significant changes in healthcare have also impacted nursing education.
On this episode of HL Shorts, we hear from Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing, about how nursing education has evolved to fit the needs and values of the new generations of nurses. Tune in to hear his insights.
Adequate nurse staffing ratios are associated with better patient outcomes, says this CNO.
The nursing shortage impacts other nurses by causing burnout and exhaustion, and inadequate staffing directly affects patient safety and experience.
CNOs must be aware of those risks and consider all possible staffing models and solutions so that they can make the best decision for their hospitals and health systems.
According to the American Nurses Association, proper nurse staffing improves patient outcomes and satisfaction among nurses and patients. One proposed solution for ensuring proper staffing is staffing ratios.
Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.
"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."
What are the benefits?
According to Tilton, higher nurse staffing ratios can reduce the likelihood of adverse events, falls, and patient deterioration. In this case, nurses have more time to monitor patients and spot warning signs, and they can intervene quickly when complications arise.
"Optimal staffing ratios enable nurses to conduct thorough assessments, administer medications safely, and implement proper infection control measures," Tilton said, "thereby minimizing the risk of errors and harm to patients."
Proper staffing ratios can also help mitigate burnout and job dissatisfaction, Tilton explained, by lowering workload intensity, stress, and fatigue.
"When nurses are not overwhelmed by excessive patient assignments, they can maintain a healthier work-life balance, experience less emotional exhaustion, and feel more engaged and fulfilled in their roles," Tilton said.
Additionally, staffing ratios can allow nurses to practice at the top of their license, according to Tilton. They provide more time for professional development opportunities as well, such as continuing education, specialty certification, and leadership roles.
"Nurses can collaborate more closely with interdisciplinary team members, participate in care planning, and contribute to quality care initiatives," Tilton said, "when they are not overwhelmed by excessive workload demands."
Financial impact
Just like with any new program or workforce strategy, CNOs need to be able to justify the cost to the rest of the C-Suite.
"While ensuring appropriate nurse staffing ratios may require upfront investment," Tilton said, "it can yield long-term financial benefits for healthcare organizations."
There are several financial benefits to staffing ratios that can lead to saving more time and money for both the nurse and the health system.
"Improved patient outcomes, reduced lengths of stay, lower rates of readmission, and higher patient satisfaction scores associated with optimal staffing ratios can lead to cost savings, enhanced reimbursement rates, and increased revenue generation," Tilton said, "for hospitals and healthcare systems."
Proper staffing ratios also lower nurse turnover rates, according to Tilton, which is an additional financial benefit as well as a solution to the staffing shortage.
"Organizations that prioritize nurse satisfaction and retention by maintaining safe staffing levels can avoid the high costs associated with recruitment, orientation, and turnover of nursing staff," Tilton said.
Overall, Tilton explained, staffing ratios for nurses promote patient safety, quality of care, and better organizational performance.
"By prioritizing adequate staffing levels and workload management," Tilton said, "healthcare organizations can achieve better clinical outcomes, enhance the patient experience, and create a supportive and sustainable work environment for nurses."
Legal implications
While there is no current federal legislation mandating nurse staffing ratios, several states have legislated standards for staffing ratios or have made attempts to do so.
California has had legally mandated staffing ratios since 1999, which according to National Nurses United, are based on individual patient acuity and are designed to fix unsafe staffing in acute-care settings. The California staffing ratios require numerical RN-to-patient ratios as well as a patient classification system. The law also regulates the use of unlicensed assistive personnel and restricts "floating" nursing staff.
Implementing staffing ratios, however, requires levels of nuance depending on the health system.
"It’s important to note that the impact of legislation mandating staffing ratios can vary," Tilton said, "depending on factors such as geographical location, healthcare setting, patient population, and resource availability."
Health systems might run into several implementation challenges, Tilton explained, including budget constraints, potential staffing shortages, and a resistance to change from staff. These roadblocks can impact the effectiveness and outcomes in a mandated ratio scenario.
"Policymakers, healthcare leaders, and stakeholders must carefully consider the unique context and implications of staffing ratio legislation," Tilton said, "to maximize its benefits and address potential challenges effectively."
Nurse educators and nurse leaders must come together to be the unified voice and advocate for the nursing profession, says this nurse educator.
HealthLeaders spoke to Jason Dunne, chief academic officer at the Arizona College of Nursing, about the current landscape of nursing education and how CNOs can partner with academic institutions to create pipelines into the industry. Tune in to hear his insights.
New graduate nurses coming out of nursing school should have these qualities, says this nurse educator.
Amidst one of the largest workforce shortages in healthcare history, CNOs are looking for ways to recruit new graduate nurses now more than ever. Nursing schools must provide the proper curriculum for new graduate nurses so that they can enter the clinical environment equipped with the necessary skills for modern nursing.
According to Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing (AZCN), there are a number of qualities that nurses must learn to ensure career longevity.
Here are the four qualities of a career-ready nurse.
Nursing education is evolving to accommodate new generations of nurses, says this nurse educator.
Amidst one of the largest workforce shortages in healthcare history, CNOs are looking for ways to recruit new graduate nurses now more than ever.
Many health systems are partnering with nursing schools and other academic institutions to help raise the next generation of nurses and create pipelines into the industry. CNOs need to stay up to date on the current state of nursing education to maximize the potential of incoming new graduate nurses.
There are several reasons for the nursing shortage, and according to Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing (AZCN), the American Association of Colleges of Nursing (AACN) anticipates that 1,000,000 nurses will retire by 2030.
“At the same time, I think our population is aging and living longer, creating higher demands for nurses,” Dunne said, “and in recent years, the pandemic only exacerbated the situation, and many nurses opted to leave the profession early, unfortunately.”
Additionally, the Bureau of Labor Statistics (BLS) expects the nursing workforce to expand by 6% over the next 10 years, Dunne explained. Nurses are also experiencing high levels of burnout, which is also causing them to leave the profession.
“The other piece that’s near and dear to my heart is nursing school enrollment is not keeping pace with the demand for new nurses,” Dunne said. “So even with the high interest in the profession, many qualified applicants across the country are just not being admitted because there’s not enough spots for nursing program applicants.”
Several factors are blocking students from enrolling in nursing programs, according to Dunne, including funding from the federal and state governments, and clinical availability. Nursing schools also struggle with recruiting faculty, specifically those who have at minimum a master’s degree.
“As students progress to the nursing program, they actually need clinical experiences and health systems to hone skills and be competent, so those are not as readily available as we’ve been moving forward,” Dunne said. “It sounds like a perfect storm as you think about the future of nursing.”
Preparing career-ready nurses
Nursing schools must provide the proper curriculum for new graduate nurses so that they can enter the clinical environment equipped with the necessary skills for modern nursing.
To Dunne, there are a number of qualities that nurses must learn to ensure career longevity.
“One of the things that’s top of mind for me is critical thinking skills, which really forms the basis of how we approach situations in terms of analysis, integration, [and] prioritization,” Dunne said, “and that forms the foundation of this term called clinical judgment, which is an essential component of safe clinical practice.”
Nurses also need to understand the burnout risks associated with the position. According to Dunne, 52% of nurses are considering leaving their current position due to insufficient staffing. To combat burnout, it is essential that nurses learn self-care.
“[Nursing educators must help] new nurses understand what [self-care] means and really intentionally build it into a nursing curriculum,” Dunne said, “so folks out of the gate are understanding how to take care of themselves, [and] how to fill their cup.”
New graduate nurses must have an awareness and appreciation for patient diversity as well, said Dunne, since the world is diverse and culturally rich.
“That creates a level of complexity for nursing that nurses need to possess cultural competency,” Dunne said, “meaning having the skills and abilities and skillset to really take care of patients and their families from a variety of cultural backgrounds and settings.”
Communication and multitasking are other key components for new nurses as the industry continues to evolve.
“You don’t have to change careers to change your job,” Dunne said. “There’s so many diverse opportunities for nurses, you may get tired of one spot, [but] there’s so many opportunities for nurses to pursue other experiences.”
Evolving with new generations
CNOs also must be aware of how nursing education is changing to accommodate the viewpoints and expectations of new generations. The integration of technology has shifted nursing education just as much as it has revolutionized the rest of the healthcare industry.
Dunne explained how the use of high-fidelity simulation and new mannequins alone has shifted nursing education tremendously by mimicking human situations and experiences. Online learning, virtual reality, AI, and virtual science labs are also on the rise, which warrants an increase in data literacy education.
“Having these experiences for our students allows them to engage in patient care scenarios in a safe environment,” Dunne said, “really helping them to build the necessary clinical judgment skills that are essential for safe practice.”
Competency-based education is a concept that has gained momentum, according to Dunne.
“Now it’s [about] the demonstration of specific competencies, [and if] students are gaining the learning they need as they move forward,” Dunne said, “and many programs actually tailor education experiences to the individual student needs where they are.”
Interprofessional education has become front and center as well. Working with other members of the healthcare team has proved to be extremely beneficial, Dunne explained.
“Learning alongside each other, understanding roles [and] responsibilities as you get out into the healthcare world really helps to create great patient outcomes,” Dunne said.
Mental health and a focus on holistic patient care are also priorities in current nursing practice, along with the idea of lifelong learning. Generational differences also need to be addressed in nursing education, since new nurses prefer more collaborative and technological approaches to learning, Dunne explained. There is also a much stronger focus on ethics and social justice, in both nursing education and patient care.
“Healthcare continues to evolve and become more complex,” said Dunne, “so we’ve got to keep pace in order to provide safe, effective care to our patients.”
Bridging the gaps
To fill spots in nursing programs, nursing schools need to tailor the academic experience to better suit the students as they move through the curriculum, Dunne said. Academic institutions must provide resources and remove obstacles, and remember that being a student is not as traditional as it used to be.
“The folks that we serve, they have families, jobs, children, other priorities, and it’s really important for nursing schools to help students navigate life so they can be successful academically,” Dunne said. “If we don’t help them build those life skills, academics is not even on the priority list.”
Nurse educators need to see the whole student, Dunne explained, and align their program’s mission values with the social justice values that nursing students care about.
“We at Arizona College sponsor students to be part of the National Black Nurses Association, the National Association of Hispanic Nurses,” Dunne said, “and we just want to create a culture where students are engaged and active members of the learning process.”
For CNOs, partnering with nurse educators and academic institutions to create pipelines into the industry is an essential component of sustaining the nursing workforce, Dunne stated.
“I believe schools need to work closely with clinical partners to ensure that curriculum and training aligns closely with the needs of the workforce,” Dunne said. “Nursing education, programs, [and] schools need to keep pace, so our students are workforce relevant.”
AZCN offers a BSN program at 20 campuses across 13 states, and is designed to prepare students for their careers as registered nurses. At each of these campuses across the country, they have community advisory boards that include the healthcare partners in each campus’ local community.
“These advisory boards are essential to creating those synergies between academic teams and the practice teams,” Dunne said, “to ensure lines of communication are open and also that we’re able to be responsive to the needs of our practice partners [with] how quickly health and health information [are] changing.”
Nurse residency programs, joint faculty appointments, mentorship between academia and practice, scholarships and grants, and tuition reimbursement programs are all ways that academic institutions and health systems can partner to recruit and retain more nurses.
Lastly, Dunne recommended that nurse educators and nurse leaders come together to be the unified voice and advocate for the nursing profession.
“As we know, nursing is a trusted profession,” Dunne said, “and we really need to continue to advocate for the needs of our nurses, short term as well as long term.”
Nurses need to be involved in decision-making surrounding AI, says this CNIO.
HealthLeaders spoke to Robbie Freeman, vice president of digital experience and the chief nursing informatics officer at Mount Sinai Health System, about five questions nurse leaders should be asking while implementing AI. Tune in to hear his insights.
