Depression in Nurses: The Ripple Effect
By Anita Wong, contributor
While depression is one of the most common mental health conditions in the United States, it's twice as common among registered nurses than those in other occupations. Nurse depression can impact the well-being of nurses and their job performance.
How prevalent is depression among nurses?
The National Institute of Mental Health reports that 7.1% or 17.3 million American adults have had at least one major depressive episode. Women experience depression at a rate twice that of men, making nurse depression a particularly important issue. Nursing is dominated by women, with 2.2 million female RNs compared to 330,320 male nurses in 2018, according to the U.S. Census Bureau.
"Nearly 20% of nurses reportedly suffer from some kind of clinical depression, yet it is a topic that no one really wants to talk about," says Dr. Dorothy Dulko, a faculty member for Walden University's Master of Science in Nursing. She adds, "It is crucial that the profession addresses the stigma surrounding depression in nurses by educating nursing leaders and nurses on the causes, signs and symptoms of depression and empowering them to break the silence on this important issue."
Risk factors for nurse depression
Nurses are on the front lines of patient care and must deal with stressful situations every shift. Kevon Owen, a clinical psychotherapist who treats medical professionals in Oklahoma City, says, "Often times we find that the combination of intense stress and negative coping can compound into deep, well-masked depression symptoms."
The level of clinical acuity is directly linked to higher levels of depression in nurses, says the journal Workplace Health and Safety. The greatest symptoms of depression are reported by nurses working in psychiatric, intensive care and surgical units and those that experience workplace violence or traumatic events.
Owen suggests nurses may not prioritize self-care. "Medical professionals are good at caring for others but often woefully guilty of neglecting their own needs and mental health red flags," he explains.
How work culture affects nurse depression
Nurses already face challenging hours, a lack of resources and responsibility for their patients' lives, but a lack of workplace support can make a nurse feel helpless.
"There is a common expectation that nurses simply have to be strong in order to succeed in the profession and survive their daily routines, and that if they aren't strong enough, then they will just fail," says Dr. Dulko. "This often creates a workplace culture that leaves nurses feeling powerless, afraid, stressed, anxious and helpless, which can all lead to depression."
Owen agrees that a lack of control contributes to depression. "[It's] the knowledge of a full census and the fact that you're it for the care that's going to be given," he says. He adds that nurses may feel devalued or under-appreciated by patients and administrations.
Impact of depression on a nurse's well-being
The most frequently reported symptoms of depression by registered nurses include:
- Sleep problems
- Trouble concentrating
- Feelings of helplessness
- Frustration and anger
"Depression spills over into different parts of life and can affect relationships with family [and] friends and interest in non-work-related activities," adds Dr. Dulko. "The need for sleep and pain or stress relief may also lead to self-medicating and substance abuse."
Impact of depression and nursing on patient care
The study in Workplace Health and Safety found that the most significant impact of nurse depression on patient care is presenteeism. This is the loss of productivity that happens when employees continue to come to work but don't perform at their best due to health problems.
Among nurses, presenteeism from depression results in:
- Medical errors
- Patient falls
- Overall poorer quality of care
Nurses with depression are 26% to 71% more likely to report a medical error.
What can be done?
While it's not possible to eliminate depression among nurses, employers must understand the risk factors and prioritize an RN's health and well-being. Creating a space where nurses feel that they can discuss their symptoms and receive support is an important first step.
"Addressing the stigma of nurse depression is imperative," adds Dr. Dulko. "Seeking help from a mental health professional is an important step for nurses with depression, which nurse leaders should support by ensuring that confidential treatment is visibly available for staff."
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