Nursing the Nurses

Nurses suffer from trauma and depression too – so outside of R U OK day, uPaged asks who is nursing the nurses?

Nursing, irrespective of how you work – whether you’re a full-time staff nurse or work via a nursing agency – can be stressful, fast-paced, full-on and requires vast amounts of responsibility, energy and focus. Vocations such as nursing can make a person more prone to struggling with anxiety, workplace stress and major depression. This isn’t a conversation that should just be reserved for RU OK day though. With depression estimated to impact 18% of people in developed nations, a higher prevalence for women, and typically presenting in younger adults  – we ask – who is nursing the nurses?

The nursing culture and depression

A culture of survival and ‘just keeping on going’ has grown over many decades in many hospital facilities, so as a career choice, nursing definitely has the potential to be detrimental to mental health and well-being. Nurses have always been perceived as invincible towers of strength, yet we witness and work amongst people suffering some of the most tragic, traumatic and devastating injuries and illnesses.

While some nurses do thrive on coping with the stress of the job, others who struggle can feel a sense of failure or loss, which, in turn, can lead to depression. Beyond a cranky or rude patient, nurses need to deal with circumstances beyond their control – patients that become more unwell or even die, and this can be extremely difficult to cope with, even for the most resilient and capable of us, as every patient leaves their mark.

Depression is a mental health issue and it’s a condition that is particularly important to address within the nursing profession, as, apart from the suffering it causes to the nurse in question, it can also directly affect the quality of patient care, as well as fellow nurses and their workload.

The statistics are alarming. One study of Australian nurses demonstrated that ‘depressive symptoms were common in nurses’ and cited a prevalence rate of over 30%, compared to only 4% of the general Australian population. The study went on to state that anxiety symptoms were common in the nurses studied, with a prevalence rate of over 40% compared to 14% of the general Australian population.

Nurses suffering from mental health issues may find it difficult to concentrate at work, manage their time effectively, and may become more prone to making mistakes when it comes to things like calculating drug doses. Unfortunately, it can be very hard for afflicted nurses to seek treatment – many fear the stigma of mental illness, and worry that they will be seen as less capable of looking after patients if they are struggling with mental illness themselves.

What causes depression?

The aetiology of depression is multifactorial, and may include any one of a combination of some of the following:

• Genetics

• Past history of major depression

• Anxiety disorders

• Low self-esteem

• Substance misuse

• Trauma or other stressful life events

• Poor education

• Poor parental warmth

• Early childhood adversity

• Parental substance misuse, mental illness or criminality

• Poor social support

What are some of the signs of depression to look for?

• Less motivation to go out/be productive at work/see friends and family

• Not enjoying hobbies as much as before

• Difficulty concentrating

• Drinking alcohol to cope

• Low mood or self-esteem

• Feeling guilty or overwhelmed

• Feeling overwhelmed

• Thoughts of suicide

• Not looking forward to anything in life

• Feeling tired and run down

• Insomnia, or oversleeping

• Significantly decreased or increased appetite, with weight loss or gain

One nurse’s story

Given the number of stressful events that nurses witness each day at work, coupled with long shifts and anti-social hours, it is no surprise that nurses can be prone to depression, anxiety and stress.

One uPaged nurse we interviewed explained her transition from full-time to casual to help manage her depression. Jen explained:

“Over several years, I’d started to feel like I was living two lives – at home, I slept every minute I could. I was disengaged, uninterested, constantly lethargic, and eating poorly, and deliberately distanced myself from friends and family, citing work exhaustion as my excuse. At work, I played the game of laughing off the trauma of ED, joking with my colleagues, and blaming a busy home life for rejecting social invitations with my colleagues.

One day, I found myself in the pan room with my back to the door, shaking, unable to breathe, choking back tears, and trying to hold it together and brace myself to go back to the trauma room. Deep down, I’d known something wasn’t quite right for a long time, but the stigma attached to admitting I had a problem coupled with a fear of discrimination stopped me from getting help.

It was a fellow nurse who stopped me on the way out of the pan room that day. She’d seen me leave the trauma room and instinctively knew something was up. Without her simple questioning and intervention that day, I don’t know how I’d be now. ”

Jen was lucky – and started on a program organised by her GP. She loves nursing, but found full-time work back at her old hospital too much. Jen now works as an on-demand nurse across several hospitals, choosing when and where she works to suit her. Today she credits her nursing friends for nursing her through her crisis, and talk of depression, anxiety and stress is commonplace amongst her social circle, which she says ‘has been a huge help.’

What to do if you or someone else needs help?

We all have an obligation to start the conversation. There is no shame in broaching the subject of feeling disconnected or distracted or overwhelmed with fellow nurses, family and friends, nor is there in asking ‘are you OK?’

R U OK? has a raft of brilliant resources to assist and has developed our four conversation steps to give you the skills and confidence to navigate a conversation with someone you’re worried about:

1. Ask

2. Listen

3. Encourage Action

4. Check-in

Services such as Lifeline offer anonymity if you or the person who needs assistance isn’t comfortable talking to someone they know.

It is really important to make an appointment to see a doctor, to ensure you/they are diagnosed properly. A diagnosis of depression can facilitate treatments that range from referrals to clinical psychologists for counselling, and cognitive behavioural therapy to mindfulness and meditation training, or to the prescription of antidepressants and referrals to psychiatrists. The earlier treatment is received, the more likely it is that escalation of depressive symptoms to greater levels of severity can be avoided.

Additionally, it is important to see a doctor to ensure you aren’t suffering from an altogether different kind of disease – diabetes mellitus, hypothyroidism, and anaemia, to name a few, share similar symptoms with depression.

Stress and Trauma from the Australian bushfire crisis

There are several online forums and services helping people cope with the ongoing stress and trauma of the fires that continue to ravage Australia. The NSW Minister for Mental Health Bronnie Taylor has encouraged people recovering directly from bushfires to access mental health and counselling services.

“My message to the brave people in fire ravaged communities like those of Northern NSW, the Mid-North Coast and the Hunter is to reach out for help and tap into the counselling and mental health services available on the ground,” Mrs Taylor said. “The widespread loss and distress caused by a major event such as this impacts the whole the community, and those affected need support now and in the months ahead.”

Where you can get help

• If there are current, strong thoughts of suicide, please ring 000 or have the person present to the emergency department of the nearest hospital for psychiatric assistance and assessment.

• A GP may recommend a range of options which may include medication to help you through a slump or a referral to a clinical psychologist.

• Additionally, an emergency department psychiatric doctor or GP may refer to a community mental health service that can provide outpatient clinic appointments, follow-up and treatment.

Mental health emergency phone numbers are available for over-the-phone counselling, support and advice.

In the event of an emergency, please call 000.

Nurse & Midwife Support: 1800 667 877

A 24/7 national support service for nurses & midwives providing access to confidential advice and referral.

Lifeline: 13 11 44

Online Chat, Text, Phone, Video Chat, and Face-to-Face Service. Crisis support, emotional assistance and suicide prevention.

Suicide Call Back Service: 1300 659 467

Online Chat, Phone and Video Chat Service.. Suicide Call Back Service is a nationwide service that provides professional 24/7 telephone and online counselling to people who are affected by suicide.

Griefline: 1300 845 745

Phone and Face-To-Face counselling service for people suffering grief. For a full list of contacts, click here.

Beyond Blue: 02 6363 8444

Beyond Blue Support Service provides advice and support via telephone 24/7 (just call 1300 22 4636), daily web chat (between 3pm-12am) and email (with a response provided within 24 hours).

Red Cross: 1800 733 276

Information on managing distress for communities, parents and caregivers after a distressing event, available in seven languages. Link here.

RAMHP: 02 6363 8444

Rural Adversity Mental Health Program (RAMHP) operates across rural and remote NSW, and has co-ordinators in fire affected areas working directly with communities, providing on the ground support, connecting people to support and assistance and visiting evacuation centres daily. Visit this link here and type in your postcode to find your nearest coordinator.

NSW Mental Health: 1800 011 511

NSW Health has provided information in relation to bushfire assistance via this link. It’s Mental Health Line can be on 1800 011 511 so you can be connected to your local mental health service.