On this 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. 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 wellbeing. 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.
No more hiding behind a veneer of capability and resilience. It’s time we talked freely and without judgment about mental health and its impact on nurses.
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:
Past history of major depression
Trauma or other stressful life events
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
Drinking alcohol to cope
Low mood or self-esteem
Feeling guilty or 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 nurses 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-timer 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, eating poorly, and I 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:
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, 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.
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.
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. https://www.ruok.org.au/findhelp