By Grant Brookes, NZNO president
A light was shone into a dark corner last month, when NZ Doctor magazine published a blog on depression among nurses.
It generated a strong reaction. When I shared the blog on social media, a lot of nurses responded.
Some of the responses were public comments. But other nurses shared stories of depression with me privately – including traumatic events which aren’t talked about.
I have learned of several suicides of some people in our profession in recent months.
But the overwhelming response was relief at being able to speak about this taboo subject, and a desire to get it out in the open. The nurses I spoke with also talked about why the problem is so big, and what might help.
And the problem is big – much bigger than it appears. For reasons I’ll get to, nurses are not disclosing their depression.
As one nurse put it, “I’m seeing more depressed nurses trying to hide it under a smile these days”. Another said that according to her GP, over 60 percent of the health professionals enrolled at that practice were on anti-depressants.
With almost two decades of experience working in adult mental health, I have an understanding of depression, from a nursing perspective.
I’ve practised long enough to remember old concepts like “reactive depression” (occurring in response to stressful events) and “endogenous depression” (with no previous stressor). These days, all depression is seen as linked to stress in some way.
Some of the nurses who spoke with me talked about stressors specific to their group. For the Internationally Qualified Nurses, who make up over a quarter of our workforce, there is separation from family support networks, and often cultural dislocation as well.
One mental health nurse talked about the emotional impact of “dealing with out of control behaviour”. “It’s a thankless job”, he said.
A former prison nurse told me, “During my year working as an RN in prisons I witnessed violence and experienced cases involving sexual violence, self-harm/suicide, physical assault and death. That there was no support available from my employer is still shocking to me”.
But there were also common themes. The reality for all of us in the acute care setting is that we relate to people in distress. As one nurse put it, we have “constant experiences of vicarious trauma”.
Another common theme was expressed by a rural nurse. She told me that her team all love nursing. “We do it because we like caring. But it compromises your personal values when you can’t give that care, when you know it’s not ideal. It creates a conflict within yourself”.
A younger nurse described the same thing. She said she had done postgrad last year and learned to name the problem. “It’s moral distress”, she said. Many others talked about how their mental health was affected by this stressor, too.
The increasing demands on nurses, including more and more time being spent at work, were also widely reported. “I have colleagues who work many extra unpaid hours and are constantly exhausted”, a Senior Nurse told me. “It is commonplace to hear colleagues tell of how they cannot sleep at night. Some are gaining weight, others losing it, and tears are not uncommon. The relentlessness of the work is demoralizing and there is the constant fear of making a mistake”.
More hours at work also means less time for the family. This leads to feelings of guilt. These are strongly associated with depression.
Sometimes these feelings of guilt are deliberately created by managers. One nurse said, “I have been told that ‘it is an expectation of nurses to work beyond your scheduled hours’, ‘you are reluctant to change’, ‘what if it was your mother?’, to list a few”.
This is related to the problem of workplace bullying, another stressor linked to depression which was mentioned by many.
Some who shared their stories spoke of colleagues who expressed negative attitudes towards nurses with depression. But on the other hand, all mentioned others in the nursing team who had supported them.
The range of attitudes among managers appears narrower, however. I was told that nurses with depression are not supported by their managers in the way that, say, staff with health conditions like asthma or diabetes are.
“There needs to be a general acceptance that you can work with depression”, a ward nurse told me. Others named what it means when nurses with depression are treated differently by employers: “stigma”. A number of people said they think this is why depression is not disclosed by nurses.
Based on this, the things which might help address this hidden epidemic start to become clear. Firstly, campaigns to destigmatise mental illness in society at large are part of the solution, to enable safe disclosure and help-seeking. The experiences of the former prison nurse also point to the need for debriefing after traumatic incidents.
Professional and clinical supervision were also raised by some of those I spoke with – and not just by mental health nurses, who use it much more often than anyone else. As one nurse said, “Supervision is not individual therapy, but it can help with problems before they get that big, and it can signal the need for extra mental health support”.
But the helping strategy which was mentioned most often was EAP (Employee Assistance Programme). For employers who opt into it, EAP provides short-term counselling for staff, for free. This appears to be reasonably accessible in DHBs, but Primary Health Care Nurses told me that it’s sometimes harder for them to get.
While many appreciated EAP, there was this also this comment from an Enrolled Nurse: “A service like EAP is needed to help staff acknowledge and alleviate some of the pressures, but I also understand they’re not a cure and that the Ministry of Health and the government need to own some accountability for why there’s added stress of late in the workplace”.
This leads onto a final point, made by a Primary Health Care Nurse. Depression, and the stressors which cause it, are not just individual and workplace issues. They are social problems, too.
“There is this view among nurses that things are getting tough and that we can’t do much about it. Depression can be related to the feeling that we have no control. Until nurses collectively realise this and use our influence, then I would anticipate that depression and burnout will only increase”.
We all feel down from time to time, but symptoms of depression should be taken seriously if they last for more than two weeks. You might be showing a number of the warning signs, or none in particular – everyone is different. If you are in any doubt, talk to your doctor or try the Self-Test on the depression.org.nz site.
You can also
- call the Depression Helpline to talk to a trained counsellor. They’re available 24 hours a day, every day. Freephone 0800 111 757
- visit depression.org.nz
- find out about other services that can help
April 14, 2016 at 6:56 am
Thank you Liz for this article…I completed my RTN four and a half years ago now. I hadn’t nursed for almost a decade and what an eye opener it was for me to spend my clinical placement component in an acute medical ward… I was stunned at how little time is spent with patients and how nurses seem to be doing so much reporting and administration work, very little “hands on”. I was nearly put off nursing completely…it seemed way too stressful…! I quickly realised secondary health was not for me! I was able to gain employment in primary health. The remuneration is (sadly) less however I relish the opportunity to help promote health, educate and prevent hospital admissions. I work outreach in the community and now have an invaluable insight into primary health care and it’s valuable role in health outcomes. This too can be stressful, meeting ministry of health targets and reporting requirements etc. To be welcomed into people’s homes is a priveledge yet distressing at times…to see poverty first hand and the barriers people face in accessing health care impacts on the health professional…stress and burnout are very much out there in community/primary health care settings. I am pleased to say that my employer encourages clinical supervision and EAP support for staff. I implore nurses to utilise these…both have assisted me to remain well in my nursing role. We all have many other stressors to deal with in our modern lives. We owe it to ourselves to seek support before stress leads to depression and burn out.
April 14, 2016 at 8:44 am
I am a school nurse and the comments in the article about the implications of social factors affecting our clients are I believe a significant factor in my own case of burnout. Regular supervision helps but the social needs of the students get worse and my personal struggle to face these is constant. I like the term “moral distress” to describe the issues which can face nurses in any field. The topics of depression and burnout for nurses need more exploration, thank you for this article. Jennifer
April 19, 2016 at 7:37 pm
I registered last November and am happy with a supportive team in Waikato within mental health however as a student witnessed continuous bullying towards students and until DHBs address this we will lose top potential students. The worst situation I saw was a team of nurses bully a lovely Maori student and this is why they are not succeeding and shame on them.