Should Nurses Undergo Mental Health Checks?

A nurse’s mental health is critical to nursing care. Mental health affects critical thinking, decision-making, and violent tendencies, and it can lead to an unsafe work environment. Healthcare experts and public health officials are taking greater notice of the need to protect the mental health of healthcare workers.

The pandemic increased stress on nurses, doctors, and other healthcare workers, who already bear a burden of suicide greater than the general public. The mental health crisis within healthcare is expected to last longer than the COVID-19 pandemic.

The rise in depression and anxiety has raised questions about using mental health checks for nurses. Consider the options and solutions shared by several nurses to this ongoing crisis.

One of the healthcare disparities highlighted during the COVID-19 pandemic was the clear and present problem of rising violence against nurses and other healthcare workers. It also shed a light on the increasing rate of mental health challenges among nurses and doctors.

According to a federal government report, healthcare workers are five times more likely to experience violence in the workplace than employees of any other industry. Hospitals are taking steps to protect their staff by identifying security risks and training staff to prevent violence.

But what happens when violence originates from the healthcare workers? Mental health conditions like depression, anxiety, burnout, and feeling unworthy of being a healthcare professional can lead to poor decision-making or dangerous behavior.

Lucy Letby was charged with killing seven babies and attempting to murder 10 others from 2015-2016. After being charged with the murders, officials found disturbing handwritten notes in her home where she admitted her crimes.

She wrote, “I killed them on purpose because I am not good enough to care for them. I am a horrible, evil person.”

Jonathan Hayes was a nurse in North Carolina who was charged with murdering two patients with a lethal injection of insulin and the attempted murder of a third who survived. Even more disturbing, experts believe that the most prolific serial killer was a nurse by the name of Charles Cullen. He admitted to killing at least 29 patients, but experts believe the number could be closer to 400.

The percentage of nurses who intentionally harm their patients is very small. However, nurse burnout, which affected 15.6% of nurses in 2019 and 62% of nurses since the start of the pandemic, can contribute to medical errors, such as in the RaDonda Vaught case.

According to a 2017 study, as many as 251,000 deaths each year may be attributed to medical errors. These rates are significantly higher in the U.S. than in other countries, such as Canada, New Zealand, the United Kingdom, and Australia.

These numbers support Valerie Gale’s, MAOM, BSN, RN, opinion that taking care of mental health may often be more important than taking care of physical health. The clinical and healthcare landscape strains resources; she believes it is vital to the long-term success of nurses and the healthcare system to create healthier workplaces.

Ryan Sheridan, PMHNP, works in an integrative practice that provides holistic care. He believes that nurse mental health checks should be standard practice. Nurses are increasingly exposed to unsafe work environments, which contributes to other factors that may lead to burnout.

He believes these health checks do not need to be complicated and should be the responsibility of the employer.

“Let’s zoom out a little to view this as any other health-related concern at work. If a nurse was harmed while appropriately performing the duties of their job, this would be a worker’s compensation or occupational health matter,” he says.

When the healthcare industry normalizes mental health, it helps to reduce the stigma that mental health still carries with the general public. If the stressor which triggers a mental health-related issue occurs outside of work, the employer should still provide support since healthy nurses provide higher-quality care.

Not all the nurses we spoke to had the same opinion. Gale believes that creating an additional standard could carry the potential to increase stress and pressure on nurses.

“It could be perceived as ‘just one more thing’ to do to be able to work,” she says.

Sandy Litardo is the lead nurse at Symetria Recovery. It is her perspective that the responsibility to ensure nurses’ mental health should come from the nurses and employers. She believes this may require hiring additional personnel to evaluate mental health and ensure nurses are ready to work.

A nurse’s mental health and the nursing care given are connected. When nurses experience poor mental health, the quality of nursing care often suffers. A 2020 paper revealed nurses who reported poor mental and physical health were 26-71% more likely to make a medical error.

Nurses reported that depression led to the highest cause of medical errors. In addition to the impact it has on patient care, mental health also has an impact on an employer’s overhead costs as it increases turnover and absenteeism. These, in turn, exacerbate nurse staffing shortages and hurt patient satisfaction and patient outcome.

Healthcare organizations clearly are responsible to help promote mental health support for nurses since it impacts patient outcomes and their overhead. Nurses with better mental health are more engaged, have a lower turnover rate, and represent a cost saving to the institution.

Unfortunately, there continues to be a stigma around seeking mental health support, including within healthcare. Sheridan supports consistent mental health checks for nurses, but not as a part of the interview process.

The law precludes employment based on a mental health diagnosis, so he suggests mental health checks become part of the onboarding process. This helps the institution ensure that nurses are supported and prepared to address the challenges they face. It also encourages the nurse to meet the expectations of their job.

“Healthcare organizations should recognize nursing can weigh heavily on mental health. These organizations would find that attracting and maintaining a workforce is much easier when mental health is taken into account,” he says, “not as a means of employment eligibility or termination but as a means of employee empowerment and development.”

Sheridan does not see a downside from a health or clinical perspective to providing mental health checks for nurses. Talking about mental health sheds light on an area of health that should not be stigmatized, especially in the healthcare arena.

He knows that when someone is contemplating suicide, asking them about their intentions reduces the likelihood of an attempt.

“While the organization may have resource concerns for implementation or program funding,” he says, “it is important to remember how the organization stands to benefit from a healthier and happier workforce of nurses, including increased productivity and reduced turnover, which ultimately drives positive outcomes for patients.”

Most nurses and public health experts agree that incorporating mental health checks for nurses is an important part of protecting the healthcare system. However, they differ in how those checks should be accomplished.

Gale proposes that mental health checks could be incorporated into nurses’ annual physical examinations. Rather than separating a mental health check into a separate evaluation, they could be incorporated into assessments that address physical and psychological conditions.

Sheridan believes nurse mental health checks do not have to be complicated. In addition to incorporating them into the onboarding process, Sheridan suggests using quarterly online questionnaires like the Patient Health Questionnaire-9, General Anxiety Disorder-7, or something similar.

This type of automated assessment every quarter can provide a solid foundation for the organization to track changes in mental health over time. He also suggests doing an in-depth face-to-face check-in on an annual basis with a mental health provider, possibly in tandem with other occupational health requirements.

“When mental health is openly prioritized within an organization’s culture, support is in place should issues arise day to day. This empowers the nurse to seek help in more stressful situations or environments, including short-staffing scenarios, violent encounters, and surges of acute illness like COVID-19,” he says.