Opinion: Self-Care Is Key to Preserve Mental and Emotional Wellness for Oncology Nurses

Debi Fischer, MSW, BSN, BA, LCSW, RN

Although there is holiday cheer all around us, RNs in oncology still face the reality of burnout and post-traumatic stress disorder (PTSD).

RNs with serious mental illness have been a focus of conversation since Nicole Linton, a travel nurse, was charged with killing 6 people in a horrific car accident.¹

Nicole Linton is a 37-year-old travel nurse currently in jail in Los Angeles, California.¹ She walked out of her job at a major LA hospital and was involved in a horrific car fatality. She was diagnosed with bipolar disorder before her accident and was not on any medication.

Linton is being held on $9 million bond, which was later removed as a possibility. She has been charged with 6 counts of murder and 5 counts of vehicular manslaughter with gross negligence.¹ This case highlights the vulnerability of nurses with mental health issues.

Nurses, similar to the general population, are at risk for severe mental health problems. Paying attention the well-being of colleagues, as well as learning to instill self-care practices into daily workflows, are therefore critical for RNs.

Mental Health Issues and the RN

Nurses suffer from burnout and PTSD and in fact are at risk for suicidal thoughts and tendencies. PTSD symptoms were identified in 22% of RNs in 2 studies and 18% of those evaluated fit into the parameters of a full-scale PTSD diagnosis.² Female RNs are more prone to suicide completion than women outside of the health care setting (11.9% vs 7.5%). In addition, male nurses commit suicide more than men in the general population. (39.8 compared with 28.2 per 100,000).²

The American Nurses Association (ANA) formed a task force in 2019 to look at the problem of nurse suicide.² The data reveal that the prevalence of mental illness in the health care work force in general is 40% for anxiety, 49% for PTSD, 37% for distress in general, and 37% for rates of depression.² In so far as suicide compared with female doctors, there is a 70% higher rate in female nurses.²

Solutions for the Nurse

A solution to these mental health problems may be found in the ANA Code of Ethics for Nurses.² This code states that nurses are obligated to practice self-care in addition to taking care of their patients. This is an international theme. Similar solutions for self-care for RNs are promoted in Japan, Australia, Canada, and the UK.²

In addition, Jean Watson’s Theory of Human Caring promotes self-care of the nurse as an essential part of practice.² It further explains that the nurse be kind to her or himself as well as show oneself compassion. This is necessary to provide the same level of care to patients.

Some other solutions in addition to promoting talking about self-care theories are more practical and include “pizza parties, coffee bars, meditation rooms, and self-care modules.³ Employers need to assess their employee’s mental health care needs. There are 2 groups that are trained to deal with mental health issues in the health care settings. They are mental health nurses and nurse coaches who are board certified.³

The Stigma Is Still Here in 2022

Nurses advocate for social work and psych consults for their patients in oncology and other settings. When it comes to themselves and mental health, a stigma still exists.³ There may also be a double standard in this scenario. It is acceptable to have a patient with mental illness but a coworker with the same problem may be not treated as well.

The topic of resiliency is the elephant in the room here. Nurses are taught to be resilient, flexible, and adaptable and their superpower is multi-tasking. These attributes though admirable in the nurse universe can backfire. A nurse with a mental illness may fall through the cracks until they have a mental health emergency,³ such as losing a patient, a parent or dog. Other crises could involve going though a divorce or breakup.³ Resiliency is the goal but is a not a solution all the time especially if someone is depressed. Self-care as a solution can be part of an evidence-based plan³.

Oncology nurses work in a setting that might exacerbate any underlying mental health problems. While getting through a shift may feel like the main goal, self-care and resiliency is equally important for the RN.

References

1. Ibrahim S. After A high-profile car crash, Nicole Linton’s family is searching for truth in tragedy. ESSENCE. November 26, 2022. Accessed December 20, 2022. https://bit.ly/3WzltAs
2. Linton M, Koonmen J. Self-care as an ethical obligation for nurses. Nurs Ethics. Published online July 28, 2020. doi:10.1177/0969733020940371
3. Butler RM. Serious mental illness in healthcare and academia: a lived experience. J Psychiatr Ment Health Nurs. 2022;29(5):624-629. doi:10.1111/jpm.12862