Synopsis: Following the death of his friend and colleague, a critical care nurse becomes inspired to end the stigma against mental health help-seeking in healthcare workers, becoming a leader in suicide prevention efforts in the healthcare workforce.
While attending the funeral of his childhood friend and fellow nurse, Chris Wojnar reflected on the stories he heard from others who also knew and worked with his friend. Wojnar learned that his colleagues noticed subtle signs of distress but the overall picture of imminent danger wasn’t always clear to those around him.
“People were saying, ‘I noticed he said this or I noticed he said that. They felt something was wrong but they didn’t know what to say or what to do. Hearing everyone saying that lit a fire in me to educate others about the signs of struggle in healthcare workers that can lead to suicide and what practical things we can do to intervene,” Wojnar says.
According to Davis et al., the number of nurses who die by suicide has increased every year since 2007. Between 2007 and 2008, 207 nurses died by suicide. Each year that number has risen with the most recent data showing 729 nurses died by suicide between 2017 and 2018 (2021). The same 2021 study showed that among all nurses, there was a death by suicide rate of 23.8 per 100,000 vs 20.1 per 100,000 in the general population, but in female nurses, that rate more than doubled. In women nurses, the suicide death rate was 17.1 per 100,000 compared with 8.6 per 100,000 of the general female population.
Another study published in 2023, found that relative to non-healthcare workers, registered nurses, health technicians, and healthcare support workers in the US were all at greater risk for suicide than the general population. In physicians, as we learned in our first post in this series, the rate of suicide in male physicians is 40% higher than in the general population, and 130% higher in female physicians than in the general public.
Why suicide rates are so high in this cohort is multifactoral, but across the healthcare frontlines, two commonly cited pressures are a culture that perpetually demands a brave face, no matter how relentless the exposure to trauma, along with the invasive nature of how licensure agencies frame mental health questions in their credentialing applications, categorically demanding disclosure of any mental health conditions, instead of asking about current mental or physical conditions that might impair the applicant’s ability to practice medicine – and most important, whether they are receiving support for their condition.
“I get that it’s difficult to ensure the protection of the community and those we serve, but we also have to protect those who serve,” Wojnar says.
Wojnar, himself a suicide attempt survivor, wasted no time turning his vision of mental health support for healthcare workers into reality. Within a year of his friend’s death, Wojnar spearheaded the implementation of a workforce wellbeing committee at his hospital – the largest in Wisconsin. The committee, now an integral part of the hospital’s culture, continues to analyze health risk assessment data collected by staff to customize interventions according to identified needs. His research into what kinds of suicide prevention programs existed for the healthcare setting led Wojnar to a Zero Suicide pilot to prevent patient suicide at another Wisconsin hospital.
There, he learned how the Zero Suicide framework is a systematic approach to protecting patients at risk of suicide through evidence-based training for healthcare providers and continuous quality improvement through research and evaluation.
Seeing Zero Suicide in action led to Wojnar’s next inspiration.
“The common thought process is always ‘patient first’, and of course this is true, but also true is that by taking care of ourselves and prioritizing our own health, we are also putting the patient first,” Wojnar says. “If we’re the ones implementing the suicide prevention protocols for our patients, then it makes sense we should also be implementing the same kinds of protocols among ourselves.”
Wojnar began to advocate for applying the Zero Suicide framework to healthcare workers. He took his case to the president of his hospital and soon was named to an organization-wide Zero Suicide Integration Committee tasked with implementing this dramatic culture-change system-wide. This experience exposed Wojnar to a number of suicide prevention strategies, including a staff-focused Zero Suicide for Teammates Subcommittee, several postvention initiatives, and an awareness program to aid in promote mental health help-seeking among medical personnel.
As Wojnar continued to educate himself about suicide prevention in the healthcare setting, he found H.O.P.E. – Helping Our People Elevate through tough times – Certification, a novel program for organizations seeking to engage their workforce, promote resilience, and develop and sustain a caring culture, he became a champion of the program.
H.O.P.E. is specifically geared toward implementing the National Guidelines for Workplace Suicide Prevention through the development and implementation of best practices in workplace mental health, and of having accountability mechanisms in place to ensure all practices are followed. In addition, there is third-party verification of completion and external verification to ensure guidelines are met.
Integrating these two frameworks makes sense, according to Wojnar, because of their shared vision and multifaceted approach to transforming systems and culture. Both emphasize research and evaluation for quality improvement and impact measurement. By combining these two programs, healthcare organizations can customize a comprehensive, sustainable strategy that not only protects patients and personnel from suicide risks, but also supports overall wellbeing.
“I would argue now that the H.O.P.E. Certification should be in place before implementing the Zero Suicide framework,” says Wojnar. “Having the H.O.P.E. Certification in place first can provide a strong, supportive foundation for the subsequent implementation of the Zero Suicide framework, ensuring a more cohesive, effective, and enduring approach to suicide prevention and overall well-being in the healthcare workforce.”
This integrated approach addresses the root causes of mental health challenges within the healthcare workforce, providing support and resources necessary to continuing their vital work.
By integrating the Zero Suicide Framework with H.O.P.E. Certification, it is possible to improve patient care while also creating healthier, happier healthcare professionals.
“Years ago, a provider asked me what I thought life could still offer me. I realized I had no idea if my darkest thoughts at that time were true, and the possibility that there might be something better out there was enough to pivot and use the skills I had been taught to preserve life, and also to give life meaning,” Wojnar reflects. “Offering people hope gives them an alternative to their pain. That’s why I think the H.O.P.E. Certification is a vital part of worker wellness in the hospital setting, where it’s easy at times to feel both helpless and hopeless.”
For more information on Zero Suicide and HOPE Certification, please visit Zero Suicide and HOPE Certification.
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