The pandemic rages on—just probably not the one that you are thinking of right now.
There is currently a mental health pandemic in the nursing and healthcare workforce. Rates of burnout, stress, anxiety, depression and suicide are higher in nurses than in the general population. This phenomenon has been associated with turnover (which is worsening the current nursing shortage) and preventable medical errors, the third leading cause of death in America.
Many of the reasons for this mental health pandemic are well-documented, including system issues such as short staffing, work overload, long shifts, electronic health record issues and the influx of bureaucratic tasks that take time away from what nurses entered the profession to do: take care of patients. My research also shows that nurses who perceive that their organizational culture is supportive of their well-being and that they matter to their organization have better mental health outcomes.
It stands to reason, then, that leaders in healthcare systems and government at all levels should invest substantially in helping to ensure that our nurses are in optimal mental health and well-being. This includes building cultures of wellness that decrease mental health stigma, fix system issues, prioritize self-care, deliver evidence-based interventions known to improve mental resiliency – a protective factor in the development of mental health disorders – and provide treatment and support to those who are struggling in order to save their and their patients’ lives.
Unfortunately, mental health stigma is alive and well in the nursing profession. Applications for registered nurse (RN) and advanced practice registered nurse (APRN) licensure too often contribute to this stigma and prevent nurses struggling with mental health issues from getting needed help. My team just released an audit in Worldviews on Evidence-Based Nursing, which found that nearly three-quarters of the United States use nursing licensure applications that include intrusive and stigma-inducing questions regarding mental health and substance use. Some of those questions include:
- “Within the past five years, have you been or are you currently being treated, or on medication for, any mental or emotional illness which may impair or interfere with your ability to practice safely and in a competent and professional manner?”
- “Are you currently participating in a substance abuse and/or alcohol or drug treatment program or been diagnosed with a substance abuse disorder which in any way currently affects or limits your ability to practice safely and in a competent and professional manner?”
The Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications: A Toolkit to Audit, Change and Communicate, developed by the Dr. Lorna Breen Heroes’ Foundation (2022) and endorsed by the National Institute for Occupational Safety and Health, was used to conduct our audit. A more appropriate question following the Toolkit recommendation would be: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice…in a competent, ethical and professional manner?
In our audit, we note that the Federation of State Medical Boards “released recommendations [in 2018] concerning the removal of invasive mental health and substance use questions from physician licensure applications… the National Council of State Boards of Nursing has not yet released comparable guidance.”
We must fill that gap as quickly as possible. RN and APRN applicants are too often afraid of losing their jobs and forgo care they need. We cannot keep expecting our nurses to keep pouring from an empty cup; we must do better for the people who we desperately need and count on to take care of all of us.
State Boards of Nursing must act now. Time is of the essence to modernize and humanize licensure applications as a step in resolving nursing’s mental health pandemic and saving lives.
