Early Career

  • Taking Care of Your Mental Health as a Nurse Anesthesia Resident

    By H. Tammy Huynh, MAJ, USAF, NC, MSHS, CCRN, CEN

    Disclaimer: This article discusses suicide and suicidal ideation, which some may find disturbing. If you or someone you know is suicidal, call the National Suicide Prevention Lifeline (800-273-8255) and go to the nearest emergency room. The AANA thanks the author for sharing her story, the emotional hardship faced, and lessons learned and shared from this experience.

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    A semicolon is used when an author could’ve chosen to end their sentence but chose not to. The author is you and the sentence is your life.

    Project Semicolon

    For the last few months, I have been brainstorming on topics relevant to nurse anesthesia residents (NARs) in order to write my next article. I threw around a few hot issues such as emotional intelligence, bullying, and incivility. Despite being important, I felt as though something was missing from these topics. During the AANA’s Assembly of Didactic and Clinical Educators 2022 forum, I found a subject near and dear to my heart after attending a luncheon where Charles Griffis, PhD, CRNA, spoke about suicide prevalence and prevention for nurse anesthesia residents. Griffis is an assistant clinical professor at the UCLA School of Nursing who previously served on the AANA’s Health and Wellness Committee. He is also a clinical instructor at the University of Southern California Program of Nurse Anesthesia. When he was a member of the AANA Health and Wellness Committee then AANA President-Elect Dina Velocci, DNP, CRNA, APRN, asked him to explore NARs and suicide after two NARs took their own lives. This motivated him and two colleagues to do a study in Fall 2021. Griffis presented the results for their observational, cross-sectional, descriptive, anonymous, online survey of 122 program directors (22 respondents) and 3,000 randomly selected NARs (134 respondents). Some of the results of the survey were eye opening. Approximately 90% of NARs reported that they rarely seek help from a program or AANA, and 24% of NARs know a story of a Certified Registered Nurse Anesthetist (CRNA) or NAR who was lost to suicide.1

    I write this article to share my experience and not to discuss the cure for depression, since we know it can be multifactorial and complex. I argued with myself for a while on whether I should share my story – a sensitive topic and a difficult chapter in my life that few people know about, of when I was at my lowest point. I always felt I was a strong woman, but this story will show you that depression can affect anyone, anytime, anywhere.

    In 2018, I was selected for a highly competitive position. The hours were long, the stress was high, and I was functioning in an unfamiliar environment.  I was living in Alaska where I really had no social support system, not one person I was comfortable enough to open up to, and my best friend had recently moved to Virginia. At that time, I did not notice the symptoms of depression subtly creeping up. The Alaskan winters were dark and cold with the sun rising around 9am and setting around 4pm. There was usually only seven hours of sunlight – all seven hours where I was inside the office trying to stay on top of my game. For a few months, all joy and spark in my life was absent. I felt my life was just a scene from Groundhog Day where I was going through the motions and just existing. I did not have an appetite but attributed that to the stress of the job. The thoughts of suicide were fleeting at first, but I felt like an empty vessel. For the first time in my life, I felt alone and hopeless.

    I hit rock bottom in the middle of one night and needed to end my misery. I wrote my suicide note, arranged my financial affairs, and devised a plan that would affect the fewest number of people. I didn’t know who to call since I was afraid to be a burden and didn’t know who would care. While contemplating how to end my life quickly and painlessly, I called the suicide hotline. That night, I didn’t feel as though I had a future. I couldn’t see anything else ahead of me and didn’t see any resolution from that feeling. I was oblivious to my surroundings. Anyone could have been in front of my face yelling, “Don’t do it! There’s more to life than this!” and I wouldn’t have heard them. I didn’t think anyone else could empathize with how I was feeling and felt even more alone. To this day, I believe the only people who understood my thoughts that night are the ones who have sat on the same ledge with a fiery blaze behind them, and the only way to escape was to jump.

    The man on the other end of the suicide hotline patiently listened to me speak, listened to me as I held the phone in silence, and asked me questions to help me understand how I was feeling. I started thinking about all my feelings and how they led me to this point. I knew I needed some sort of help; I just didn’t know where to begin. I told him I needed to go to the emergency room, and he agreed. As I walked into the emergency room, my life changed. As I think back to that night, I wish I had remembered the name of the man from the suicide hotline to thank him for what he did for me. Mental illness does not discriminate and can affect all walks of life.

    As NARs embark on a new professional journey, they find themselves in a highly competitive field facing new challenges.  Although these new challenges can be a motivator for better performance, the combination of academic stressors, clinical stressors, and external stressors can lead to maladaptive behaviors. These harmful levels of stress can negatively affect their health and lead to subpar clinical performance such as poor coordination with complex tasks, decreased learning, and reduced productivity.2

    Unfortunately, NARs fall under two high-risk categories for suicide: graduate students and healthcare workers. Thus, NARs are in the highest risk groups of suicide among the general population, which has been regarded as an occupational hazard in the healthcare industry. Increased workload; high rates of burnout and fatigue; a career with human suffering and loss; and increased substance abuse have been contributing factors to suicide ideation in graduate healthcare students.3 Additionally, many NARs are expected to move to locations far from their social support of family and friends to attend school or clinical rotations.

    I had a few factors that led to that pivotal night: an inadequate support system, isolation from family and friends, a high-stress environment, burnout, anxiety, as well as seasonal affective disorder during the winter. I cannot tell you the countless times I have received a suicide prevention briefing sharing warning signs a person could exhibit. However, although I was living during dark times, my co-workers and peers didn’t recognize any of the signs because I hid them all. My closest co-worker at the time told me he would not have known I was suffering because I always came to work with a smile and my “bubbly” personality. The suicide prevention briefings would also have a list of numbers to call or websites that provide additional support. I just couldn’t find the words or express what I was feeling if I called. I also didn’t think they could provide me with the support I needed.

    The last few years have been a rollercoaster ride, but one thing I have learned is being more cognizant of my mental health especially after starting my doctoral program. I have vowed to keep my mental health a priority. I now recognize my own signs and symptoms of depression such as isolation, social withdrawal or agitation. Today I take a “mental health day” when overwhelmed and use supportive friends, family, and mentors to share burdens and seek advice. Working out at the gym significantly improves my mood. I also plan time to enjoy my hobbies and sometimes I plan days with no structure. I volunteer and participate in meaningful activities that feed my soul, which has been linked to reduced depression through fostering social connections.5 By helping others, I also help myself.

    I am changing my thought process by listening to the messages from my supportive group and my own inner voice and recognizing that everything negative in life is temporary. A permanent action, such as suicide should not be the solution for temporary emotions and negativity in life. During my darker moments, I repeat that mantra to myself and picture the light at the end of the tunnel.

    If you’re wondering how you can help, and you are comfortable doing so, one approach is to share your experiences – this might save someone’s life. Let other people know they are not alone with their struggles. Be understanding, patient, and compassionate. Life is already difficult, and we don’t know what other people are going through. You cannot control the complexities of people’s depression, but you can help by not adding to their stress. Understand that every individual has their own path with different struggles and different experiences. Not everyone will have the same coping mechanisms, social support, or personal experiences. Don’t think of suicidal thoughts as cowardly, rather look at it as the wrong solution to the problem faced by a person in a personal crisis, and work to help them see another solution and get to it. With kindness, compassion, and willingness to help, we can save the lives of our friends, families, and colleagues.

    AANA Health and Wellness/Peer Assistance  www.AANAWellness.com

    AANA Depression and Suicide www.AANA.com/Suicide

    National Suicide Prevention Lifeline 800-273-8255

     Acknowledgements

    I would like to thank Dr. Griffis for motivating me to share my story and providing me valuable feedback for the article. I would also like to thank Lt Col (retired) Stacy Carr for always checking up on me throughout my time in the program and for her input on the article.

    Thank you to my site directors Lt Col Hodgen and Maj Mark Albright for being champions of emotional health and being supportive throughout phase II.

    1. Griffis CA, Van Pelt M, Bamgbose E, DeVon H. Wellness and suicide prevalence and prevention for SRNAs. Oral presentation at: American Association of Nurse Anesthesiology Assembly of Didactic and Clinical Educators; February, 2022; Colorado Springs, CO.
    2. Chipas A, Cordrey D, Floyd D, Grubbs L, Miller S, Tyre B. Stress: perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists. AANA J. 2012:80(4 Suppl):S49-S55.
    3. Awan S, Diwan MF, Aamir A, et al. Suicide in healthcare workers: determinants, challenges, and the impact of COVID-19. Front. Psychiatry. 2022;12:792925. https://doi.org/10.3389/fpsyt.2021.792925
    4. Nathan NA, Nathan KI. Suicide, stigma, and utilizing social media platforms to gauge public perceptions. Front. Psychiatry. 2020;10:947. https://doi.org/10.3389/fpsyt.2019.00947
    5. Dolan EW. Study: volunteering is linked to reduced depression via increased social connectedness. PsyPost. October 30, 2018. Accessed March 15, 2022. https://www.psypost.org/2018/10/study-volunteering-is-linked-to-reduced-depression-via-increased-social-connectedness-52440