It was getting late, but I had an exam coming at the end of the week. I looked up from my medical-surgical textbook and glanced around my living room. The laundry was sitting unfolded in the basket, the dishes were piled in the sink—I couldn’t even see the coffee table, and I was pretty sure that was my stethoscope peeking out from underneath my backpack in the middle of the floor. I needed to remember to bring it to clinicals the next day, but at that particular moment, I had to write out the pathophysiologic process of Graves’ disease, even if the laundry pile killed me. If I didn’t pass my next test, there was a good chance I’d fail out of my nursing program.
That’s basically how it went throughout the last year of my two-year associate degree in registered nursing before I graduated in 2009 and started working in the field. I had just gotten married—probably the most stressful thing I could have done while completing an intense nursing program. My husband had already graduated and was working a financial desk job. The only people I knew that understood the pressure I was under were sitting in the same classrooms as me—my colleagues never batted an eye when I told them I had spent a solid eight hours of one day studying; they were off doing the same thing.I was secretly struggling. I cried easily over things that shouldn’t have been a big deal, like overcooking the chicken breast so it tasted like rubber. I felt exhausted all the time. I was tired even on my “days off” from class, which weren’t really what they sounded like: Taking a day off from studying was a good way to flunk out. Anger bubbled up inside of me and morphed into hurtful words I spewed if my husband didn’t get me the right toppings on my McDonald's order, or if he, like, breathed wrong. For months, I chalked all of this up to the stress of school.One morning while my husband was getting ready for work, I was still in bed—my first class wasn’t until later in the morning. I was facing the window, my body turned away from him. Maybe it was the sheer fact that I needed to face another day, but I was crying. When he went to kiss me goodbye, he noticed my tears.
“Please don’t go to work,” I told him. He kissed me, and, eventually, he left—he needed to. What was wrong with me? This was the first time I recognized it for what it was: I was depressed. That day, I called my doctor and made an appointment. We started a treatment plan together, including antidepressants.It’s possible that my classmates understood what I was feeling even more than I thought at the time: Nursing students have a higher prevalence of depression than the general population. The prevalence of depression in medical students was also higher than the general population, at over 27 percent according to a 2016 study in the Journal of the American Medical Association.Although it's worth noting that nursing and medical students do not necessarily have a higher rate of depression than non-nursing or medical students, "anxiety over clinical placements" augments the stresses of general higher education, according to one study published in Nurse Education Today in 2018. The prevalence of students from "lower socio-economic backgrounds, [and] 'first-in-family' students (i.e., first person in their family to attend university), mature age students and female students," says a 2016 study published in Frontiers in Psychology, "makes it more likely that they will have external commitments that compete with their studies, such as work commitments and caring for dependents," resulting in additional stress.
Rebecca Gilbert, another nurse I know, told me that this was her experience of nursing school after experiencing a miscarriage during her final year of nursing school. “I was fully depressed and was not admitting it,” Gilbert says. “I had a very difficult time studying for tests because the depression made me feel like there was no hope for anything: No hope for me to graduate. No hope for me to get a job. After being on the other side of the hospital bed, I didn’t even want to work in a hospital. I had to record all of my lectures and force myself to listen to them in the car over and over again in order to absorb anything.The mental health issues Rebecca and I experienced in nursing school are mirrored in the professional nursing workforce, as well: Depression is over twice as prevalent in nurses as it is in the general population—18 percent versus nine percent. I wanted to speak to some individuals who were experts in their field and how their counseling of others struggling with depression related to my own experiences in nursing school.Rachel O’Neill, Ph.D., LPCC-S (OH), is a mental health counselor at Talkspace, an online therapy resource. She specializes in anxiety, depression, and life stresses, and has also worked in college and academic counseling settings. According to O’Neill, the nature of our profession can lead to mental health issues. “Nurses work in a high-touch profession and have constant contact with patients,” explains O’Neill. “This can lead to issues with self-care, as nurses are focused on the care of other people. Nurses often have the added burden of dealing with issues like understaffing, feeling overworked, dealing with the realities of health care and managed care," in addition to other workplace stressors.
“Unfortunately, there is no ‘last call’ for nurses at the end of the day,” adds David Foley, PhD, MSN, RN-BC, MPA Assistant Professor and Director of Faculty Development, Case Western Reserve University Frances Payne Bolton School of Nursing. “We are continually in demand as we care for others. Lack of self-care, compassion fatigue, and disruptions to home family routine can all be contributing factors to depression.”I wasn’t exactly surprised to hear this: As nurses, we’re very well-versed in all sorts of diseases, conditions, and mental disorders. Nurses have an understanding of the chemical imbalances of depression just as we do with the concept of high blood pressure. But while we may be willing to discuss our hypertension medications at the lunch table, we’re not so keen on talking about what it’s like to be medicated for depression or anxiety. So, for several weeks, I didn’t tell anyone about the antidepressants I had started taking every evening. I felt a lot of stigma about my depression because I was a medical professional. How could I be a nurse if I couldn’t get a grip on my stress levels?Honestly—it’s fine not to tell colleagues about depression if that’s not for you. For some, keeping a diagnosis quiet from others is a way to preserve their own mental health, and I wouldn’t want to take that away from anybody. But I kept quiet because I was embarrassed. I thought I needed to keep my depression private. I was self-conscious because nurses tend to judge ourselves on the basis that we have a “character flaw” instead of a mental illness. In my head, that sounded like, I should be exercising more. I should be stronger. I should be able to work through my problems and let things roll off more easily. Because we’re nurses, and already under enormous stress, we can be our own worst patients.
Experts I spoke with argued that our field needs to create a better environment for people with mental illnesses, like reducing workplace stress, understaffing, and nurse fatigue. “Medical professionals are taught to put on a brave front,” explains O’Neill. “Instead of talking about their own struggles with mental health, they are essentially asked to perform as if the stress of the job isn’t impactful.” She encourages nurses to talk about their stress and depression as an important first step in confronting the stigma of mental health issues, which is more likely to happen when we create a climate where nurses and nursing students feel comfortable asking for support and are aware of how to access mental health resources that may be offered in the workplace or school.Some schools have begun creating mental health task forces for students, like New York University's Mental Health Advocacy Nursing Student Association, and both nursing students and nurses in federally funded facilities who experience mental health issues may request accommodations under the Americans With Disabilities Act—a list of resources for those experiencing depression, compiled by the Job Accommodation Network and the U.S. Department of Labor, outlines what some of those might look like.Foley says that any change in job or work assignment can be stressful, and this stress can contribute to depressive symptoms. “Nurses can feel like they are swimming upstream—trying to deal with all of these hurdles, but also still trying to be helpful to patients. Those feelings of powerlessness can, in turn, lead to feelings of stress, anxiety, and depression,” says O’Neill.Though institutional change is most important to mental health advancements for nurses and nursing students, Foley explains that having a mentor in the workplace can be helpful to nurses, especially newer ones like myself. “They can help dissipate stress by teaching a nurse not only the formal rules of the workplace, but also help with the informal rules and social structure.” Personally, my stress levels and depressive symptoms have lessened when I’ve been able to be taken under the wing of a more seasoned nurse. There’s something about being able to have someone who knows the similar experiences you’ve been through that makes working in a high-stress profession less isolating.
Having someone to turn to when things are overwhelming is a crucial way to address the issue of depression in medical professionals, but we can’t underestimate how important getting the proper treatment is when experiencing symptoms. I tried to push my depression down for a long time during school, denying I really had a chemical imbalance. It wasn’t until I faced it head-on and started treatment that I began to feel like myself again. Or, at least, someone who is able to think more rationally during times of extreme stress and emotional lows.I’m working on talking about my depression more—and getting over the initial embarrassment that it makes me look weak when I do disclose it to my peers. Experiencing depression as a medical professional has been humbling. It’s allowed me to extend my empathy toward others also struggling. I’m able to be more present and caring with my patients who are undergoing a new mental health diagnosis. I’ve learned so much about mental health, and that depression is not a character flaw. Since so much of my time pre-diagnosis was spent thinking I had failed somehow, I want to show others they don’t have to feel that way.