Inpatient psychiatric care is supposed to keep patients at acute risk of suicide safe and provide them with the assessment and standard of care they need to recover. But often, the nurses responsible for caring for these patients lack the training and proper experience needed to prevent suicide.  Hospital leaders, including all physicians, must ensure all staff—including psychiatric nurses– are trained and properly supervised to protect patients from injury or death. Sadly some hospitals put profits before safety and training takes from the bottom line.  Nurses, who believe they are not competent to protect patients must obtain proper training to become competent and not attend to patients until they are properly trained.

According to a report published in the Journal of the American Psychiatric Nurses Association, there are no standard competencies for assessing and managing the suicide risk for psychiatric mental health (PMH) nurse generalists – even though the majority work with acutely suicidal patients in inpatient psychiatric settings.

The language used in this report is chilling for anyone with an interest in the well-being of patients at risk of suicide. The APNA’s report indicated there are “serious gaps in nursing education” in suicide risk assessment, prevention and intervention, and there are “no developed structures and processes” for these generalist nurses who provide care and treatment to patients at risk of suicide.  Hospitals, to their detriment, are often relying on nursing schools to properly train nursing students on patient safety as it relates to suicide prevention.  The nursing schools don’t know what they don’t know about patient safety for suicidal patients. Consequently nursing students are being graduated not equipped for their duties in psychiatric hospitals.  Furthermore licensing boards are not properly testing nurses for suicide prevention in hospitals.

Other care providers in these same inpatient settings, such as most psychiatrists and some—but few– mental health clinicians, have specific training in suicide prevention. But because generalist nurses have, according to the APNA report, “the greatest contact with suicidal patients,” their lack of training exposes these patients to significant risk. The warning signs of suicide are often subtle and intermittent, and they can easily be overlooked by a psychiatrist or clinician who spends limited time with the patient. Meanwhile, the nurses who provide at-risk patients with direct care rarely understand how to recognize those warning signs – or how to appropriately intervene.  Most inpatient nurses do not know that death by hanging is the number one way patients die in psychiatric hospitals; nor do they know that patients will have irreversible brain damage in just a few minutes when brains are deprived of oxygen by hanging.  If nurses knew these facts they would resist any physician order requiring a suicidal patient to be watched only every 15 minutes.

Psychiatric nurses themselves identify a significant risk to patients

Perhaps most concerning of all, these PMH generalist nurses have self-identified the issue as being dangerously unprepared to work with suicidal patients. In one study cited in the APNA report, not one of the PMH nurses interviewed believed they were adequately educated to work with suicidal individuals. Most stated that they felt a “sense of inadequacy” when caring for patients at substantive risk of suicide – and those feelings of inadequacy could well cause those nurses to fail to intervene at critical moments.

Yet despite these significant warning signs, too many inpatient care facilities throw these generalist nurses, who will work with their most vulnerable patients, into a so-called “baptism by fire.” They are expected to learn on the job with little continuing education or support – and that dangerously inadequate level of care puts their patients at extreme risk of dying by suicide.

Fortunately, the APNA has stated that it will take steps to train psychiatric nurses in suicide assessment, prevention and intervention to provide a higher standard of care to future patients. However, inpatient care facilities are responsible for the safety of their patients. When patients at acute risk of suicide come to inpatient care, their care cannot be left in the hands of medical professionals not adequately trained in suicide prevention. And when patients die by suicide after not receiving adequate care, those negligent inpatient facilities must be held accountable.