Depression feels like you are carrying a cave on your back. It feels like you are a snail and your shell is your cave. It’s where you go when you are afraid, when you cannot speak, when your voice cannot be heard, and where you go to get away from the world.
Depression is a world of darkness surrounded by light, laughter, and love, but when you are in the cave you are numb to the world, numb to emotions and feelings, and hidden from experiencing change. Depression is not a disease that can be easily recognized, it sneaks in and steals someone’s life right before their eyes.
As a nurse leader, the first step in identifying depression and dealing with suicide ideation is to learn how to coach, mentor, and guide your staff through difficult situations. It is to first understand what living with depression feels like, evaluating your own self-care attitudes and behaviors, and learning how to listen with intention.
The Role of Derailment in Depression
Derailment occurs when your life is on a set direction or path, and then environmental factors, situations, or circumstances causes a change in that path. This derailment could be as simple as changing a career, or as dramatic as having a loved one or patient die unexpectedly. Derailments are not planned; they occur spontaneously and without warning. Most of the time, many are not prepared for a derailment because their energy has focused on completing the current journey.
Nurse leaders must deal with multiple derailments at any given time. Depending on the personal and emotional connection, the derailment may be viewed as positive or negative. Many times, when a derailment occurs at work, nurses innately internalize this action, and the work problem then transforms into our personal problem to resolve. This is because our thoughts, emotions, and behaviors are intertwined in our work as we care for people.
Although it is natural for nurses to feel connected to their work, there should be an expectation that nurse leaders and their teams learn how to navigate through derailments. It is especially important to recognize when a colleague may be experiencing an abnormal response or reaction during a derailment situation.
What’s Right, Maybe Wrong and What’s Wrong, Maybe Right
Many nurses do not have experience with understanding, acknowledging, or coaching a team member who may be experiencing the signs and symptoms of depression (outside dealing with personal depression and suicide ideation).
Depression can look like a person who is always energetic, willing to work, wanting to be engaged at work, and a high performer. It can also look like the person who is uninvolved, only works their scheduled shifts, and is reluctant to share their personal life.
A major advantage as a nurse leader is access to our colleagues in the behavioral health space. The opportunity to learn about depression and suicide and to understand how to communicate with team members is vital in maintaining the health of a unit, department, or organization.
It is ineffective to have a blanket approach and mislabel a team member who is demonstrating these behaviors, without learning about the disease, its process, and the impact on an individual. The development of an interdisciplinary approach to address depression and suicide ideation contributes to creating a safe environment and freedom of thought within the team.
Consulting a subject matter expert can help the leadership team understand the disease process, how it manifests, and how to best help a team member who is having this experience. Seeking information demonstrates competence, integrity, and humanity amongst the leaders and the willingness to acknowledge that depression happens but the cry for help will not be overlooked.
Leading by Example
Depression and suicide ideation are sensitive topics that potentially impact fragile individuals who live in their cave of emotions and past experiences. When leaders take a stand to advocate for those experiencing depression and suicide ideation, they also become vulnerable. Vulnerability can be overwhelming, very emotional, scary, and potentially a disruption to a nurse leader’s current life.
Allowing vulnerability requires strength, confidence and courage. It also requires a “shedding” of internal fears and anxieties and may even provoke feelings from past experiences. It is a great tool to use when nurse leaders are creating a safe environment, but nurse leaders must learn how to harness the power of vulnerability. This includes setting expectations and rules for what is to be shared in the safe space vs with leadership and developing a plan of assistance, such as EAP, when vulnerable conversations include suicide ideation or a “cry for help”.
It is very important to partner with a behavioral health subject matter expert so that nurse leaders can be guided in the right direction at the appropriate times and that what they are sharing is appropriate within the work environment.
Final Thoughts: A Time for Healing
Establishing a safe environment, identifying the behaviors of depression and suicide ideation, and demonstrating vulnerability are not milestones that are created overnight. There is no quick fix solution or easy recipe to follow. Derailments require time to absorb and understand what has happened in a person’s life, allowing time to freely express thoughts and feelings.
Perhaps the solution is the person finds a new work environment or needs time off and away from the workplace to gather thoughts or make important decisions. Whatever that resolution is, it will need to be made by the individual and accepted by the nurse leadership team to demonstrate advocacy and support during a critical time in a person’s life.