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Shining A Light On Nurse Mental Health

Updated: Aug 10, 2024

Welcome back to the Advocate Subscription podcast where we bring to the forefront the issues that matter most to our nursing community. This July, as we observe National Minority Mental Health Awareness Month, our focus is on the mental health of minority nurses.


Minority nurses often face unique stressors that can significantly impact their mental well-being. These can include systemic biases, cultural challenges, and additional pressures both within and outside the workplace. This month, we aim to shed light on these issues, provide supportive resources, and foster an open dialogue about mental health.


In her most recent podcast episode, Maggie features Kristin Waite-Labott BSN, RN, CARN, CPRC, the founder and president of WisPAN. As we mark minority mental health awareness month, Kristin shares her personal journey with SUD and provides guidance on finding resources for your mental health journey.


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Shining A Light On Nurse Mental Health


July Highlights

4th of July: Hope you had a great 4th!  This is a time for us all to celebrate our country.  Remember to take care of yourself amidst festivities, especially when outdoors. Extreme temperatures can cause heat related illness.  Enjoy the outdoors, friends, and family. Ensure you find time to relax and recharge.


UV Safety Month: Protecting your eyes and skin from harmful UV rays is crucial, especially during the summer months. Use this opportunity to educate patients and colleagues about the importance of UV protection. Get yourself some sunglasses and pack sunscreen. They are not overrated!


Drowning Prevention: Summer is a peak time for water-related activities. Pediatric nurses, in particular, should be vigilant about drowning prevention and aware of the emotional toll that such incidents can take on healthcare providers.  This is also related to weather, keep in mind that hurricane season and flooding are upon us. Remember: “turn around don’t drown,” and please be safe out there.  


Mental Health Advocacy: This is our highlight this month.  I want all my people to hear me when I say you are NEVER ALONE and there are resources out here for you. We are always here and I can always direct you to resources in your area.  Your mental health matters.  This month, we encourage all nurses to advocate for mental health, both for themselves and their colleagues. We will be discussing Tristin Kate Smith, a young nurse who tragically took her own life, in other posts and the podcast this month. Her story underscores the urgent need for better mental health support in our profession. Self care starts with you.  


Case Review

This month’s case review dives into the fictionalized scenario inspired by the high-profile case of Dani Schofield, a former nurse facing 44 counts of second-degree assault due to allegations of drug diversion and patient harm. As we explore this case, you’ll gain insights into the critical importance of adhering to policies, laws, and standards of care in nursing.


In honor of Minority Mental Health Awareness Month, this review also examines the impact of mental health challenges and Substance Use Disorder (SUD) in the nursing profession, particularly among minority nurses. This analysis serves as an educational tool to help nurses better understand the severe legal consequences that can arise from lapses in care and the significance of self-advocacy in protecting both patients and professional licenses.


Download Now

Don't miss out on the full detailed analysis! Download the complete case review now to deepen your understanding of how to safeguard your nursing practice from potential legal risks. This comprehensive guide is packed with educational insights to help you navigate the complexities of mental health and legal obligations in nursing.



Share Your Thoughts

Your voice matters! We invite you to share your experiences and strategies for managing mental health. How do you cope with stress and maintain your well-being? What support systems have been most helpful to you? Your insights can be invaluable to fellow nurses navigating similar challenges.

Thank you for being a part of this community. Together, we can create a supportive environment where every nurse feels heard, valued, and cared for.


What's Happening Around the Nurse's Station?


Advocacy in Action

The tragic story of our sister nurse, Tristin Kate Smith, has been viral on national news and social media recently. Although not a minority, Tristin was a nurse suffering with mental health issues, unfortunately leading her to take her own life. This young lady has especially caught my attention due to the circumstances surrounding her death. There was reportedly a letter she wrote addressing “her abuser,” describing a work environment most of us have been in. I get messages from fellow nurses complaining about current work conditions that seem similar to the ones described by Miss Smith. As a nurse, this was heartbreaking. I am also from Dayton, Ohio, so I felt I could understand the physical environment she was in. I not only identified with the things she was stating about the state of healthcare, like referring to it as a toxic relationship, but also the feeling of being helpless in that environment. We all can identify with her in some way, but you my friends are not alone. You are NEVER alone.  There are so many of us out here for you.  


This is why I am passionate about helping you to advocate for yourself and your patients. In order to help you deal with this toxic relationship, you need tools to fight back. This is why knowing things like the rules and regulations that govern your professional incense and getting professional liability insurance is so important.


Elevating Your Practice

My motto:  “Knowledge is power.” Please embrace my words and let me help you to navigate the complexities of nursing.  It's essential to protect your professional license and invest in your professional development. Unfortunately, I hear from nurses almost every day who are having unpleasant interactions with governing agencies or litigations. Let me help you, my fellow nurse.  You do not have to do this alone as I have created courses, ebooks, and resources tailored to nurses of all ages and experience levels. Resources await my fellow nurses.  


A Call to Unity

As you gather around the proverbially “nurses station” regardless of what setting you are working, let’s not just stand as colleagues, but as allies in our pursuit to better our profession.  Extending a nurturing hand to those who may be at a social disadvantage, or who seem to be struggling to cope will add courage and confidence to everyone's lives! We are always taught to look at the patient in front of us, but we also need to look at our sisters and brothers. Together, let's amplify minority voices, bridge generational divides, and build a brighter future for nursing—one rooted in unity, empathy, and inclusivity. Together united in the pursuit of upholding the integrity of our beloved profession.  Together we are stronger, united we can and will make change.


Did You Know?

Did you know that as healthcare providers, it's not only our duty but our responsibility to screen for suicidal and homicidal ideation? This requirement applies to our patients and to our colleagues. Yes, you heard it right! We're not just protectors of our patients' well-being but also guardians of each other's mental health.


Quick Tips and Insights:

Just like we have each other's backs in the face of a medical emergency, it's crucial to watch out for signs of distress or unusual behavior among our colleagues, especially as a nurse leader who may have access to privileged information that others may not. A simple check-in or offering a listening ear can make a world of difference.


Cultivate an environment where open conversations about mental health are encouraged. Whether it's during a shift handover, break time, or a casual chat, normalizing discussions about emotional well-being could not be more essential.  Please note that happy hours at a bar where alcohol is the primary focus may not be the best approach and could exclude those who do not drink.  


Nurse leaders especially, but even as staff, it’s essential to familiarize yourself and your team with resources available for mental health support, both within and outside the workplace. Whether it's an Employee Assistance Program (EAP), counseling services, or support groups, knowing where to turn in times of need is invaluable.


Important Information:

Studies have shown that access to nursing resources can have a protective effect on patient outcomes, but let's not forget that these resources are equally beneficial for safeguarding the mental health of nurses themselves.  Who better to turn to then someone who is a nurse who can identify with one another. That is so very powerful!


Empowering Nurses in the Face of Drug Diversion


Nursing advocacy is essential, especially in light of recent drug diversion cases in the media. As healthcare providers we hear the word diversion but are not provided a clear definition.  We assume it means a controlled substance. In the Podcast I was on a few months ago with Terri Reynalds, Pharmacist, you hear me asking her to actually define what diversion meant.  It is not specifically tied to a controlled substance, so let’s dive a little bit deeper here nurses. 


Understanding Drug Diversion

Drug diversion, the illegal distribution or misuse of prescription medications, is a serious issue in healthcare settings. It jeopardizes patient safety, tarnishes institutional reputation, and poses legal risks for healthcare professionals.


Theft of a drug, the basic definition, is a crime which the facility can report nurses to law enforcement. In most states, if a nurse is arrested it is an automatic report to the board of nursing. I can tell you as a prior investigator for the board of nursing, there are times I received just the mug shot of the nurse after they had been arrested and fingerprinted with no other information to start my investigation with. Please be sure to review your state nurse practice act.  Most states have mandatory reporting.  


Professional Liability Insurance (PLI)

PLI is crucial for nurses facing allegations or investigations. It provides financial protection in case of legal claims related to professional negligence, errors, or omissions in practice. PLI may cover legal fees, settlements, or damages awarded to patients or effected parties, safeguarding personal assets and ensuring access to experienced legal counsel.


Understanding administrative actions and the role of PLI is essential for nurses navigating issues related to drug diversion or other allegations. It underscores the importance of proactive risk management and legal preparedness in protecting both career and professional integrity.


Protecting Your License

Your nursing license is more than a credential; it’s your gateway to work.  If you do not have a license then you cannot call yourself or work as a nurse. 33 states have specific language around who can and cannot call themselves a nurse. Holding a nursing license signifies your commitment to patient care and professional integrity under the entity enabling you the ability to practice as a nurse. Here's how you can safeguard it:

  1. Know Your Nurse Practice Act (NPA): Familiarize yourself with the Texas Nurse Practice Act (NPA). It sets forth the legal boundaries and standards of nursing practice essential for compliance and professional conduct to include if you find yourself with allegations of diversion.  

  2. Master Your Employer's Policies: Understand and adhere to your facility's policies and procedures, especially those related to controlled substances and the removal of waste of these substances. Compliance mitigates risks and upholds ethical standards of the nursing profession and your professional practice.

  3. Document, Document, Document: Did I say document? I cannot stress enough the importance of timely, concise and accurate documentation. It is crucial for continuity of care and legal protection and protecting your professional license and ability to generate income. Ensure thorough documentation of patient interactions, medication administration, and any deviations from normal practice. Let me say that again, if there are any deviations from the standard of care you must make a note.  

  4. Advocacy for Nurses: Advocate for you and your nurse colleagues. Speaking up about concerns regarding possible drug diversion saves lives. Your voice can drive positive change for nurses and improve outcomes for patients.


Part of what I do as an advocate for nurses and a legal nurse consultant is to educate. Nurses often have no idea what the process looks like when they are reported to a board for diversion.  If a nurse is reported to an agency, the duty of the agency is to protect the public, not the provider, and therefore the organization has to open up an investigation.  More often than not the nurse is evaluated for: fitness to practice.


If a nurse is struggling with substance use disorder (SUD), they should not be punished for a mental health issue. Therefore, each board, or agency, has a relationship with an independent organization to offer services under “diversion” for a nurse.  Each state has their own program. For example, Texas has Texas Peer Assistance and or TPAPN. These organizations are not funded by the boards, or agencies, and are there to provide resources and support for the nurse to get them back into practice safely. 


Fitness to Practice

What does this mean?  It means a nurse is safe to interact with the public. Maintaining fitness to practice ensures safe and effective nursing care. Understanding the criteria you will be evaluated under is essential.  For example, the Texas Board of Nursing's Rule §213.29 is crucial. This rule covers issues related to substance use disorders, mental health conditions, and medical impairments.

  • Substance Use Disorders: Nurses must demonstrate sobriety and compliance with treatment for at least twelve consecutive months to retain licensure. Participation in treatment programs and peer assistance can provide verifiable evidence of recovery.

  • Mental Health Conditions: Controlled behavior and adherence to treatment plans are necessary to ensure safe nursing practice. Individualized evaluations assess fitness to practice based on patient and public safety considerations.

  • Medical Conditions: Nurses managing medical conditions requiring prescription medications must demonstrate their ability to function safely. The Board evaluates individual circumstances to determine licensure conditions.


Texas Board of Nursing Rule §213.29

  • Self-Evaluation: Nurses must ensure they are fit to practice before providing care. This includes self-evaluating their physical and mental health (Rule §213.29(a)).

  • Substance Use: Individuals diagnosed with a substance use disorder must show evidence of sobriety for at least twelve consecutive months. This includes completing treatment programs and undergoing random drug screens (Rule §213.29(d)).

  • Mental Health: Nurses with mental health conditions must demonstrate controlled behavior and adherence to treatment plans, including medication compliance, to maintain licensure (Rule §213.29(e)).

  • Medical Conditions: The Board assesses how prescription medications or other medical conditions affect a nurse's ability to practice safely. The evaluation considers the individual's behavior, diagnosis, and treatment plan (Rule §213.29(f)).


By understanding and adhering to these guidelines, nurses can better protect their licenses and ensure their fitness to practice.


Becoming an Advocate in Your Workplace

Advocacy extends beyond individual practice, it can be defined by fostering a supportive work environment where other nurses thrive and ultimately patients receive better care.  

  • Positive Mindset: Rest. Eat. Drink plenty of fluids and take time off. Approach challenges with optimism and prioritize self-care to deliver safe patient care effectively.

  • Effective Communication: Communication is not just with patient’s. We must professionally communicate with other providers using essential tools like SBAR (Situation, Background, Assessment, Recommendation) to address issues promptly. Open up communication with peers and mentors and foster to develop an open environment.  

  • Supporting Colleagues: Collaborate with colleagues. Start advocating for things that will improve our environments like staffing, protocols, and patient safety measures. Uphold professional standards collectively and stand united. You are never alone.  

  • Seek Guidance: As your advocate, not only am I here to support and guide you, but so many millions of others nurses as well.  We all bring something different to the table. Your voice matters and it ultimately helps save lives. Do not hesitate to reach out if you need my assistance, as a subscriber you receive preferential booking! Let's discuss how I can assist you, my fellow nurse. You are never alone! Knowledge is power.


Advocating for Nurses' Mental Health

Prioritizing mental health is essential, particularly after challenging periods like the COVID-19 pandemic. Let’s follow, learn, and benefit from resources provided by exceptional nurses like Sarah Warren, BSN, RN and Lavender Brighid:

  • Sarah Warren BSN, RN: Emphasizes the importance of self-care through practices like meditation and journaling to combat burnout and compassion fatigue. “Sarah is a Dominican-American registered nurse, writer & activist who uses storytelling across social media to help humanize care. Sarah explores healthcare and humanity through critical analysis of oppressive systems to challenge us to build a just world together. She is the co-founder of 501c3 non profit Don't Clock Out, a community organization dedicated to supporting healthcare workers through the impacts of moral distress.” 

  • Lavender Brighid: Empowers healthcare leadership by promoting mental health awareness and resilience through initiatives like mindfulness sessions and peer support groups. “Brighid Gannon is an Award-winning serial entrepreneur and psychiatric nurse known for building and growing innovative healthcare businesses that challenge the status quo and increase access to care where it is needed most. Brighid believes that mental health care is a human right and fundamental to our overall wellness. Her mission is to re-imagine how psychiatric care is delivered in order to make the mental health journey more effortless, kind and effective. Brighid is driven by empathy and thrives when working in collaboration with others. Her work is grounded in a community engaged approach.” .  https://www.joinlavender.com/  https://www.ivypsychiatry.com/


By advocating for our own mental health, we advocate for better patient outcomes.  What we do is hard. We matter, nurses matter, nurses mental health matters. You have sisters and brothers out there who have created resources specifically in mind for you, please use them. Reach out to them. You are never alone. We love you and we all stand together.


Empathy and Action: A New Era in Nursing Leadership


Nursing leadership must be acutely attuned to the mental health challenges, burnout, and compassion fatigue that disproportionately affects nurses and minority nurses at higher incidence. We need to aggressively act to address these concerns. Here’s how we can take action:

  • Creating Open Communication Channels: It is essential to start creating spaces where nurses feel safe to discuss their mental health concerns. They should be able to express the challenges they face and not be threatened to be reported to a governing agency. Open dialogue and education about mental health issues is essential for building resilience and promoting well-being in healthcare, and the retention and future of the nursing profession.

  • Supporting Nurses in Distress: Every nurse deserves our unwavering support, especially in times of stress or crisis. Let’s develop response teams equipped to provide immediate support post-critical incidents, ensuring that every nurse involved receives the care they need and not only immediately after the event but days, weeks and months later.  

  • Addressing Traumatic Experiences: We cannot ignore the profound impact of traumatic events on our nursing staff, whether it’s a distressing code involving a minor or any other traumatic experience. Let’s normalize seeking assistance and provide comprehensive support to mitigate long-term effects, compassion fatigue, mental health issues and suicide.

  • Promoting Resilience and Well-being: Let’s promote wellness initiatives that prioritize resilience, mindfulness, and most importantly self-care. Part of caring for your employees starts with nursing leadership staffing adequately and not reaching out to staff on their days off, or pressuring staff to pick up additional shifts. By empowering nurses with the tools they need to manage stress and prioritize their well-being, we foster a culture of compassion and sustainability.


By championing open communication, collaboration, mentorship, diversity, adequate staffing and robust mental health support, nursing leaders can create an environment where every nurse feels valued, heard, and empowered. Together, we can cultivate a culture of advocacy, resilience, and excellence in nursing—a testament to our commitment to the profession and the patients we serve. Let’s continue to listen, support, and advocate for positive change in nursing leadership. Your voice matters, and together, we can shape a brighter future for nursing.


Dear Nursing Leaders,

In the tumultuous landscape of healthcare, your role isn't just about policies and protocols—it's about empathy, support, and proactive advocacy for those who dedicate their lives to caring for others under your nursing leadership. As we navigate post-pandemic realities, the need for compassionate leadership has never been more evident. Here’s how you can make a profound difference starting today:


1. Embrace Non-Judgmental Support - Nursing isn’t just a profession; it’s a calling fraught with emotional highs and lows. From personal tragedies to professional stressors, nurses face challenges that can deeply impact their well-being. It’s time to lead with empathy, creating a culture where nurses feel safe discussing their struggles without fear of stigma or judgment.


Action Tip: Institute peer support programs where nurses can confidentially seek guidance and solace from colleagues who understand the unique pressures of the profession.


2. Proactive Mental Health Initiatives  - The mental health toll on nurses cannot be overstated. Post-pandemic, the incidence of burnout and compassion fatigue has reached alarming levels, akin to that seen in combat veterans. It’s imperative to prioritize mental health resources and resilience-building programs in healthcare organizations.  We need our nursing leaders to help champion these efforts.


Action Tip: Implement regular mental health check-ins and wellness workshops. Encourage mindfulness practices and provide access to counseling services tailored to the needs of nursing staff.  Post flyers everywhere, include bathrooms (oftentimes the only place a nurse will visit in a 13 hour period) on the inside of the stall. Studies show that if we see something 7x or more it will stick. A nurse might remember in crisis that there is help within the organization. POST IT.  


3. Educate and Empower - Knowledge is power, especially in navigating the complexities of nursing regulations and support systems. Equip yourself and your team with the understanding of state-specific programs. Invite leaders from the Peer Assistance Programs (PAPs) that are designed to help nurses facing substance use disorders or mental health challenges.


Action Tip: Familiarize yourself with local PAPs and promote awareness among your nursing staff. These programs offer confidential support and rehabilitation options, emphasizing recovery and professional reintegration rather than punitive measures.  As a nurse leader it’s your duty to know and advocate for these services for your nursing staff. 


4. Foster a Culture of Prevention - Instead of dealing with the ‘sharpnel’ after the event why not start putting into place preventive and supportive measures? Prevention is key to mitigating the impact of stressors and traumatic events on nursing professionals. Act now to implement proactive measures that safeguard mental health and prevent crises before they escalate.


Action Tip: Establish resilience-building initiatives, such as stress management workshops and peer-led support groups. If there is a patient who expires on your unit and or there is a code, when it’s appropriate to bring the team together, pay special attention to the primary nurse, not only immediately after the moment but days, weeks and months later. Trauma doesn’t always present immediately.  Check in with your staff.  


5. Advocate for Change - As leaders, your advocacy can drive systemic improvements that benefit nurses across the board. Speak up for things that naturally support mental health such as adequate staffing, safe working conditions, and policies that support career longevity and professional growth.


Action Tip: Engage NOT only with policymakers, hospital administrators, and nursing associations to advocate for legislative changes that protect nurse rights and enhance workplace conditions but also with the frontline staff. Your voice matters—your voice can have a positive change.


6. Open Communication and Collaboration: Let’s foster a culture where nurses feel empowered to voice concerns and ideas openly. Regular meetings and forums can provide valuable spaces for discussions, insights sharing, and collaborative problem-solving. By prioritizing transparency, we build trust between nursing staff and leadership.


7. Mentorship and Support Programs: Mentorship is a cornerstone of professional development. Establishing robust mentorship programs pairs seasoned nurses with new recruits and those from diverse backgrounds. This guidance is invaluable in helping navigate challenges and nurturing confidence in their roles.


8. Diversity and Inclusion Initiatives: Embracing diversity isn’t just a buzzword; it’s a fundamental commitment to equity. Our policies and practices should reflect inclusivity, valuing the unique perspectives and contributions of all nurses. Celebrating diversity isn’t just about representation; it’s about ensuring every voice is heard and respected.


9. Lead by Example: Our actions speak louder than words. Let’s demonstrate our commitment to open communication, collaboration, and inclusivity in everything we do. By actively listening to concerns and treating every voice with respect, we set a standard of empathy and understanding.


10. Provide Ongoing Education: Knowledge is power. Regular training sessions on nursing regulations, license protection, advocacy skills, and mental health awareness empower nurses to advocate effectively for themselves and their patients. Education is not just about compliance; it’s about empowerment.


11. Advocate for Mental Health Resources: Our nurses deserve more than just words of support; they need tangible resources. Let’s advocate tirelessly for adequate staffing, resources, and support systems to ensure every nurse—especially those from minority backgrounds—has the tools they need to thrive. We must remove barriers to career advancement and foster an environment where all nurses can flourish.


Nursing leadership isn’t just about managing; it’s so much more than that.  Nurses look up to you and rely on you to support them and their environment. Nursing leadership is about developing relationships with staff and fostering healthy work environments. A huge piece of that is supporting mental health, what we do is oftentimes unimaginable.  Nursing mental health starts with their environment which is dictated by nursing leadership. Be the nursing leader that has an open door and invites all nurses in. The future of nursing depends on our collective dedication to creating supportive environments where every nurse can thrive.



Looking for More Resources? I Got You Covered!

Remember my fellow nurses and healthcare providers that Advocates For Nurses is your one-stop shop for empowering your nursing journey:




  • Schedule a Consultation with Me: Need personalized guidance or want to discuss a specific situation? Remember as subscribers you receive a free 15 min consultation!



These resources offer a variety of support, from crisis intervention to ongoing mental health care, and are specifically tailored to the needs of nurses:


National Hotlines

  1. National Suicide Prevention Lifeline

  2. Crisis Text Line


Peer Assistance Programs

  1. Wisconsin Peer Assistance for Nurses (WisPAN)

  2. Texas Peer Assistance Program for Nurses (TPAPN)

  3. California Nurses Assistance Program (CANAP)


National Support Organizations

  1. American Nurses Association (ANA)

  2. National Alliance on Mental Illness (NAMI)

    • Phone: 1-800-950-NAMI (1-800-950-6264)

    • Text: Text "NAMI" to 741741

    • Website: nami.org

  3. American Holistic Nurses Association (AHNA)

  4. Nurses House, Inc.


Online Resources and Support Communities

  1. The Well-Being Initiative by ANA

  2. The Emotional PPE Project

  3. COVID-19 Mental Health Support Line

    • Texas: 1-833-986-1919

  4. NurseGrid

  5. Healing Healthcare Systems


Stay tuned for more advocacy tips, resources, and case reviews! And always remember, you've got a friend and advocate in Maggie Ortiz, RN, MSN!

Comments

"Nurse Advocate Maggie is a wealth of knowledge. I had worked with her in the ICU years ago and hadn't realized that she was working in this capacity now. I started bouncing ideas off of her when I was being investigated by the BON and low and behold she was able to help to assist me and my lawyer with the most up to date unbiased and evidence based knowledge. Everything we discussed was direct, succinct, and relevant to my investigation. I am thankful for Maggie's expertise. She set me at ease in a very stressful time in my life. Thank you Maggie."

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Advocates for Nurses clarifies that all information, education, and advocacy provided is for educational purposes only and does not constitute legal advice.

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