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Why ‘only’ women nurses?
We have been asked why our research focuses solely on women nurses.
We have given a great deal of consideration to the design of the studies within this project, including consulting with nurses and our project stakeholders. We made the decision to focus specifically on women nurses for a range of reasons and in this blog I will focus on three of these.
by Dr Hilary Causer
We have been asked why our research focuses solely on women nurses.
Firstly, let me clarify that when we talk about women in the context of our research, we are referring to anyone who identifies as a woman. This definition has been developed in collaboration with nurses who have experience of suicidality, and we will use it when recruiting nurse participants into our studies.
We made the decision to focus specifically on women nurses for a range of reasons:
In response to the statistics regarding suicide rates by women nurses
Because women’s and men’s experiences of being a nurse are different
Because suicide is a gendered experience and there is a notable lack of research that specifically explores women’s experiences.
Because historically, women’s experiences and distress are more likely to be understood as medical problems.
Solutions and interventions to address women’s distress and suicidality have been individualised. This suggests that women are seen as being responsible for their own problems, whereas the root cause may lie in the ways that society and the workplace are organised.
In this blog I will focus on the first three.
Women nurses have a heightened rate of dying by suicide
This project came to fruition in response to the heightened rate of suicide among women nurses who have a 23% greater risk of dying by suicide than women in other professions. This statistic is echoed in other western countries such as Australia and the USA. However, male nurses, health care assistants, or midwives do not demonstrate a similarly heightened rate.
“women nurses have a 23% greater risk of dying by suicide than women in other professions”
Whilst the statistics tell us ‘what’ is happening, we don’t currently understand ‘why’ it is happening. Therefore, we are undertaking five distinct studies, using qualitative and mixed research methods, that focus on the experiences of women nurses. Our research findings will not only add to current knowledge, but also identify necessary changes to the working lives and environments of women nurses to address this longstanding anomaly.
Gendered experiences of being a nurse
Research tells us that there are distinct differences in the experience of being a nurse according to gender. Almost 90% of UK nurses are women, thus nursing is a female majority profession. Despite this, women nurses are less likely to progress to senior roles than male nurses and are paid less on average than male nurses.
They are also more likely than their male counterparts to experience discrimination, bullying, and harassment at work and are significantly more likely to experience gender-based violence inside the workplace and intimate partner violence, a known risk factor for suicide outside the workplace. Women health staff, including nurses, were also more likely to experience anxiety, depression, and sleep disorders after working through the Covid-19 pandemic. A recent report on suicide in female nurses in England states that of nurses who were in contact with mental health services 18% percent reported problems at work compared with 6% of women in other occupations.
“Almost 90% of UK nurses are women”
For some women nurses these gendered experiences occur at the intersection with other factors, which further complicate their experiences. For instance, 40% of the NHS workforce, and 60% in social care, are workers from the global majority, many of whom gained their nursing qualifications before migrating to work in the UK. Nurses who identify as Black are disproportionately referred to the nursing regulator.
It is clear, that while the experiences of male nurses are valid and important, they will not helpfully contribute toward growing our understanding of what is happening for women nurses.
Gendered experiences of suicide and gendered suicide research
There are also gendered differences in suicidal experience. The most significant being that nearly three quarters of all people who die by suicide are men. Paradoxically, incidents of self-harm and suicidal thoughts and attempts are more frequent for women. The means by which people die by suicide also differ between men and women, as do the most likely age at which people die by suicide.
These differences have shaped the research agenda. Specifically, as most deaths by suicide are men, research has focused on seeking to understand risk factors and preventative factors that pertain to men. This has resulted in a dearth of research into women’s suicide in any cohort.
“suicide research has focussed on risk factors and preventative factors that pertain to men”
This is problematic as it means that certain contexts or life events which are specific to women remain unexplored. These include the care burden and the ‘second shift’; menstruation, pregnancy/infertility and menopause; dominance of patriarchal messaging and systems in society and workplaces; sexual and domestic violence and coercive control; violence in the workplace; and experiences of working in female majority professions.
Our research, by focusing on women nurses, will provide novel and valuable evidence that will grow our collective understanding about how suicide might be experienced differently for women.
Our answer to your question
We have given a great deal of consideration to the design of the studies within this project, including consulting with nurses and our project stakeholders. Our answer to your question, ‘why only women nurses?’, is, because they face greater risk of dying by suicide, and have distinctly different experiences to men nurses, and because women’s experiences around suicide are currently under-researched and poorly understood.
To learn more about the approach that we will be taking in our research, and the feminist and critical arguments that underpin our approach, take a look at our previous blog post by our Principal Investigator Dr Ruth Riley.
How our understanding of context informs our understanding of nurse suicide; and why we need change.
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
by Dr Ruth Riley
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
The suicide rate among women nurses is 23% higher than women in other occupational groups.
These numbers are more than just statistics but speak of human stories of distress and suffering in women nurses across continents. Yet their voices, experiences, and stories are largely unaccounted for in dominant suicidology approaches and suicide prevention policies.
High suicide rates in women nurses have been documented for over 20 years in the UK and in other high-income countries too. Yet workplace practices, policies and research have failed to address the realities and contexts of nurses’ lives.
Current approaches and why they are failing women nurses
Deaths by suicide are often what we see or hear about but hidden beneath the surface are the diverse contexts that contribute to distress and suicidality. Our studies will argue that mainstream research approaches are not only gender- and colour-blind, but also focus on individual-level characteristics and the mental health of individual nurses and rely on methods which fail to account for wider contexts.
In North America, there is a trend which advocates screening for mental illness in nurses which may further label and individualise women’s (and others’) distress. This may compound stigma and increase shame, leading to the concealment and non-disclosure of feelings and distress and presenteeism, particularly in healthcare cultures which lack compassionate leadership and psychological safety.
Why we need to revision our understanding of distress and suicidality in women nurses
In contrast to these approaches, the ambition of our project is to address these under-researched contexts using critical suicidology which questions the mainstream approaches that locate ‘the problem’ within the individual. Our position argues that by individualising distress, attention is distracted from the political, social and economic contexts and systems within which nurses work and live. Solutions aimed at addressing these wider contexts and systemic problems – which include deep-rooted violence against women, both inside and outside the workplace, discrimination, poor working conditions, and other workplace injustices, are overlooked. Employing a feminist approach will enable us to better understand the patriarchal, social and structural systems which impact women nurses, nurses from the global majority, and othered communities. This is a timely project as we witness continued distress compounded by ongoing injustices, the pandemic and workforce and resource shortages.
Joining the dots – politics, mental health, and women.
Individualising distress and labelling distressed women as unwell goes hand in hand with current – neoliberal – political mindsets. For example, we are expected to maintain ‘good’ mental health despite changes in political and organisational systems which contribute to and sustain inequality and injustices for women and othered communities.
Messages about self-care, help-seeking and individual resilience are all examples of the drive toward individual responsibility for mental wellbeing. Therefore, the unjust systems that oppress and disadvantage women and others are excused any responsibility.
A feminist understanding of ‘mental illness’
Mainstream approaches to treating distress or ‘mental illness’ and the messages surrounding it are largely uncritical – relying on taken-for granted knowledge. Such approaches, as above, are underpinned by biological and medical models and are predominantly understood from a medical and male viewpoint. This poses a problem for women and for marginalized and minoritised communities.
In the UK and other high-income countries, women are three times more likely than men to be diagnosed with depression and anxiety. This proportion increases when women are also Black, lesbian and/or older. Historically, women are more likely to be institutionalized, in asylums and hospitals, receive psychosurgery, electroconvulsive therapy and psychotropic medication (particularly antidepressants), which can be accompanied by harmful side and withdrawal effects, including suicidal thoughts.
Medicalizing women’s distress and focusing on the individual is a form of institutionalized gaslighting, as their distress symptoms are reduced to a diagnosis yet their voices, experiences and the contexts contributing to their suffering are overlooked. In feminist research, women participants often resisted a medicalized diagnosis of depression as they attributed the cause of their misery to structural factors, including poverty and violence.
We argue that focusing on the personal, overlooks the political, and fails to hold to account those systems, structures and cultures which contribute to and sustain social, colonial and economic injustices, gender-based violence or the impact of work cultures and working conditions on women. This includes women nurses and ethnically diverse nurses and will apply to women working in other occupations, including doctors.
What is the ambition of this project?
This ground-breaking project has five different studies which will capture the diverse experiences and accounts of a range of women nurses and those from the global majority. We will also be capturing the views of the public, including friends and families of nurses to explore their understanding of what contributes to nurse distress and suicidality. In providing space and opportunities for new perspectives, we will gain a more nuanced understanding of relevant contexts while providing a voice and platform for under-represented nurses.
The project aims to transform research approaches, and trends in suicidology and significantly shift our understanding of the contexts that contribute to distress and suicidality within the nursing population. This research may also have direct implications for women working in other occupational groups. We wish to launch a more nuanced approach and debate about the contexts that impact women inside and outside the workplace.
The project will lead to societal benefits too by increasing public understanding of these issues. We want to change hearts and minds so that suicide is no longer viewed as an individual problem and its contexts are more widely understood.
I am proud to be leading this ambitious project with a passionate and experienced team, who include international experts, award-winning creative artists and, crucially, nurses themselves, who have shaped the project and research priorities. Over the next 5+ years, we will be working with nurses, for nurses, to radically revision our understanding of distress and suicidality within the nursing community.
