Why Many Nurse Practitioners Are Reluctant to Get Mental Health Care

Ana Gascon Ivey

January 24, 2023

Often nurse practitioners (NPs) are great at taking care of everyone but themselves. In fact, Medscape’s Nurse Practitioner Burnout & Depression Report 2022 found that six out of 10 NPs are burned out, and close to four in 10 are depressed. 

"Nurse practitioners inherently are wired to be caregivers and put self-care on the back burner," says Arlene Wright, DNP, a nurse practitioner for 22 years and director of advanced practice for Millennium Physician Group in Fort Myers, Forida. "In many ways, the mindset of prioritizing our well-being is almost a contradiction to the caring and curing model we embrace."

Nurses Practice Self-Help, Instead

Medscape’s report found that some NPs rely on maladaptive coping skills such as isolation, drinking, and binge eating to manage burnout. Others turn to healthier coping strategies like exercise, meditation, or talking to family members and friends. But less than 20% seek help from an outside source.

 

Americans, in general, don’t seek mental health help for a wide range of reasons. A study from the Mental Health Million Project identified some deterrents in the general population including uncertainty about treatment, preference for self-help, stigma, cost, and access.

Danielle McCamey, DNP, a nurse practitioner for 11 years and founder and chief executive officer of DNPs of Color, a nonprofit that works to increase diversity in nursing doctoral studies, says that belief in self-help is at the top of the list of deterrents for nurse practitioners.

"We tend to have the perspective that we can handle our mental health on our own," says McCamey. "Sometimes that skews our realization of how bad our mental health is because we can still manage to be functional and productive in our roles."

"In our profession, we’re told we have to push through it, so we put our heads down and barrel through it," says Vern Langford, DNP, a nurse practitioner for 11 years and president of the Florida Association of Nurse Practitioners.

"We’d rather not work burned out, but we all know other providers who are, and we don’t do much about it. We have the mentality of being in this sinking ship together. It’s just the unfortunate nature of nursing." 

Stigma Is Still Real

Even though many Americans are more open to mental health discussions, stigma is also an issue. A survey by The Harris Poll for the American Psychological Association found that 87% of American adults believe mental health disorders are nothing to be ashamed of. However, this optimistic view has not wedged its way into nurse practitioners’ workplace culture.

"Some nurse practitioners don’t pursue mental health support because they worry about how they’re going to be treated by other colleagues," says Langford. "If they think the people around them may find out about it, they fear they may hold it against them.

"We can’t get better unless we have an open conversation and destigmatize mental health issues," Langford adds.

But Langford also says the stigma is more self-perpetuated than a reality. "We don’t acknowledge our mental health issues because we’re afraid the people we work with are going to shame us, but the truth is once you open up, you’ll find other nurse practitioners are some of the most supportive, compassionate people you can talk to."

Repercussions From Employers

Nurse practitioners also fear repercussions to their licenses. For example, many state boards require NPs to disclose their psychiatric history. If, for instance, an NP has spent time in a mental health facility or a psychiatric hospital, they must include this information in their renewal application. If they don’t disclose it, they risk getting denied.

Langford tells Medscape that it leaves us wondering why the board needs that information. But she thinks the board would help anyone who disclosed such mental health information the way they help someone with a drug or alcohol problem. "It’s a self-imposed doubt. Unfortunately, we live with this constant fear of losing our licenses. We don’t want to do anything to put our license in jeopardy."

Nurse practitioners who want to climb the corporate ladder also fear discussing their mental health. They’re afraid of getting passed over for promotions if they’re open about a mental illness.

"If an employer has to choose between someone who has disclosed a mental illness and someone who doesn’t have a mental illness, we’re afraid they may choose the one without," says Langford.

The Best Ways NPs Can Get Mental Health Help

The bottom line is that nurse practitioners need mental health support, and they need to get it in a way that feels safe for them. The following strategies may help:

Wellness apps. Mindfulness or meditation apps can help NPs decompress during work shifts, on the drive home, or days off. These apps teach relaxation techniques such as guided breathing exercises. 

Work "besties." "A work bestie is someone who understands you as a person and understands what you’re going through professionally," says McCamey. "It’s that person or a group of colleagues you can check in with and talk about your stressors. Those check-ins are instrumental in maintaining mental health." 

Mentors. "A mentor is not only a professional but also someone to check in with, to have decompressive conversations, and to talk about work-life balance," says McCamey. 

Smartwatches. Set reminders on a smartwatch for mindfulness and deep breathing exercises during shifts. A smartwatch can also help with fitness tracking at work. "Taking a break to go for a walk and get steps in is very beneficial for stress reduction," says Langford. Additionally, use a smartwatch to track sleep. "Quality and quantity of sleep can reduce the stress response," Langford tells Medscape.    

NPower. NPower is a benefit of the American Association of Nurse Practitioners (AANP). The initiative provides a way for NPs to connect with mental health providers online at no additional cost.  

Telehealth therapy. Nurse practitioners can meet with a mental health professional online from the convenience of home. Telehealth can also help NPs who want privacy and don’t want to go to a counselor that their colleagues may go to for therapy.  

Unfortunately, these strategies don’t address the larger issue — the need for nurse practitioners to be open about mental health without feeling guilty or fearing repercussions. 

Langford believes change must start in nursing schools with faculty and within the curriculum. For example, professors must be willing to talk about what to do when you have anxiety, burnout, or depression, where to get help, and ways to manage mental health when you’re an NP.

"They need to teach that mental health care is normal," says Langford. If schools raise a generation of nurses who talk about their mental health as openly as their diabetes or high blood pressure, then NPs may be more willing to seek help.

In the meantime, McCamey says mental health is a complex, multilayered problem. "Until we take steps to make people feel empowered to advocate for their wellness, we’re not going to change the culture.

"Until then, we’re going to have nurse practitioners who fly under the radar, who are highly functional at their jobs but burned out or depressed."

Ana Gascon Ivey is a health and medical writer based in Savannah. She also teaches creative writing at a men's correctional facility.

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