How Do Occupational Experiences Contribute to Suicide Risk PMH Nurses?

Q&A With APNA Annual Conference Presenter Christopher Wojnar

APNA member and upcoming APNA 40th Annual Conference presenter Christopher Wojnar, MSN, APRN, PMHNP-BC, is a psychiatric-mental health nurse practitioner, creator and founder of NurseSuicide.org, suicide prevention strategist, and suicide attempt and loss survivor. His work focuses on translating lived experience, suicide science, and systems thinking into practical approaches to suicide prevention for nurses and health care organizations.

In time for National Recovery and Suicide Prevention Month, Wojnar’s presentation encourages attendees to think differently about the pathway to nurse suicide and to look beyond how distressed someone appears and understand the psychological processes through which occupational experiences can contribute to suicide risk. 

APNA: What led you to focus on suicide risk among nurses, and what do you think psychiatric-mental health nurses need to understand about this issue?

Wojnar: My interest in nurse suicide is both personal and professional. I have my own lived experience with suicide, and I have also experienced the loss of nursing colleagues to suicide. As I became more involved in suicide prevention, I kept coming back to a question that our usual conversations about burnout did not adequately answer: How does an occupational experience become suicide-relevant?

Research using the National Violent Death Reporting System has identified a cascade of circumstances surrounding some nurse suicide deaths, including job-related problems and significant professional transitions. My work takes that observed cascade and applies contemporary suicide and psychological theory to explore what may be happening within it.

Burnout describes an important form of occupational distress, but it is not a suicide theory. Contemporary suicide theories give us constructs such as defeat, entrapment, hopelessness, burdensomeness, loss of belonging, and capability. When we examine occupational adversity through those constructs, we can ask more precise questions about how a threat to someone’s professional identity, livelihood, or future could contribute to narrow perceived options and a feeling of having no way forward.

APNA: Nurses are often taught to recognize and respond to suicide risk in their patients. Can it be more difficult to recognize suicide risk in their colleagues?

Wojnar: Yes, but I would go further and question whether recognition by colleagues should be the foundation of our prevention strategy. Healthcare teaches and rewards people for functioning under extraordinary conditions. Nurses learn to compartmentalize, remain composed, put the patient first, avoid burdening the team, and keep going. Those adaptations are often necessary to do the work. The problem is that the same rules may become counterproductive during a psychological crisis. 

My organizational systems work describes this tension explicitly: self-reliance, emotional suppression, compartmentalization, and persistence can be highly adaptive professionally while potentially contributing to concealment, isolation, or entrapment when they become rigid. That creates an important paradox. 

A nurse can be experiencing significant suicide risk and still be taking excellent care of patients.

If the crisis itself threatens someone’s professional identity, disclosure may become even more complicated. The person may be operating from deeply internalized rules such as:

• I should be able to handle this
• I cannot burden the team
• I have to keep going
  

If asking for help is also perceived as potentially threatening to employment, licensure, credentialing, reputation, or belonging, help-seeking may feel like another threat rather than an obvious solution. I do not want the message to be that nurses simply need to become better at detecting suicidal coworkers. 

Prevention has to work even when distress remains invisible and even when the person does not feel safe disclosing it.

APNA: Your work looks beyond burnout to suicide-specific risk. What warning signs, experiences, or transitions should PMH nurses be paying closer attention to?

Wojnar: What becomes more concerning than warning signs is transitions in psychological state like movement toward defeat, hopelessness, shame, perceived burdensomeness, restricted options, or entrapment. For example, “I cannot keep working this schedule” communicates something different from “There is no way out of this.”

Occupational transitions like an adverse clinical event, complaint, investigation, suspension, job loss, substance use concern, licensing or monitoring process, workplace violence, or return to practice following a mental health crisis, may be important because they can suddenly threaten several things at once: identity, livelihood, belonging, reputation, agency, and the person’s imagined future. None of those events should be interpreted as inherently causing suicide, but the theoretical question is: What happens next?

The shift I am proposing is from asking only, “How much stress is this nurse experiencing?” to also asking, “What is happening to this person’s sense of identity, agency, belonging, hope, and available options?”

APNA: What are some ways PMH nurses can support a colleague who may be struggling?

Wojnar: A supportive colleague matters, but psychological safety is also produced by what happens after someone speaks. If a nurse discloses a mental health condition or substance-use problem and then encounters shame, isolation, opaque processes, threats to employment, or fears about professional consequences, telling people that it is “safe to ask for help” will not make it so. I think of the organizational response as potentially becoming a second exposure. The first exposure may be an adverse event, complaint, impairment, personal mental health crisis, or suicide attempt. What happens next can either restore options or further restrict them. My organizational work contrasts restorative responses such as confidentiality, procedural justice, support, and protected leave with punitive or opaque responses that may amplify shame, defeat, isolation, and entrapment.

When someone does disclose to a colleague, that interpersonal response still matters. We can listen, take the disclosure seriously, avoid judgment or distancing, and help the person access appropriate care when that is within our role. But we should not confuse individual kindness with structural safety. Organizations and leaders control many of the conditions that determine whether disclosure actually is safe. Responsibility should follow authority.

APNA: What resources or supports should nurses know about if they are concerned about their own mental health or a colleague’s?

Wojnar: How to access mental health treatment, employee assistance programs, peer-support resources where available, employee health services, crisis services such as the 988 Suicide & Crisis Lifeline, and any state or professional programs available to healthcare workers. The more important issue is whether those resources are actually usable. We often respond to clinician distress by creating another list of resources. That assumes the barrier is lack of awareness. Sometimes the barrier is that using the resource itself has perceived risk. 

A nurse may be asking: 

• Is this really confidential? 
• Who will know? 
• Could this affect my job? 
• What does this mean for credentialing or licensure? 
• What happens if I need time away? 
• What happens when I come back?

I encourage organizations to evaluate resources from the perspective of the person who is most afraid to use them. It is not enough to ask, “Do we have an EAP?” We should ask, “Would a nurse who believes their career is already at risk trust this pathway enough to use it?” 

APNA: As we recognize National Recovery Month, what does recovery look like for nurses who have experienced a mental health crisis or suicide risk, and how can our profession better support that process?

Wojnar: For me, recovery is closely connected to restoring options. A serious mental health crisis can disrupt much more than symptoms. For a nurse, it may affect professional identity, relationships, financial security, confidence, belonging, and the ability to imagine a future. If someone has experienced a suicide attempt, hospitalization, substance-use disorder, impairment, investigation, or time away from practice, recovery may include the question, “Is there still a place for me in nursing?” That question matters. Recovery should restore agency, connection, dignity, hope, and multiple viable paths forward. For some people, that means returning to the same position. For others, it may mean accommodations, a different specialty, a different role, time away from practice, or deciding that their future does not depend on returning to exactly who they were before the crisis.

We know far less than we should about clinician attempt survivors, near-misses, and return-to-work trajectories. My broader work identifies that as an important evidence gap. A recovery-oriented profession should make futures visible. No nurse should be left believing that the only acceptable outcomes are to keep functioning exactly as before or lose everything.

APNA: What do you hope PMH nurses will take away from your upcoming APNA Annual Conference presentation?

Wojnar: I want attendees to leave thinking differently about the pathway to nurse suicide. My framework examines how occupational adversity might interact with professional identity and contribute to psychological states such as defeat, restricted options, entrapment, hopelessness, or burdensomeness. Contemporary ideation-to-action theories then help us think separately about the transition from distress to suicidal ideation and from ideation toward suicidal behavior, including the role of capability and means. 

This is not a validated causal pathway, and I am not suggesting that occupational adversity inevitably progresses toward suicide. Some of these relationships are well established, while others, including the proposed role of professional identity disruption and adaptive professional rules, require direct empirical testing. But theory gives us something descriptive mortality data alone cannot: hypotheses about where the cascade may become suicide-relevant and therefore where it might be interrupted.

I do not want PMH nurses leaving my session with another burden: “Now I have to identify which of my coworkers might be suicidal.” The question is not only whether we can recognize an individual at risk. It is whether we can build healthcare systems that do not require a person in crisis to overcome the very professional rules, identity threats, and organizational barriers that may already be narrowing their perceived options to receive help.

That is the shift I hope attendees take away: from asking only how we identify the nurse at risk to asking how we interrupt the conditions and psychological processes through which risk can escalate.

Published September 2026

>>> Keep your practice informed with more information and resources from APNA on Suicide Prevention & Recovery and register to attend the APNA 40th Annual Conference for Wojnar’s full presentation and more sessions pertinent to your practice!