APNA Position: Competencies for Nurse-Assessment and Management of Inpatient Suicide Risk

Introduction

Suicide is a leading cause of death, according to the Centers for Disease Control (2025). In particular, the risk of suicide for persons with psychiatric conditions in the hospital is high, and suicide risk continues to be elevated immediately following hospitalization (Forte et al, 2019). To address this health crisis, national efforts are underway to improve competence in suicide prevention for the psychiatric-mental health workforce. The Joint Commission Safety Goal 15.01.01, effective 2019, requires identifying persons at risk for suicide (The Joint Commission, 2018). Despite the fact that mental health professionals frequently encounter individuals at risk for suicide, a significant number lack relevant training in suicide-related care (Wakai et al, 2020).

The American Psychiatric Nurses Association is committed to supporting psychiatric-mental health nurses and participating in national efforts to improve confidence and competence in suicide prevention for the mental health workforce. Although they are the largest workforce providing care for patients at risk for suicide, until the 2014 development of the APNA Psychiatric-Mental Health Nurse Essential Competencies for Assessment and Management of Individuals at Risk for Suicide, no standard competencies for nurses who care for patients with mental health conditions existed (Bolster et al., 2015). These competencies clearly define the essential knowledge, skills, and attitudes that psychiatric-mental health nurses need to deliver safe, effective, and ethical care related to suicide assessment and management.

The American Psychiatric Nurses Association takes the position that the APNA Psychiatric Mental Health Nurse Essential Competencies for Assessment and Management of Individuals at Risk for Suicide address serious gaps in education for nurses who care for persons with mental health and substance use needs. Further, their adoption improves outcomes in suicide risk assessment, prevention, and intervention, ultimately increasing safety.

Discussion

To ensure that nurses are competent to assess and manage the care of people at risk for suicide, the APNA Board of Directors established a Task Force to develop nursing-specific inpatient suicide prevention competencies in August of 2013. This task force represented a unique partnership of national experts in suicide prevention, including inpatient nurse leaders, national Assessing and Managing Suicide Risk (AMSR) trainers, nurse educators, and a consumer expert in recovery with lived experience of suicidality.

The group, with the support of the AMSR leadership, created nursing-specific competencies adapted from existing nationally recognized competencies for assessing and managing suicide risk (SPRC & AAS, 2008) using a step-wise approach that included competency identification, components, and evaluation. Validity of the competencies was established through a consensus process and the competencies were reviewed by nurse leaders and interprofessional experts on suicide prevention.

These competencies, by clearly defining the level of competence needed for these skills, improve the standard of inpatient nursing care for suicide prevention and reduce suicide morbidity and mortality in persons who are hospitalized for inpatient psychiatric-mental health treatment. To support their adoption into clinical practice, the task force subsequently developed a competency-based curriculum that includes identifiable tasks and measurable outcomes and is updated every three years. The APNA Suicide Prevention Certificate Program, by translating the competencies into real-world practice, builds foundational knowledge, strengthens clinical judgement, teaches communication techniques, reinforces ethical and legal responsibilities, and supports interdisciplinary collaboration, thereby developing nurse confidence and competence.

Since the publication of the competencies and curriculum, thousands of professionals have completed APNA training in suicide prevention. Findings indicate that nurses feel more confident and competent in their suicide assessment skills, are equipped to develop a suitable safety plan with patients at risk for suicide, and possess more confidence in operationalizing the competencies in practice. Targeted courses that build on this program further help nurses tailor their skills to serve diverse populations at higher risk of suicide, including youth, older adults, and LGBTQIA+ individuals.

Position

It is the position of the American Psychiatric Nurses Association that these suicide competencies address a critical gap in suicide prevention efforts across health care settings. To promote safety and establish a best-practice standard for nursing assessment, especially for hospitalized patients at risk for suicide, these competencies must be equitably disseminated to the diverse population of practicing nurses who serve individuals at risk. The APNA Suicide Prevention Certificate Program and supplemental courses, designed to operationalize these competencies, provide nurses with the practical skills, clinical judgment, and confidence needed to apply these competencies in clinical settings.

Conclusion

APNA urges diverse healthcare facilities and academic settings to inclusively adopt these nursing competencies in order to equitably increase patient and nurse safety and enhance nurses’ confidence and competence in caring for patients at risk for suicide. Doing so will ultimately improve diverse patient outcomes. The educational curriculum that is based on the competencies should be viewed not only as continuing education for nurses, but also as a supplement to undergraduate nursing education as an established standard of care.

Approved February 2015; Revised December 2020, May 2022,September 2025

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References

Bolster, C., Holliday, C., Oneal, G., Shaw, M., (January 31, 2015) “Suicide Assessment and Nurses: What Does the Evidence Show?” OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 1, Manuscript 2. DOI: 10.3912/OJIN.Vol20No01Man02

Centers for Disease Control and Prevention. (2025). Suicide Data and Statistics. Retrieved  from https://www.cdc.gov/suicide/facts/data.html

Forte, A., Buscajoni, A., Fiorillo, A., Pompili, M., & Baldessarini, R. J. (2019). Suicidal risk following hospital discharge: a review. Harvard review of psychiatry, 27(4), 209-216.

Knesper D.J., American Association of Suicidology, Suicide Prevention Resource Center. Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc. (2011). Retrieved October 1, 2020 from http://www.sprc.org.

Suicide Prevention Resource Center (SPRC) & American Association of Suicidality (AAS). (2008). Assessing and managing suicide risk: Core competencies for mental health professionals. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved October 1, 2020 from http://www.sprc.org.

The Joint Commission. (2018). National Patient Safety Goals Effective July 2020 for the Behavioral Health Care Program. Retrieved October 1, 2020 from: https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2020/npsg_chapter_bhc_jul2020.pdf

Wakai, S., Schilling, E. A., Aseltine Jr, R. H., Blair, E. W., Bourbeau, J., Duarte, A., … & Welsh, A. (2020). Suicide prevention skills, confidence and training: Results from the Zero Suicide Workforce Survey of behavioral health care professionals. SAGE open medicine, 8, 2050312120933152.