APNA Position: Competencies for Nurse-Assessment and Management of Inpatient Suicide Risk
February 2015; Revised and approved December 2020; Revised and approved May 2022
Introduction
Suicide is the tenth leading cause of death according to the most recent data from the Centers for Disease Control (2020). 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 competencies 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). Likewise, Goal 7 of the 2014 National Action Alliance Care Critical Intervention Task Force encourages training for clinical team in suicide prevention and related issues (NAASP, 2014).
The American Psychiatric Nurses Association takes the position that these competencies address serious gaps in education for nurses who provide care to persons with mental health and substance use needs and that their dissemination will improve outcomes related to suicide risk assessment, prevention, and intervention, ultimately increasing safety.
The American Psychiatric Nurses Association is committed to supporting psychiatric-mental health nurses in their vital work and participating in national efforts to improve competencies in suicide prevention for the behavioral health workforce. In 2013, The Association for Suicidology (AAS) published a policy paper targeting training for psychiatrists, social workers, psychologists, and counselors, but not for nurses. Although they are the largest workforce providing care for suicidal patients, 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 psychiatric conditions and/or substance use disorders existed (Bolster et al., 2015). A 2020 review of the literature reveals no new references for nursing competencies beyond those developed by APNA.
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 and that their dissemination will improve 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. The 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. Based on a literature review, the group identified a workable model for developing the competencies and, with the support of the AMSR leadership, created nursing-specific competencies adapted from nationally recognized competencies for assessing and managing suicide risk (SPRC & AAS, 2008). On a regular basis that literature review is updated and reflected in the education material. The overall aim of the competencies is to improve the standard of inpatient nursing care for suicide prevention and to reduce suicide morbidity and mortality in persons who are hospitalized for inpatient psychiatric-mental health treatment.
The competencies were developed using a step-wise approach, including competency identification, competency components, and competency evaluation. Validity of the competencies was established through a consensus process. Nurse leaders and interprofessional experts on suicide prevention provided internal and external review. The task force subsequently developed a competency-based curriculum which includes identifiable tasks and measurable outcomes.
Since publication of the competencies and curriculum, more than 3,500 professionals have completed APNA training in suicide prevention and intervention with 100 nurses educating and disseminating the curriculum. Findings indicate that nurses feel more confident using suicide assessment skills and better understand why patients consider death by suicide. Nurses are able to develop a suitable safety plan with patients at risk for suicide and report more confidence in operationalizing the competencies in practice.
Conclusion
It is the position of the American Psychiatric Nurses Association that these suicide competencies address a gap in suicide prevention efforts and should be inclusively and equitably disseminated to the diverse population of practicing nurses serving the target population as a means to increase safety and provide an example of best practice for nursing assessment of hospitalized patients who may be at risk for suicide.
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 more equitably.
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.
Summary
The APNA Board of Directors endorses the APNA Psychiatric Mental Health Nurse Essential Competencies for Assessment and Management of Individuals at Risk for Suicide.
It is APNA’s position that these competencies must be equitably disseminated throughout the healthcare delivery and nursing educational systems.
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. (2020). CDC WONDER: About Underlying Cause of Death, 1999-2018. Retrieved from https://wonder.cdc.gov/controller/datarequest/D76;jsessionid=98147758D90AF124E9297BDD7DC4
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.
National Action Alliance for Suicide Prevention (NAASP): Clinical Workforce Preparedness Task Force. (2014). Suicide prevention and the clinical workforce: Guidelines for training. Washington, DC: Author.
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
