Estimated reading time: 5 minutes
In nursing, we often learn and discuss medical topics such as detecting sepsis, identifying and treating strokes, and responding to cardiac or respiratory crises. Yet not enough do we discuss how to identify and respond to someone experiencing a mental health crisis, particularly suicide and suicide prevention.
Despite growing awareness surrounding mental health, suicide remains one of the leading causes of death and continues to be one of the most urgent public health crises of our time, despite being widely recognized by experts as largely preventable.
And too often, healthcare systems still treat suicide risk and prevention as something that belongs exclusively to emergency rooms, behavioral health, or even worse, just a regulatory check mark.
But nurses are poised to change this.
Over the past 16 years, working across both medical and behavioral health settings—and the past 8 years focused specifically on suicide prevention research and implementation—I have seen firsthand how suicide risk frequently presents outside of psychiatric units.
With more than 14 million adults in the United States reporting serious thoughts of suicide each year, patients at risk for suicide are cared for every day across nearly every area of healthcare, including general medical units, critical care, oncology, obstetrics, and other specialty settings. Some arrive with suicide risk already recognized. Many do not. Their emotional suffering may be subtle, hidden beneath physical illness, trauma, pain, fear, or overwhelming life stressors.
Nurses are often the closest to these patients and moments.
We are the ones spending the most time at the bedside. We can notice changes in behavior, mood, and affect. We hear comments made in passing that others may overlook. We recognize when something feels “off” long before it appears in a chart or screening tool. Suicide prevention should not be seen as separate from nursing practice—it is nursing practice.
Nursing is not just tasks and interventions; it is rooted in assessment, human connection, advocacy, and holistic care.
Yet many nurses continue to report feeling underprepared and lack confidence to address suicide risk and prevention, particularly in acute medical settings where there are competing demands, limited behavioral health resources, a lack of competency-based education, and stigmas that still create barriers to meaningful interventions. In many organizations, suicide prevention remains underprioritized, reactive, or implemented only to the extent required by regulatory standards.
But these gaps do not change the reality.
The reality is that research has shown for many years that many individuals who die by suicide interacted with a healthcare provider in the weeks or months prior to their death, estimated to be more than 80%.
Health systems, including acute care settings, represent critical opportunities for identification, intervention, and connection to support for patients at risk for suicide. When nurses are equipped with the education, tools, and organizational support to engage in suicide prevention confidently, they become one of the strongest protective factors within the healthcare system itself.
Suicide prevention does not require nurses to become experts in psychiatric nursing care, but it does require nurses to be prepared and supported in three critical areas: identifying risk, maintaining safety, and facilitating support after discharge.
Identification
Evidence-based suicide screening tools have become increasingly important in helping healthcare teams identify patients who may otherwise go unnoticed, particularly when used universally in medical settings where mental health concerns are not the primary reason for admission. When paired with therapeutic communication, these tools create opportunities for nurses to play an important role in early intervention and prevention.
However, screening tools are only as reliable as their implementation—including consistent use, adherence to evidence-based questioning, and the honesty of patient responses. Because of this, additional opportunities to identify suicide risk exist through clinical observation. This is where nursing assessment becomes critically important. Nurses are often the first members of the healthcare team to recognize emotional distress, behavioral changes, or warning signs that may indicate someone is at risk for suicide.
Safety
Once suicide risk is identified, nurses play a central role in maintaining a safe care environment. In acute care settings, this should include strict environmental safety and observation practices, immediate escalation of concerns, strong interdisciplinary collaboration, and ongoing reassessments of a patient’s psychosocial status.
While safety interventions are essential and should be driven by best practice protocols, they can sometimes feel overwhelming, restrictive, or isolating for patients already experiencing emotional distress. Therefore, the nurse’s role also includes preserving the patient’s dignity and emotional safety, enabling the patient to feel seen and supported during significant vulnerability.
This also aids in reducing stigma.
Support
Not all patients identified as at risk for suicide will require or be transferred to inpatient psychiatric care. Many will continue receiving treatment or be discharged directly from medical settings, making discharge planning and continuity of support especially important.
One of the highest-risk periods for individuals experiencing suicidal thoughts is in the days and weeks following discharge from care.
While case managers, social workers, or behavioral health specialists may coordinate discharge planning, nurses continue to play a critical role in advocating for patient needs during interdisciplinary discussions and ensuring patients understand the resources available to them prior to discharge.
This includes reinforcing and reviewing follow-up recommendations, and ensuring they are given crisis resources such as the 988 Suicide & Crisis Lifeline. Discharge can be an overwhelming and vulnerable transition for patients.
Even brief moments of connection, support, and education during discharge planning can have a powerful impact on suicide prevention.
Together, these responsibilities reflect what nurses do- recognize risks early, support patients during their vulnerable moments, and advocate for needs beyond admission.
Healthcare organizations also must recognize that suicide prevention cannot exist solely as an annual learning module or policy. It must be embedded into organizational culture, interdisciplinary collaboration, and everyday clinical practice.
Nurses should be included in implementation efforts, research, policy development, and systems redesign surrounding suicide prevention initiatives.
As healthcare continues to evolve, so do our patient populations and their comorbid needs. Nurses are uniquely positioned to bridge the divide between physical and mental health care because nurses have always cared for the whole person, not just the diagnosis.
Suicide prevention is not someone else’s responsibility in healthcare.
It is all of ours. And nurses have an essential role.
