If you or someone you know may be struggling with suicidal thoughts, dial 988 to reach someone with the Suicide and Crisis Lifeline. They're available 24 hours a day and provide services in multiple languages.
Two months after his daughter died by suicide, Ron Smith, found a note titled "Letter to my abuser."
His daughter, Tristin Kate Smith, 28, wasn't writing about a person. Smith, a nurse was addressing the American health care system.
"I gave my heart. My body, and my mind to you; dedicated long hours and days and gave you my all," Smith, who had worked at several health care facilities wrote.
After finding the letter, the father decided it was worth sharing to raise awareness on the toll the health care system had on her as well as other nurses.
The letter first published as a letter to the editor in the Oakwood Register slowly went viral amongst health care professionals online, with many relating to Smith's words.
A passion for helping people
Ron Smith said his daughter always knew she wanted to be a nurse.
"Some people go into nursing for many different reasons, but this was a calling for Tristin. She loved caring for people," he said.
The youngest of six, Smith remembers his daughter as an upbeat and confident person.
"I think she made a big impact with her friends," he said.
She was a woman of many hobbies, he said. She loved to write and the arts, and was an exceptional baker.
"She had a green thumb. She loved to plant flowers, and she had a love for animals too. That was just, oh my gosh. Anything with animals she loved. She enjoyed long boarding, hiking, she liked anything outdoors. The ocean," he added.
Smith said it wasn't until he began cleaning out her home that he saw the signs of depression. He was aware that she was struggling with the working conditions of being an ER nurse but did not see any signs that his daughter was dealing with a mental health issue.
Despite her love for nursing, Smith said his daughter often complained that there was "never any help" on her unit.
It wasn't until two months after her death, when her father found her note, that he realized the extent of what she experienced.
The note was dated to a few months before her death, and expressed her feelings towards the health care system. While, it's difficult to ever know what led to Tristin's death, the frustration she expressed in her letter resonated with nurses across the country.
Dr. Jessi Gold, a Washington University in St. Louis psychiatrist who specializes in the mental health of health care workers said it's difficult to pinpoint one reason why someone would take their own life and it's never as simple as "work equals suicide or stress in health care equals suicide."
"It's an environment that is becoming really untenable for a lot of people and contributing to mental health problems that are leading them to outcomes like [suicide]," Gold said. "But it's not as simple as work equals suicide."
Tristin's letter addressed issues of staffing shortages, assaults on health care workers, unfair compensation, and the overall stress and burden that is placed on nurses. Several health care workers told USA TODAY that it's extremely challenging working bedside and they understood what Tristin described, but they wish she and other health care workers were aware of the growing number of resources to help them.
Health care workers are human, not just 'heroes'
"I don't think people realize burnout and all of these things; the workplace violence, the unsafe staffing ratios, and the burden we're putting on these humans, they're humans. I know people call them heroes, and their actions can be very heroic, but they're still human. And they're burning out and they're leaving the field," Jennifer Silacci, a psychotherapist and founder of Therapy Aid Coalition said.
Silacci's organization works to provide affordable mental health care to health care workers. Silacci told USA TODAY that one of the biggest things she sees impacting health care workers is access to mental health resources. For many there's still stigma against being treated for things like depression and anxiety, and some fear losing their licenses or retaliation if they choose to seek help.
Silacci said health care workers she's spoken with don't feel properly supported. Many have expressed feeling as if they went from "hero" during the pandemic to "zero."
"We went from bells ringing in New York City during the pandemic abundant meals being brought as thank yous, to continuing to do this work, while the rest of the country felt like the pandemic was over. And we are numbers now," Silacci said she's heard from her health care worker patients.
Several surveys have shown nurses leaving the profession, or at least leaving bedside care, in record numbers. One survey published in May estimated that 1 in 3 of all nurses are looking to leave the field.
Taccara Durrett, a registered nurse in Connecticut, said there's a unfortunate cycle of burnout among nurses that trickles down. When nurses get to a point where they feel they can longer work in the profession, that leaves an even greater workload and stress on nurses who stay. Those remaining nurses also tend to be younger and less experienced, all of which increases their stress and exasperates their burnout.
Durrett, who has been a nurse since 2009, said she's seen many seasoned nurses leave the profession, take on less demanding roles.
Instead of learning from theses experienced nurses, younger nurses now are now getting only a few weeks of training before being "thrown" in to work on their own.
"So they're afraid of making mistakes. They're afraid to lose their licenses. They are afraid of killing somebody," Durrett said. "This is the worst that I've ever seen health care and nurses are so stressed and burnt out. This is crazy, and no one is listening to us."
Sarah Warren, a registered nurse, and co-founder of Don't Clock Out, a non-profit that provides peer support and mental health services to health care workers said she was thrust into a leadership role just two years into her career.
Warren became a charge nurse during the COVID-19 pandemic, a role typically designated for those with more experience. However, with so many leaving the field, younger ones had to fill in their place.
"That was a really heavy responsibility. My mental health really struggled during the pandemic. From 2020 to 2021, I was just progressively declining, I experienced numbness, I experienced intrusive thoughts and experienced suicidal ideation towards the fall (and) summer of 2021," Warren recalled.
Warren eventually went into therapy and was able to get medication which she says probably saved her life, but said it was "really heartbreaking that a role that I deeply, deeply love, took so much from me mentally."
An informal survey of over 2,000 health care workers from Therapy Aid and Don't Clock Out found that over 80% of nurses who responded expressed feeling burned out. Over 70% had fears or concerns about staffing ratios, and 53.5% had fears around workplace violence.
Additionally, over half expressed feeling depressed and overall general fear. Silacci said the most concerning finding was that 16% expressed having suicidal thought, almost three times the amount from the previous year's survey.
Tristin Smith's letter highlighted the individual workload, and fear she felt working in the emergency room.
"A big issue I hear a lot from nurses is related to staffing, an expectation that they can carry more patients than is safe. And so they know that it's not good for the patients, and that makes them worried and concerned," Gold said.
"And it's not just that they feel more burdened by the work, it's that they're actually concerned for someone's safety. And that also worsens their mental health."
Ron Smith, said his daughter would sometimes cry or "actually get physically ill before she would go into work."
"I talked to her about maybe we should switch careers here if this is the way that you're reacting to this," he said.
While Tristin did leave the industry briefly, she went back. After spending a lot of time, and money to become a nurse, and having the desire to make a difference, she found it hard to leave, her father said.
Prioritizing health care workers' mental health is critical
Gold said there's a number of things health care workers can do to maintain their mental health in this industry, and that also includes being able to tell when it's time for them to leave the profession.
"These peer support organizations, mental health organizations for health care workers, we are a band-aid as long as the environment is harmful. And so we can provide support as best we can, but for a lot of health care workers, leaving the environment that is harming them is their only way out," Warren said.
Silacci said while there are several organization specifically tailored towards helping health care workers cope and understand that they're not alone – a solution to this crisis lies in changing the system to allow nurses to feel safe and get the care they need without fear or retaliation.
Warren said these organizations are tasking "health care systems to begin to address the harm they've caused a collective workforce." Silacci, Gold, Warren, and Durratt said it's critical to give nurses and other health care workers access to mental health care before they reach a breaking point, and stop stigmatizing their mental health struggles.
Silacci said it's critical to remove the superhero image projected on to health care workers and instead view them as humans who do "heroic" things. Gold said their role is inherently exposed to second hand trauma, and as humans they need support to deal with that.
Additionally, all agree that short staffing is a key issue, and would like to see more nurses added onto shifts so one nurse isn't taking on more patients than is safe.
Overall, they said without proper care for nurses, the health care industry, which touches everyone at one point or another is unsustainable.
Resources for health care workers
Gold and Silacci said that while its important to discuss the struggles facing health care workers, it's unfortunate that stories like Tristin's happen. While it's critical to talk about it, they wants to ensure that health care workers know they're not alone, and resources are available. Several organizations providing peer support and therapy are listed below.
Don't Clock Out - Free online peer support groups for nurses and health care professionals.
Physician Support Line - Free, confidential support line, for physicians, by physicians.
Therapy Aid Coalition - Free & low-cost therapy for health care workers.
Debriefing The Frontlines - Provide psychological first aid, sustained emotional wellness programs and continuing education to nurses.
Operation Happy Nurse - Free online community available to all nurses.
While Tristin may have not known about these resources, the organizations aim to help health care workers experiencing mental health issues get better. Ron Smith wants to continue telling his daughters story in hopes of helping other health care workers.
Reading his daughters letter, Smith said he started to "feel angry because the working environment that she says she was working under was horrible. That's why I wanted to get this story or get this letter posted out there to bring awareness. If there's one nurse that took her life, my daughter, is there any way that we can prevent another nurse from committing suicide?"
This article originally appeared on USA TODAY: Nurse Tristin Smith's letter highlighting systemic abuse strikes chord