24 Worldviews on Evidence-Based Nursing, 2020; 17:1, 24–31. © 2020 Sigma Theta Tau International Special Issue Sustainability and Outcomes of a Suicide Prevention Program for Nurses Rachael Accardi, LMFT ● Courtney Sanchez, LCSW ● Sidney Zisook, MD ● Laura A. Hoffman ● Judy E. Davidson, DNP RN FCCM FAAN ABSTRACT Background: We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse-centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at-risk nurses. Aim: The purpose of this paper is to report the 3-year sustainability and outcomes of this nurse suicide prevention program. Methods: Descriptive statistics are provided of program outcomes over the course of 3 years. Results: Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous sui- cide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred sev- enty-six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. Linking Evidence to Action: The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well-re- ceived, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now sup- ports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions. BACKGROUND International studies have consistently reported that nurses are at greater risk of suicide than the gender matched population (Alderson et al., 2015; Braquehais et al., 2016; Cheung et al., 2016; Milner et al., 2017; Silva et al., 2015; Suicides by occupation, England: 2011 to 2015, 2017; Tramutola, 2015). Early U.S. data suggest this also may be true in the United States (Davidson et al., 2019; Davidson, Stuck, et al., 2018). A suicide prevention program called the Healer Education Assessment and Referral (HEAR) program, ini- tially designed for physicians, has successfully detected phy- sicians at risk of suicide (American Foundation for Suicide Prevention [AFSP], 2016; Downs et al., 2014; Martinez et al., 2016; Moutier et al., 2012; Norcross et al., 2018; Zisook et al., 2016). HEAR provides education about risk factors and proactive screening focused on identifying, supporting, and referring physicians for untreated depression or suicide. HEAR has been acclaimed as a best practice in physician suicide prevention by the American Medical Association (AFSP, 2016). The physician HEAR program had been in place 7 years when we conducted a pilot to expand the program to nurses (Davidson, Zisook, et al., 2018). During the first year, 185 (7.5%) nurses completed the anonymous encrypted online screening, and 41 (22.2]%) engaged in counseling online, by email, by phone, or in person. Twenty-six nurses accepted referral for continued treatment. With this success, the executive team budgeted to perma- nently extend the HEAR program to nurses and healthcare staff by funding two full-time therapists and a .35 psychi- atrist to provide services for 17,500 employees and faculty (Davidson, Zisook, et al., 2018). The purpose of this manuscript is to report the sustain- ability and outcomes of the HEAR expansion. Work vs. home stressors are explored. Modifiable work-related stressors that leaders may address to enhance clinician wellness and reduce Key words nurse, depression, suicide prevention, workplace wellness, occupational health