Quick summary: September is Suicide Prevention Month, a time for nurses to sharpen their knowledge of suicide risk factors, screening tools, and intervention strategies. Nurses are uniquely positioned to identify at-risk patients early, initiate safety planning, and connect people to the care they need, often before a crisis escalates.
Suicide is one of the top ten leading causes of death in the United States for people ages 10 to 65, according to the U.S. Centers for Disease Control and Prevention (CDC). Every year, approximately 48,000 Americans die by suicide. That’s roughly 130 people per day, according to the American Foundation for Suicide Prevention (AFSP).
These numbers are sobering. But here’s what makes them meaningful for nurses: 80% of individuals who die by suicide have had contact with a primary healthcare provider within one year of their death (Schreiber & Culpepper, 2021). That means nurses are often the first — and sometimes the only — professionals to interact with someone in crisis.
September is Suicide Prevention Month, and it’s a good time to reflect on what nurses can do to make a real difference. This post breaks down the key things you need to know: warning signs, screening tools, safety planning, and how to protect your own mental health, too.
Related CE course for nurses: Suicide Assessment and Prevention
Why nurses are on the front lines of suicide prevention
Nurses work across every care setting, including emergency departments, primary care clinics, psychiatric units, schools, and more. That puts nurses in a powerful position to identify patients who may be struggling before things reach a breaking point.
One behavioral healthcare program saw a 65% reduction in suicide rates just 20 months after implementing a routine screening protocol (Esposito, 2015). Routine screening works, and nurses are well-placed to lead that effort.
It’s also worth noting that individuals discharged from a psychiatric facility face a suicide rate 300 times higher in the first week after discharge compared to the general population (National Action Alliance for Suicide Prevention, 2019). Nurses involved in discharge planning and follow-up care have a direct role in closing that gap.
What are the warning signs of suicide nurses should watch for?
Warning signs can be verbal, behavioral, or a shift in mood. The more signs present, the greater the concern. Key adult warning signs include:
- Talking about wanting to die or having no reason to live
- Expressing feelings of being trapped, hopeless, or a burden to others
- Giving away prized possessions or saying goodbye to loved ones
- Withdrawing from social connections
- Increasing alcohol or drug use
- Displaying extreme mood swings, agitation, or recklessness
For youth, watch for changes in school performance, withdrawal from activities, increased irritability, and talk of hopelessness or suicide plans.
An important clinical note: the risk is greater when a warning sign is new, has recently increased, or follows a significant emotional event (Jacobs & Klein-Benheim, 2021).
How do nurses screen patients for suicide risk?
Screening and assessment are different things. Screening is a brief, standardized process to identify patients who need further evaluation. Assessment is a more comprehensive, clinician-led process.
Several evidence-based screening tools are available to nurses:
Ask Suicide-Screening Questions (ASQ): A free, four-question tool from the National Institute of Mental Health (NIMH) that takes about 20 seconds to administer. It’s designed for use in emergency departments, inpatient units, and outpatient clinics.
Patient Health Questionnaire-2 (PHQ-2) and PHQ-9: The PHQ-2 is a two-question first-step screen for depression. A positive result triggers the full PHQ-9, which includes a question on suicidal ideation and helps assess depression severity.
Columbia-Suicide Severity Rating Scale (C-SSRS): One of the most widely used tools globally. It’s available in 140 languages and free for use in healthcare and community settings. The C-SSRS helps determine suicide risk severity and what level of support is needed.
Patient Safety Screener 3 (PSS-3): A validated three-item tool for use in acute care and emergency settings.
The Joint Commission recommends that all patients be screened using a brief, standardized tool, and that those who screen positive receive a full evidence-based suicide risk assessment (Joint Commission, 2019).
What is safety planning, and how can nurses use it?
A Safety Planning Intervention (SPI) is a brief 30-to-45-minute clinical intervention that results in a written, collaborative plan between a nurse or clinician and a patient. The plan outlines warning signs, coping strategies, and who the patient can contact during a crisis.
Research published in JAMA Psychiatry found that SPI with follow-up resulted in 45% fewer suicidal behaviors over six months compared to usual care (Stanley & Brown, 2018).
The six steps of a safety plan include:
- Recognizing personal warning signs
- Identifying internal coping strategies
- Contacting others to provide distraction
- Reaching out to trusted family or friends for support
- Contacting mental health professionals or crisis services
- Reducing access to lethal means
That last step matters more than people realize. Restricting access to firearms, medications, and other lethal means is one of the most effective suicide prevention strategies available. Studies show that 89–95% of individuals who survive a suicide attempt do not go on to die by suicide (Washington State Department of Health, 2016).
How should nurses communicate with patients at risk?
Approach is everything. Nurses should use a non-judgmental, matter-of-fact tone when asking about suicidal thoughts. Asking directly about suicide does not plant the idea — it reduces stigma and often helps the patient feel heard.
Practice active listening by making eye contact, rephrasing what you hear to confirm understanding, and asking open-ended follow-up questions. Avoid dismissive language or assumptions about how the patient feels.
Use the patient’s exact words in documentation rather than clinical interpretations. Document the date, reasoning, risk level, protective factors, and steps taken. Suicide risk fluctuates over time, so documentation should be ongoing, not a one-time event.
What resources and referrals should nurses know?
Having a solid list of referral resources is part of good suicide care. Key resources include:
- 988 Suicide and Crisis Lifeline: Dial or text 988 for immediate support, 24/7
- Veterans Crisis Line: Veterans can call 988 and press 1, or text 838255
- Crisis Text Line: Text HOME to 741741
- Zero Suicide Framework: A system-wide approach to suicide prevention in healthcare settings. Resources are available at zerosuicide.edc.org
- SAMHSA’s Suicide Safe Mobile App: A clinical decision-support tool for providers
Nurse burnout and suicide: caring for yourself and your colleagues
Nurses are not immune to suicide risk. Healthcare support workers have some of the highest occupational suicide rates among women (CDC). The emotional weight of caring for patients in crisis, combined with high-stress work environments and compassion fatigue, can take a serious toll.
Suicide Prevention Month is a reminder to check in on your colleagues, not just your patients. If a coworker seems withdrawn, exhausted beyond the usual, or shows other warning signs, say something. A simple “Are you okay?” can open a door.
Seek support through your Employee Assistance Program (EAP), a trusted supervisor, or a mental health professional if you’re struggling. Caring for your own mental health isn’t a luxury. It’s part of being able to care for others.
Related CE course for nurses: Nurses’ Mental Health: Suicide Prevention
Frequently asked questions about suicide prevention for nurses
What is suicide prevention month and why does it matter for nurses?
September is officially recognized as Suicide Prevention Month in the United States. For nurses, it’s a dedicated time to reinforce clinical knowledge around risk assessment, safe communication, and intervention strategies that can save lives.
Can asking a patient about suicide make things worse?
No. Research consistently shows that asking about suicide does not increase risk. It reduces stigma, creates an opening for honest conversation, and often makes patients feel less alone. Direct questioning is a recommended clinical practice.
What screening tool should nurses use most often?
The best tool depends on the clinical setting. The ASQ is well-suited for emergency and inpatient settings, while the PHQ-2 and PHQ-9 work well in primary care. The C-SSRS is widely used across settings for both screening and severity tracking.
What should a nurse do if a patient screens positive for suicidal ideation?
Notify the appropriate provider immediately, initiate or support safety planning, assess access to lethal means, and document thoroughly. Follow your organization’s protocol for connecting the patient with behavioral health services.
Are veteran patients at higher suicide risk?
Yes. The veteran suicide rate is approximately 52.3% higher than non-veterans in the U.S. (U.S. Department of Veterans Affairs, 2021). Veterans have unique risk factors including PTSD, traumatic brain injury, and difficulty transitioning to civilian life. Nurses caring for veteran patients should be especially attentive to these factors.
How can nurses support their own mental health during Suicide Prevention Month?
Use available resources like Employee Assistance Programs, peer support networks, and mental health professionals. Talk openly with trusted colleagues about workplace stress. Recognize that your own wellbeing directly affects your capacity to care for patients.
