Destigmatizing Mental Health Begins With Nursing Licensure Questions

• Nursing licensure questions about mental health have caused some nurses to avoid seeking help, according to some researchers and advocacy groups. 
• The Dr. Lorna Breen Heroes Foundation has initiated the Wellbeing First Champion Challenge to encourage boards of nursing to eliminate mental health questions from licensure applications. 
• Studies continue to show that nurses and other healthcare professionals report high levels of anxiety, burnout, and fatigue. 

The state of your mental health could affect whether or not you’re allowed to hold a nursing license. But there’s a recent push to eradicate this issue. 

“The penalties involved with reporting that you have a mental health problem are such that … people are ignoring them or not reporting them,” Anthony Papa, Ph.D., associate professor, and director of clinical training at University of Hawaiʻi at Mānoa, Honolulu, Hawaii, recently told Medscape. “We need to allow people to get the care they need and not feel like they need to hide it.” 

Licensure requirements and hospital credentialing are among the top barriers to mental health access, according to the Dr. Lorna Breen Heroes Foundation, which is leading the charge to remove mental health questions from these applications. 

Nursing Licensure Across the States

A 2023 audit of mental health questions on licensure and credentialing applications, conducted by Ohio State University and the Dr. Lorna Breen Heroes Foundation, found that “urgent action is needed.” 

“Overall, the language used by many states when enquiring about mental health and substance use was extraneous, discriminatory, unnecessary, or stigmatizing,” the authors stated. “For example, Missouri’s requirement to submit a notarized statement could be considered extraneous.” 

The foundation established the “Wellbeing First Champion Challenge,” which indicates to healthcare workers that they will not be required to “answer intrusive mental health questions.” However, as of September 2024, only four nursing licensure boards could claim that accolade: 

1. Nebraska 
2. Missouri 
3. Oklahoma 
4. Mississippi 

The Joint Commission has issued support for the foundation’s initiatives.  

Plus, legislation was recently introduced in both the House of Representatives and the Senate to reauthorize the Dr. Lorna Breen Health Care Provider Protection Act for five more years. The act allocates grant funding for healthcare organizations to help frontline workers obtain behavioral health support. 

The State of Nurse Mental Health

Report after report indicates that mental health continues to be a pressing issue in the healthcare industry, leading to burnout, fatigue, and exiting the profession altogether. 

An international analysis that focused on self-reported mental health symptoms among nurses during the COVID-19 pandemic found rates of anxiety or depression ranging from 23% to 61% and about 18% reported experiencing burnout. 

“Healthcare organizations and governmental bodies need to develop targeted mental health support programs that are readily accessible to nurses to foster a resilient nursing workforce,” the authors stated. 

While the Americans with Disabilities Act offers protection for those who have a mental health diagnosis, one law firm states that employers might try to find “other grounds to ‘justify’ a termination.” 

Employers are allowed to inquire about an employee’s mental health in the following instances:

1. “A nurse requests a reasonable accommodation to perform their duties
2. They have made a job offer, but employment hasn’t started if they ask everyone in the same job category the same questions
3. Applicants or employees have the option of not responding to a question, such as an employer tracking an applicant pool’s disability status to assess its recruiting and hiring
4. Objective evidence exists that, while working, a nurse is unable to do their job or poses a safety risk
5. Disclosing information on a disability if necessary for benefits, such as FMLA.”

The Bottom Line

Researchers and organizations believe that licensure and credentialing application questions about mental health deter healthcare workers from seeking support. This has led the Dr. Lorna Breen Heroes Foundation to establish the Wellbeing First Champion Challenge, which indicates if those questions have been eliminated from applications. 

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