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Suicide Risk Assessment
& Safety Planning

Learn to recognize warning signs, prioritize patient safety, and build collaborative safety plans for clients at risk.

NCLEX-RN

What Is Risk Assessment?

A suicide risk assessment is a systematic interview the nurse uses to evaluate how likely a client is to harm themselves. It is a therapeutic conversation, not a checklist done in passing.

Key Terms

Suicidal Ideation
Thoughts about ending one's life, with or without a plan.
Plan
A specific method the client intends to use.
Means
Actual access to the method (e.g., firearm, pills).

Warning Signs

At-Risk Client Giving away belongings Sudden calm / euphoria Social withdrawal Verbal statements of hopelessness

The Core Rule

1
Ask about ideation: Are you having thoughts of harming yourself?
2
Ask about a plan: Do you have a plan for how you would do it?
3
Ask about means: Do you have access to what you would use?

Levels of Acute Risk

LOW: ideation only MODERATE: + plan HIGH: plan + means + intent & timeframe

Safety Plan vs. No-Suicide Contract

Safety Plan
Recommended. Collaborative, lists coping strategies, supports, and emergency contacts the client will use.
No-Suicide Contract
Not recommended. A promise "not to harm self" provides false reassurance and no proven protection.

Building a Safety Plan

1
Recognize warning signs that a crisis may be developing.
2
Internal coping strategies the client can use alone (walk, music, breathing).
3
Social contacts and settings that provide distraction and support.
4
Remove access to means (lethal-means restriction) and list crisis lines.

First Priority Action

When a client states an active plan with means, the nurse must act on physical safety first. Follow the principle: safety > psychosocial needs.

Example 1: Triage

A client says: "I've been thinking life isn't worth living, but I would never actually do anything." No plan, no means.

Example 2: Acute Risk

A client states: "I'm going to overdose on my pills tonight when I get home." The client has a full bottle at home.

Example 3: The "Sudden Calm"

A severely depressed client who was withdrawn for days suddenly appears cheerful, energetic, and at peace, and begins giving belongings to other clients.

Common Mistakes

✕ Avoiding the word
Being afraid to ask directly. Asking does not plant the idea: it saves lives.
✕ Leaving the client
Walking away from a high-risk client to "get help." Stay and call out.
✕ Promising secrecy
Agreeing to keep suicidal plans confidential. Safety overrides confidentiality.
✕ Relying on a contract
Using a "no-suicide contract" instead of an actionable safety plan.

Risk Level Summary

Low Moderate High
PlanNoneVagueSpecific
MeansNonePossibleAvailable
IntentLowSomeActive
ObservationRoutineFrequent1:1 constant

Question 1 of 5

A client admits to thoughts of suicide. What is the nurse's most appropriate next question?

Question 2 of 5

A client states an intent to overdose tonight and has pills at home. What is the nurse's priority action?

Question 3 of 5

A severely depressed client suddenly appears calm and cheerful and gives away belongings. The nurse should:

Question 4 of 5

Which intervention is the most evidence-based for an at-risk client being discharged?

Question 5 of 5

A high-risk client asks the nurse to keep the suicide plan a secret. The best response is:

Key Takeaways

1
Always ask directly about suicidal ideation, plan, and means.
2
Safety first: stay with high-risk clients and provide 1:1 observation.
3
Use a collaborative safety plan, never a no-suicide contract.
4
Sudden calm after depression demands increased, not decreased, monitoring.