Psychiatric/Mental Health Nursing
Psychiatric nursing (also known as mental-health nursing) is the provision of nursing care to patients with mental illnesses. Thanks to the media and its frequently unflattering (and often not quite accurate) portrayals of psychiatric patients and nurses, psych nursing is often misaligned and misunderstood.
Psychiatric nursing (also known as mental-health nursing) is the provision of nursing care to patients with mental illnesses. Mental illnesses are medical conditions that have a direct impact on a person's thoughts, feelings, moods, interpersonal relations and ability to cope with stress (NAMI, n.d.). This can result in a detrimental affect on a person's daily functioning. Some examples of mental illnesses include the schizophrenias, depression, anxiety disorders, bipolar disorder, substance dependence and other addictions, post-traumatic stress disorders, and personality disorders.
Unfortunately, mental illness is still stigmatized in society, with illnesses and those suffering from them often seen in a negative light (Byrne, 2000). Patients are viewed in terms of stereotypes: the maniac, the neurotic, the sad one. Or patients are viewed in terms of their illness: the borderline, the bipolar, the schizo. Terms such as "crazy", "cuckoo" and "lunatic" are readily used to describe psych patients. If someone shares that they are on a psychotropic medication, others question if they are truly stable, or they see the person in terms of liability. These patients are seen as being untreatable and incurable, destined to be dependent on hospitalization and/or medications forever.
In addition, mental illnesses often do not display physical signs or symptoms, and so some may discount mental illness as not being significant. Patients who try to reach out for help are brushed off with, "it's all in your head; suck it up and get over it" or other useless tidbits of advice.
The stigma crosses over to psychiatric nursing as well. Psychiatric nurses are not seen as the life-savers that nurses in other specialties may be viewed as. Instead, psych nurses are seen as pill pushers who are quick to restrain a patient or give an injection for any real or imagined infraction. They may be seen as being "as crazy as their patients are." Psych nursing is seen as the specialty for nurses who couldn't hack it in other specialties. Or it's the specialty for nurses who want to "take it easy", yet psychiatric nursing is seen as being very violent. And of course, the rumor is that once you're in psychiatric nursing, you will lose all of your nursing skills and be stuck there forever.
It does not help that the media tends to portray psych and its patients in a negative (and often not quite accurate) light. The term "psych nurse" conjures up Nurse Ratched as its poster child. Movies frequently show psychiatric hospitals as part prison, part torture-chamber; its staff is portrayed as barbaric, if not sadistic individuals. In fact, psychiatric hospitals are a frequent setting for many horror movies. Television shows use mental illness as the catalyst for a character's violent behavior, such as the veteran going on a homicidal rampage due to his PTSD. Or news reports may remark that a criminal suspect has recently admitted to depression or other mental problems, insinuating that these problems were the trigger for the criminal actions (Tartakovsky, 2009). Or movies and television may use mental illnesses for a comic effect instead (Byrne, 2000).
The reality of mental illness and psychiatric nursing is very different. The best way to describe psychiatric patients is like this: whenever nursing students come to do clinicals on my unit, one of the first things they will say to me is that most of the patients look so "normal". And to that I reply, "they ARE normal. Most are just regular people experiencing psychiatric crisis and need help." It is true that there are very acute and unstable patient populations out there, but the reality is that many psychiatric patients are not that much different than you or I. Psychiatric facilities are not that much different than other hospital facilities, though there are extra precautions taken to ensure the safety of patients and staff.
As far as psychiatric nursing practice goes, while medications are one major nursing intervention, they are not the only nursing intervention. Psychiatric nurses do perform physical assessments and interventions. Psychiatric nurses may not use skills such as Foleys and IV placements as often as their non-psychiatric nursing counterparts. Instead, psychiatric nurses develop a different skill set where therapeutic communication and relationship building are key, and a nurse who fails to develop this skill set will struggle. While the tight job market may make this more difficult to do, nurses have been able to transition out of psych into other specialties.
Psychiatric nursing does have a higher risk of violence than you would find on a regular hospital unit. However, nursing and clinical staff are trained in de-escalation and crisis intervention, with the end result of heading off many situations before they get out of control. Measures such as seclusion, chemical restraint or physical restraint are not used with abandon, but only as last resorts.
Duties of a psychiatric nurse include therapeutic communication, assessment, development of nursing diagnoses and plans of , administration of medication, and patient education. Advanced practice psychiatric nurses provide primary care mental health services such as diagnosis, psychotherapy and prescription of medication (American Psychiatric Nurses' Association, n.d.).
Psychiatric patients frequently have medical comorbidities such as diabetes, hypertension, or hepatitis. While the focus of the psychiatric nurse is on the psychiatric illness, psychiatric nurses cannot neglect the patient's medical conditions and must provide nursing care for them as well.
Subspecialties within psychiatric nursing include geropsych, child and adolescent psych, chemical dependency and rehab, addictions, emergency psych, electroconvulsive therapy (ECT) and forensic psychiatric nursing.
Psychiatric practice settings include freestanding psychiatric hospitals, psychiatric units within medical hospitals, partial hospitalization/outpatient facilities, community settings such as clinics, private practices, home health, and correctional facilities (nursesource.org, n.d.). Other practice settings include education and research.
Mental illness does not discriminate based on age, race, gender or income level: psychiatric patients can be anyone. In addition, many patients in non-psych units/settings often have concurrent psychiatric disorders...so essentially, you will find psych patients anywhere and everywhere.
To become a psychiatric nurse in the United States, you need to graduate from a nursing program and pass the NCLEX. You can work in psychiatric nursing as a RN or a LVN/LPN. You do NOT need to major or minor in psychology to be a psychiatric nurse. Other countries may have additional requirements for practicing as a psychiatric nurse.
To become an advanced practice psychiatric nurse, you need to graduate from a masters' or doctoral program in psychiatric-mental health nursing (American Psychiatric Nurses' Association, n.d.). In addition, psychiatric/mental health nurse practitioners will also need to pass the ANCC certification exam.
Psychiatric nurses and psychiatric advanced-practice nurses are eligible for certification by the American Nurses Credentialing Center in psychiatric-mental health nursing (RN-BC and PMHNP-BC). In addition, accreditation can be attained in subspecialties. However, most accreditations are not available to LVN/LPNs.
The main professional organizations for psychiatric nurses are the American Psychiatric Nurses' Association (APNA, http://www.apna.org) and the International Society of Psychiatric - Mental Health Nurses (ISPN, http://www.ispn-psych.org). There are also professional organizations for several subspecialties in psychiatric nursing, such as advance practice psych nursing, child and adolescent psych nursing and addictions nursing.Last edit by Joe V on Nov 28, '13
About Meriwhen, ASN, BSN, RN Senior Moderator
Meriwhen has been a psychiatric nurse since day 90. Meriwhen's specialties are addictions and crisis stabilization. When not working at a hospital or as one of the assistant administrators at AllNurses, Meriwhen can be found knitting while watching classic comedies.
Meriwhen has 'never enough' year(s) of experience and specializes in 'Addictions, lots of psych'. From 'the Left Coast'; Joined Mar '07; Posts: 9,960; Likes: 11,445.Nov 28, '13Great article . In addition, there is a skill that IMO is unique to psych nursing and that is milieu management. On any other hospital unit, the pts are in their own rooms all day. On a psych unit a pt is liable to be locked out of his/her room if they isolate there all day. You have to learn to monitor the pts interactions with eachother and keep the environment safe and therapeutic for everyone.Nov 29, '13Thank you for this glimpse inside the world of psychiatric nursing and life on an inpatient unit. Your compassion and respect for your patients shines through in your writing, and I hope that there is someone like you to care for me if I ever need it.Nov 29, '13Agreed. My ability to talk has been my greatest asset. A good nurse can tell the "mood" as soon as she/he comes in the door.
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