Eliminating the Stigma Associated with Mental Health Nursing

Historically, Mental Health nursing has been an undervalued profession. In addition, Mental Health nursing is not regarded as a desired career option by most students or as a desired career option by most seasoned nurses. Changes in mental health nursing education/clinical rotations to improve the perceptions, attitudes, and overall experiences of the student nurse are needed. Ongoing plans to develop and implement an intensive mental health clinical experience for nursing students that focus on increased student participation and therapeutic interactions are necessary. By eliminating the vast stereotypes within mental health nursing we can begin to advance towards long term improved recruitment of a new growing workforce to adequately care for mental health patients while enjoying the benefits that this rewarding career choice can offer. Specialties Psychiatric Article

Eliminating the Stigma Associated with Mental Health Nursing through Education and the Implementation of an Enhanced Clinical Experience for Student Nurses

Don't be deluded by the L.I.E.S. : Limited Learning Experiences for Students --> Increased Fear and Anxiety towards Mental Health Patients --> Encourages Continuation of Stigma of Mental Health Nursing --> Stagnant nurse workforce and ultimately poor quality of care for mental health patients

As my senior year of nursing school approached, both the excitement and dread grew within me each day. I couldn't have been more excited to move on to advanced nursing skills and clinical rotations in the ICU. I longed for the opportunity to sneak a peek in places like the ED where nurses raced by like lightning flashes past curtained rooms assessing patient needs with optimal efficiency. When helicopters buzzed in the sky above, my neck craned to watch and wonder. Always thinking, "that is my ultimate plan... a year or two of med surg, a year or two of critical care experience, and then trauma work all the way , both on the ground and in the air".

Senior year of nursing school was also when I was scheduled to start my mental health nursing rotation. To say I had absolutely no anticipation for this endeavor is truly an understatement. This apprehension was not due to fear of the unknown, but instead a skewed vision of the importance of mental health nursing. However, I was not alone in my distaste for the clinical rotation. My fellow colleagues also had mixed emotions that the next several weeks were going to prove to be either a waste of time or the scare of their life. Much to my surprise, that first day of stepping onto the unit of my mental health nursing clinical site would be the start of what has become a sixteen year long career in psychiatric mental health nursing. Reflecting back now as an educator, I recognize how clinical experiences can significantly impact a student's career path.

The clinical experience has notoriously been a very crucial element of nursing education. It is the arena where knowledge comes to life. Students are able to make the first connection between what they have learned in theory and what they are seeing first hand.

It is exciting, it is anxiety provoking, and for some it is extremely scary. Clinical practice is an opportunity for students to begin to utilize their problem solving and critical thinking skills in real patient scenarios with the assistance and safety of their instructor. Mental health nursing clinical experiences are known to be the most anxiety producing. They have historically been minimally interactive. Students are typically only observing behaviors or staff duties on the unit. This encourages students to continue to feel afraid and worried to attempt to interact with the patients. By limiting the learning experiences of students, educators and healthcare facilities continue to not only encourage the stigma of mental health nursing as "not real nursing", but also perpetuate the stigma that mental health patients are not deserving of "real care".

Historically, Mental Health nursing has been an undervalued profession. Mental Health nurses were seen as wardens or custodians. Mental health patients were viewed as in need of containment or being locked away. Although treatment options for mental health patients are changing and care is becoming more deinstitutionalized, mental health nursing still remains an undervalued profession. Recruitment and retention are at extremely low levels when compared to other areas of nursing. Mental Health nursing is not regarded as a desired career option by most students or as a desired career option by most seasoned nurses.

A look at the NCLEX distribution plan for 2014 shows that content for Psychosocial Integrity contributes for approximately 11% of the exam.

On the contrary, nursing programs do not reflect the significance of this within their mental health courses. Changes in mental health nursing education/clinical rotations to improve the perceptions, attitudes, and overall experiences of the student nurse are needed. Ongoing plans to develop and implement an intensive mental health clinical experience for nursing students that focus on increased student participation and therapeutic interactions are necessary.

Efforts to ultimately improve the student's knowledge and understanding of the mental health patient while reducing the stigma of mental health nursing as a profession should include: a thorough conduction of a pre-assessment of student's fears and anxieties as well as mental health knowledge base prior to the first clinical experience, implementation of various education sessions with regards to topics such as Therapeutic Communication Techniques, Practice Patient 1-1 Interview Sessions, and Simulation Lab Sessions for Substance Withdrawal and Delirium, integration of guest speakers from various community mental health treatment sources throughout the semester during the theory course, additional educational sessions such as crisis intervention, group training, medication administration, etc. throughout clinical rotation, and follow- up with post clinical conferences to reevaluate the student's attitudes/ perceptions/concerns daily as well as learning needs.

By changing the way we present mental health nursing to students, we can expect the following projected outcomes: Increased student/patient interaction on the mental health unit-increased positive care outcomes/patient satisfaction, Improved results of post education/clinical experience assessments- decreased fear and anxiety, Improved knowledge base and attitudes of students as it pertains to mental health patients and nursing, Eliminating stereotypes of mental health nursing, and Advancement towards long term goals of improved nursing recruitment in the area of mental health to ensure adequate care for patients. When we focus on Intensive Education while providing ongoing support and feedback to students; Attitudes can change for the positive, Perceptions can change for the realistic, and experiences can change for the better.

Jessica S. Quigley RN, DNP


References

Grouthro,T. (2009). Recognizing and addressing the stigma associated with mental health nursing: a critical perspective.

Issues in Mental Health Nursing, 30(11):669-76.

Happell,B., Platania-Phung,C., Harris,S., & Bradshaw, J. (2014). It's the Anxiety: Facilitators and Inhibitors to Nursing Students' Career Interests in Mental Health Nursing.

Issues in Mental Health Nursing, 35(1):50-7.

Happell, B., Welch,T., Moxham,L., & Byme,L. (2013). Keeping the flame alight: understanding and enhancing interest in mental health nursing as a career.

Archives of Psychiatric Nursing, 27(4):161-5.

O'Brien,L., Buxton, M., & Gillies,D. (2008). Improving the undergraduate clinical placement experience in mental health nursing.

Issues in Mental Health Nursing, 29(5):505-22.

Specializes in psych/dementia.

So true Viva. ANY ONE can end up with a mental illness. I really don't understand some people's "get over it" attitude. Have they never experienced mental illness, either personally or someone in their family? What if it happens to one of their kids? It's just sad.

Specializes in Psychiatric Nursing.

Mental health nursing is an amazing field, the field in which I have found my niche. I am very proud of what I do, and I have found that others are interested in my work as well. My facility has served our community for more than 50 years. Other than a 2-year stint in a LTC facility, I have spent my entire nursing career in mental health!

Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

Agreed we must continue to work daily to build others up to facing the challenge! It may not be everyone's calling but the patients are calling out for the help of nurses in all settings so even if it's just for that one patient you have to be prepared to help.

Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

All too often profs pass on ill feelings to their students regarding clinical material/settings. We must remember that we are shaping the careers and attitudes of future caregivers. I'm so happy you were not tainted by her lack of enjoyment for mental health nursing!

Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

I always tell my students mental health nursing provides the foundation for all nursing and life! It teaches you to build relationships with your patients and no matter what setting you are in there is always a mental health aspect ... It is unavoidable. In addition, there are all too often other situations that arise with patients families, your co-workers, or in your personal life... Etc. you can not escape!

Thank you for this!

Specializes in Med/Surg, Academics.

I appreciate the special skills of mental health nurses. I was once asked to work on psych (I am a resource RN, and they were really desperate), and I declined. I hadn't seen the inside of a psych unit since nursing school! I don't have the personality for it, and I had forgotten more than I knew.

We did do a full rotation on psych, just like any other type of clinical. The nurses were amazing, and the MHWs were even more so. When we have patients with psych histories on the floor, I breathe a sigh of relief if its schizophrenia, but I am not as good at managing the psychosocial needs of patients with borderline personality disorder or bipolar disorder.

Kudos to all the mental health nurses out there.

Specializes in mental health / psychiatic nursing.
So true Viva. ANY ONE can end up with a mental illness. I really don't understand some people's "get over it" attitude. Have they never experienced mental illness, either personally or someone in their family? What if it happens to one of their kids? It's just sad.

Too true smoup. I wager many more people know some one with a mental illness than they realize. Really wish that it was easier to be open about these issues as chances are most nursing school students (most people even) know at least one or two individuals with a mental illness. It's much harder to treat an illness as something foreign and scary when it is attached to a name and face that one care's about. Or when you start going through your list of acquaintances and classmates and realize just how many of them are likely affected when you look at the statistics of how prevalent mental illness is in our society.

I started the conversation about mental illnesses with my family and stories started coming out of the woodwork - many of my close relatives have battled one mental illness or another, just finally being open about what people were struggling through meant that the burden was shared, relevant family history was shared, tricks and tips for recovery were shared. For most of them I would have never guessed that there was even an issue of mental illness going on because it was kept so private.

Important from a clinical perspective was that several individuals had the same illness and there was very strong correlation as to which drugs worked in all of their cases - knowing that you have 5 blood relatives with the same disorder and all of them - despite what paths they took to get treatment - have had the most relief with one class of drugs is important knowledge.

Loved this article. I'm not quite in nursing school yet but my intention is to go into mental health and ultimately become a PMHNP. Thanks for writing this.

Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

Thanks so much, glad you enjoyed it! Good luck to you!

Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

Thank you everyone for all of your positive comments and feedback. I am glad that this article has received such great response. I have enjoyed reading all of your posts and look forward to more as I continue on in the next weeks/months with additional articles to come. I will be branching out in this topic area, focusing on the important work that mental health nurses do/patient scenarios in which their expertise is a must. Thanks again! JSQ

Specializes in psychiatric, corrections.

I LOVE THIS. I hate when people say they wouldn't want to work in mental health nursing because it's not "real" nursing and all their skills would go to waste. Look, I was a medic in the Army and I have dropped in chest tubes, done IVs, pushed meds and worked on people who were within an inch of their lives...and I was not a nurse. You can be trained to do that stuff, you don't have to go to nursing school to be apart of the "elite class" of healthcare professionals. Your skills won't go to waste should you decide to work in another area. And as far as the patients go...lets be honest 9/10 are more a danger to themselves than other. You're more likely to be attacked by a patient with dementia then you are someone with schizophrenia. Besides, at least in a mental institution you KNOW who the disturbed patients are, in another setting how would you know? There's that video circulating of that guy who went crazy in the ER and started attacking the nurses with a metal bar.

I loved my psych rotation, I have one semester left in nursing and all I want to go is work in mental health. If other nurses don't FINE! More job opportunities for me :)