What Does it Mean to be A Mental Health Nurse?

What is it like to work as a mental health nurse? What do you do on a daily basis? This article addresses these question through the eyes of a young mental health nurse as she works at an inpatient mental health facility in the Midwest United States as she describes some of the reasons that she enjoys her job. She also describes some of the stressful situations that she has to deal with and what she likes the least about working in inpatient facility. Nurses Announcements Archive Article

What Does it Mean to be A Mental Health Nurse?

by Allen Barton

Being spat at, called names, being mooned or having water thrown on you at work sounds like a matter for Human Resources, but not if you work in mental health nursing. Dealing with the fall-out of patients' mental illness and frequent threats of verbal or physical abuse is just part of the job.

Here, a young mental health nurse, from the Mid-west United States, who works on an inpatient mental health unit reveals how she is inspired by the people she helps.

Nurse: No two days are ever the same. There is no way to work as a mental health nurse and not learn something about life. In my short career I have met some of the nicest, yet strangest and most original individuals in my life. When people find out where I work they are usually in awe and wonder. They typically all utter the same phrase, "I don't know how you do it", as they shake their heads.

Interviewer: How long have you worked as a Mental Health Nurse?

Nurse: I've been working as a Mental Health Nurse for about four years now.

Interviewer: Tell us about the patient population you work with.

Nurse: The people (patients) that I work with are usually very mentally ill and have experienced the most severe deprivation throughout their lives. The very essence of my job as a nurse is to try to relate to my patients; to take time to listen, observe and be with them, no matter how sad or difficult this is.

I work on an inpatient unit. Simply put, I work with people from 18-to-85 who present with mental health conditions who require assessment and treatment. Most of these individuals arrive on an emergency Detention (ED), which is a law that requires them to stay in the hospital for a certain length of time for assessment and treatment. While others arrive on their own through the Emergency Department, which means they gave their own consent to be on the unit.

Interviewer: What have you learned about your patients?

Nurse: When a new patient arrives on the unit it can be extremely frightening for them; the idea of arriving in this strange place is intimidating, so part of the nurses' role is to help the patient have a calm introduction to the unit and try and make it seem less scary or daunting. This helps them to settle in despite the fact they are distressed or troubled due to their mental health.

I think that we often forget they had a life before they arrived on the unit. That they were in school, or had a job and some kind of home; that they have a mother, a father, a wife or husband, and possibly children. When they arrive on the unit I try to learn about who they are, not who the chart says they are. I want to know as much about them as I possibly can. I realized that whenever I approach them as a person and not just a patient, they open up and let down their guard, it tears down the walls that they come in with. I feel like I get a look inside of their lives even for just a moment; and this is the true essence of patient care.

Interviewer: Can you tell us about a difficult patient you have had to take care of?

Nurse: There was one patient that I had come onto the unit not long after I started. This patient was very ill, it took several months of sitting with this patient all the while she spat on me, hit or pulled at me. For months I patiently sat with her and when possible calmly talked with her; then one day out of the blue she reached out and took hold of my hand and gently caressed it, she looked at my name badge and read my name out loud. We both smiled. With time we got beyond the shouting, swearing and spitting to find a beautiful woman. The days when she felt safe enough to take hold of my hand, or to sit next to me and cry made my job worthwhile.

Interviewer: What are the mechanics of your job every day?

Nurse: Obviously working on an inpatient psychiatric hospital, my average day can run the gamut, but it usually looks something like this.

At the start of shift, I receive patient handover. This is the allocation of anywhere from 5-10 patients, and usually a few major duties. Major duties can be a medication round (administration of medications); I then start visual observation round (documentation of the location and activity of patients on the unit).

During this process, I simply introduce myself to all of my patients for the shift. In completing this I develop a sense of presence and support, I outline a safety plan (which is essentially that they remain in direct contact with me about any acute alterations) with each patient, and I assess the patient's planned activity for the day. It is also during this time that I also perform an initial mental state assessment and attempt to identify any potential issues for the shift.

Interviewer: You spoke of spending time sitting with a specific patient trying to breakthrough to them. Do you get to do this often or was this a rare occurrence.

Nurse: Throughout each day, when you have time in between ones allocated duties like coordinating pathology collection, reporting on patients, making necessary documentation changes as patient risk changes, or ordering of medications, you may get to spend a few minutes with each patient to conduct a more "in-depth" assessment of their needs or to just spend time with them. During this time, especially if a patient is distressed over a specific incident/issue you as the mental health nurse may provide brief periods of counseling or advice that may help the patient to cope with their issues. As nurses, we do not generally engage in extended counseling sessions but we do at times get to spend time sitting with the patient and lending an ear or a hand.

Interviewer: So essentially your role as a mental health nurse is the management specific patients assessments, crisis and risk management, de-escalation of patients who become acutely distressed, psychotic, aggressive etc., and maintaining a sense of support.

Nurse: Yes, and of course you have a period of time toward the end of the shift where you must document in clinical files, produce a report for handover, complete various forms, and tools, and update patient care plans. Furthermore, there are a tacit of other duties that may be complete each day, these include the facilitation of group therapy (depending on the level of your education/qualifications), responding to duress alarms, completing incident reports, provision of medical care in the event of a medical emergency or self-harm, completing admission assessments, preparing a patient for direct discharge, medical supervision of patients pre and post ECT, patient physical observations and management, and presenting at mood disorder/psychosis meetings or patient treatment review meetings.

Interviewer: You stated that you do spend some time in counseling of patients: how much time do you get to spend counseling patients?

Nurse: This is an interesting question. Time spent in direct "therapy" often depends on the area in which you work and of course your employment capacity, education/qualifications. As I previously discussed, there are times when I provide counseling as part of my role as a mental health nurse; but this usually only about 5-10% of what I do, and I really do not want it to be any more than that. If you are interested in making counseling a greater part of what you do as a nurse you can certainly achieve this, usually, it involves additional education.

Interviewer: What is it like working with this patient population?

Nurse: Working in mental health nursing is not what people think it is. Most people's perception of mental health is that of violence and abusive language, intertwined with nonsensical rants; and while this is true at times it can also be very different than that, and very rewarding.

I think one of the things that I've seen most portrayed on television and in the movies is the misconception that mentally ill people are dangerous or violent. While some are, I think statistically it is about 10% or less of the mental health patient population is actually violent and most of the time, these people are victims of violence or more of a threat to themselves. But they are rarely a danger to others and I think it is important to understand and to educate people about this stigma that is associated with mentally ill people.

Interviewer: This sounds like an incredibly interesting career path. How did you get into it?

Nurse: Working in Mental Health Nursing was not actually my first choice. When I first graduated from nursing school I wanted to work in the emergency department or possibly on a neural intensive care unit. There are aspects of both of these areas that are similar to what I do now, especially when you have to deal with high levels of stress and even patient confrontation on rare occasions. The unit has a number of people who suffer from mental health issues that could lead them to act aggressively towards other service users or patients, or themselves, and part of my role is to ensure that those instances do not escalate.

I just stumbled into my position, it was actually the first job that I was offered out of school, and while it was a trying and even scary proposition at first; I absolutely love it now. Being a Mental Health Nurse is not a job you get into for the money, you do it so you can help people get better, and seeing the progress people make from when they come in to when they leave, whatever length of time that is, makes you proud of what you have done to help them.

Interviewer: Is there are anything about working in a mental health nursing that you do not like? Anything that is stressful?

Nurse: I would have to say that the part of my job that I like the least is having to restrain a patient who is out of control. Restraining someone in the bed, it makes my heart hurt to see someone or have to place someone, in that situation. Even though I know at the time it must be done as all other options have been exhausted; that it is sometimes necessary to protect the staff and the patient. I'm sure that if you asked the patient they would probably say that we are just trying to control them, but the reality is I'm there to protect their welfare so that they receive care, and although that does mean having to restrain people or be authoritative at times, it is only done with their best interests at heart.

The job can be stressful but at the same time the reward of helping someone who cannot help themselves at that time in their life and getting them back on track is what we're all here for.

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allenmrtux

About allenmrtux

My name is Allen Barton and I am currently working on my PhD. in Organizational Psychology. My dissertation thesis project is trying to determine the effects effect a patient’s medical condition, person-vocation fit, and tenure have on a mental health nurse’s affective commitment.

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

"I think that we often forget they had a life before they arrived on the unit. That they were in school, or had a job and some kind of home; that they have a mother, a father, a wife or husband, and possibly children."

This.

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