Is psychiatric nursing a dying profession?

verene, MSN · Aug 3, 2017

It is true that there is a push for more community based services and these are desperately needed, however I doubt the need for psychiatric hospitals will completely go away - in my own community the push is for psychiatric hospitals to become more focuses on acute crises in mental health, with patients transferred to community partners for longer-term care. However, there is a severe lack of beds both in-patient and out-patient, as well as lack of clinicians in all levels. In my community there are huge numbers of openings for both inpatient and out-patient pysch RNs, with many facilities offering steep incentives as the demand far out ways the number of nurses willing to work in the specialty.

I have been told both by current psych RNs and by hiring recruiters that if I want to work in psych when I graduate the issue won't be finding a job but deciding which offer to accept.

Meriwhen, ASN, BSN, MSN, RN · Aug 4, 2017

Given how overloaded our ED is with psych patients, there's a definite need for psych inpatient and outpatient services. Recidivism is sadly common among psych patients, and many patients experience multiple admissions over their lifetime. And add in the fact that a lot of nurses won't work in psych...well, I don't see the psych nursing job market drying up anytime soon.

And the push towards having more of a patient's treatment in outpatient is not a bad thing. It shortens the hospital stay and frees up the beds for other patients. It helps the patient learn to manage their illness in a less restrictive and then eventually in their own settings. It pushes patient to get involved in their own recovery.

JustKeepDriving · Aug 4, 2017

Where I am now there's a big push toward community treatment/crisis 'cafes'/day centres in order to keep people OUT of hospital as much as possible, which I wholeheartedly agree with. But these programs seem to be staffed primarily by psychologists and techs. At the same time I'm sure there will always be those too ill to be nursed at home. I think I just worry sometimes about the outlook.
What are your thoughts?

I personally am not a fan of the deinstitutionalization movement - mainly because although I understand the necessity of it, some places are overly zealous about it and the community treatment model doesn't work for everyone. States and counties rave about how they're helping people integrate into the community but generally it just turns in to "We closed a bunch of units and are saving money, Yay!" without the installation of community facilities and services for the clients who are now back in the community. The general trend I've found (now, I work predominantly corrections and jail - so I probably have some confirmation bias here) is that, as institutions close and bed space in the remaining inpatient units and state facilities gets overwhelmed there tends to be a direct correlation with incarceration rates of psychiatric patients (as they fall through the cracks within the community). Basically, making the jails and prisons into the new psychiatric institution, sadly.

To that end - I don't see psychiatric nursing going anywhere. Personally, I dislike the corporate healthcare culture of the hospitals and shy away from them - and have never had a difficult time finding a psychiatric nursing position outside of the hospital. With the push for community care you have Assertive community treatment teams, Psychiatric emergency response teams, Psychiatric Emergency departments, case management, correctional psychiatry (Jail & Prison) as well as state hospital psychiatry (The community might rally to get them closed however, at least in my state they're never able to do so because that same community isn't comfortable when they try to set up a group home for violent sexual offenders in their neighborhood - go figure) and many other options available.

I wouldn't worry about job prospects in mental health overly much - there are many people that require mental health services (and that number is not diminishing) and there are more places for psychiatric nurses than in the hospital setting.

Orca, ADN, ASN, RN · Aug 4, 2017

Part of the issue, especially with mental health units in hospitals, is that there is more profit in other areas. The homeless often use mental health units as refuges especially when the weather is bad or temperatures are extreme. There is a lot of non-payment for mental health services.

True story: I had accepted a job on a hospital mental health unit. I was in HR filling out my entry paperwork. I had everything finished except filling out the last paper to get my ID badge made. An HR employee walked in and said, "You might as well stop what you are doing. The hospital just announced that they are converting the mental health unit to a med-surg unit."

twinsmom788 · Aug 4, 2017

This post is so accurate! I totally agree that there will be a need for psych nurses. There are certain procedures such as assessment, medication administration, and emergency care that cannot be administered by a psych tech. CMS has guidelines and regulations galore that must be followed to receive accreditation and continue federal funding which most facilities depend upon.

3peas · Aug 5, 2017

There will always be room for a passionate psych nurse. Unfortunately they get burned out. Inpatient psych will always be needed. "They" can want to switch to more lucrative areas all day, but the reality is inpatient care will be needed for those who are suicidal/homicidal/or grossly diminished. MH patients are the most underserved and the most sick with physical aliments and mental. In my opinion 70% of the patients you encounter just do not have coping skills (and are unwilling to learn them in most cases), are working the system, or are terrible borderlines. But the other 30% make it one of the best jobs in the world.

GeminiNurse29 · Aug 6, 2017

I work in forensics psych. Majority of our patients (with the exception of one unit) have committed some crime or other to be sent here in the first place. Some are for life, the guilty not guilty due to insanity. Some are sent to be treated for competency and go back to jail or court. There is a long waiting list and they are always hiring nurses (and techs). Let me say, I'm glad there is a place like this because a lot of these people will never ever "get well" enough to function in society outside the institution.

In the area here, there is also a geriatric psych unit that's always busy, the local hospitals have busy psych units, and there is one dedicated to non foresnic psych patients. So I'd say there is no shortage of jobs for nurses who wanna do psych.

umbdude, MSN, APRN · Aug 6, 2017

There is no shortage of inpatient psych RN jobs in my area, not even close. Although the absolute number of psych RN jobs is much lower, there are far fewer RNs who want to work in psych. I got four job offers and one interview request (all for inpatient psych) within a month of passing NCLEX. There are also plenty of outpatient psych RN jobs in crisis stabilization units, addiction services, PACT, CBFS, and clinics.

purplegal · Aug 7, 2017

I agree with other posters that there is no lack of need for psych nurses. In my area, there's opening for psych nurses all of the time. Our psych hospital is so full that many people are on the waiting list, and many have to stay in the ER for up to a month before they're admitted. Psych patients continuously come into our ER every day. Plus, like others have said, many nurses do not want to work in this area, so the jobs are not as competitive to get. Out of the 60 people in my graduating class only about 2 or 3 landed in psych. My guess is that you would pretty much have good job security working in psych.

RNGummy40 · Aug 8, 2017

Hope this doesn't cause any offense as this is the area I'd most love to work in.
"do you think there will still be room for the nurses who want to work in acute inpatient settings?
I think I just worry sometimes about the outlook."
What are your thoughts?

LOL!!!

When I saw your questions it gave me the giggles!!! If only self fulfilling prophecy really worked in this situation, then your worries would actually be a wonderful outcome! The "push," for community care has been happening for over 40 years! Sadly, we are still failing at this great goal because our community has made an insignificant investment in nursing care. NO! Psychiatric nursing is not a dying profession, if anything it should be growing, because our psychiatric community is growing. Psychologists and techs are great but they are not skilled in medications and interventions to manage patients care plans.

What is a concern, is that there are fewer nurses wanting to enter the psychiatric field. It is a specialty field that is extremely stressful, can be at times dangerous, and time consuming. Many new nurses entering our profession do not want to work with psychiatric patients because they are not trained appropriately to work with them. They are concerned about loosing their med-surg skills or being injured after just finishing nursing school. What some new and older nurses do not realize is that mental health patients are everywhere. The approach, speech, affect, tone, and mental flexibility of the nurse are skills needed for working with mental health patients. It is psychiatric nurses who historically helped the sick in communities, especially when others had given up. If the psychiatric nursing profession were to really die, then nursing itself would not exist.

dekyrn · Aug 10, 2017

I work in an inpatient free standing psych facility. We are alarmingly short staffed and many days have more patients then we can realistically care for. Many of the patients we see Havre multifaceted issues and the majority of children are wards of the state. The need is most definitely there but changing. Stays can be as sorry as 3 days while I've also seen over 90. I believe one of the major hurtles is what insurances are willing to pay.