Question for PMHNPs

[Ddestiny, BSN, RN]

Hi all!

For a little background, I am still a pretty new LPN (passed NCLEX May 2012, have worked in a primary care doctor's office since July 2012) and just started my LPN to RN online bridge program. That being said, I'm probably getting a bit ahead of myself, but I find myself asking some questions about where I'm heading.

Sorry if this turns into a novel!

I absolutely love mental health. It's my passion, and the whole reason for why I went to nursing school was to become a PMHNP. I feel very lucky that I'm able to work for a doctor that sees my love for mental health and will help me to grow in my skills of assessing and creating a rapport with patients (the later can be a little difficult because, though I am 27, I often get mistaken for a teenager when people first meet me. This can make it understandably uncomfortable for patients to open up about topics where they are concerned about being judged or facing stigma). It is so fulfilling to see a patient respond to treatment or give you "the look" that says "hey, you actually understand".

I have also been able to shadow two psychiatrists who were kind enough to let me be involved in their appointments (mostly asking my own assessment questions) and were very encouraging.

My only hang-up is this...

As much as I LOVE mental health, and couldn't imagine NOT dedicating my life to it in some way...I also wonder about the idea of it being the specialty that I see, everyday. There are some days at work that I'm glad to see a schedule full of patients with no overt psychiatric issues, I feel like they help me recharge my emotional energy.

I have seen so many people that work in psych (both as the nurse and as the patient) that just have no energy to empathize with their patients. I can't stand the idea of becoming like that.

Have any of you had these same concerns? How do you keep yourself from burning out or losing your empathy after working in psych long-term?

Thanks for reading this whole thing. Looking forward to your responses. :)

[Agrippa]

Big part of working in any helping profession and especially in mental health, is working with your own emotions. To be a great practitioner (whether it is as a pmhnp, psychiatrist, Clinical PhD Psychologist, LCSW, etc etc...) you need to know thyself. Be aware of your own emotional life, what is draining, why you feel burnt out, issues that bring about your countertransference, etc.

This is why I'm an advocate for all mental health practitioners to undergo some form of psychotherapy themselves at some point in their training. Unfortunately, even for psychiatrists, this is not required. But without it, I feel that theres just too many areas of blind spots - so to speak. This goes for anyone that practices as a psychotherapist, even if it is just for psychopharmacologic treatment. Being able to be aware of and control your own countertransference is very important as is how you deals w/the issue of burnout. Everyone does it differently. How much of your own emotional energy your willing to allocate to your professional life is your decision.

Also, keep in mind that treatment even in a psychiatrist's office in an outpt setting is only a sliver of what a PMHNP can do. I highly recommend trying to work on an inpt psychiatric unit where you will get to see a full spectrum of pts from mood disorders to psychotic disorders.

[Psychcns]

Agree with above post-well said! The only thing I will add is that the better you take care of yourself, the more you can be there for otherwise. Also confidential supervision can be a place where you learn to be a therapist as you process your feelings. I only do psych. It can be draining. You have to know how to reenergize yourself. I swim and do yoga. Everyone has their strategies. You have to take care of yourself!!

[Psychcns]

Agree with above post-well said! The only thing I will add is that the better you take care of yourself the more you can be there for otherwise. Also confidential supervision can be a place where you learn to be a therapist as you process your feelings. I only do psych. It can be draining. You have to know how to reenergize yourself. I swim and do yoga. Everyone has their strategies. You have to take care of yourself!![/quote']

Correction: be there for others. (4th line)

[BamaPsych]

As Agrippa pointed out there is more than one area that a PMHNP can work in. If you are feeling overwhelmed and discouraged in one area you can shift your focus. There are many different patient groups etc. that can help things from becoming routine. Although I have found as a psych nurse things are never "routine":D. It is exciting that you are pursuing your goals. I will be a PMHNP in December if all goes well lol. Do not let fear or doubt slow you down if you know that is what you want to do.

[mzaur]

Take up a meditation practice. I think this should be essential for everyone, but particularly those in the mental health field. I can't imagine working in mental health without the calm, confidence, empathy, and self-awareness I gained from meditation.