Why the high turnover in behavioral health?

One thing I have observed over the years is that nurses in other specialties tend to believe psych nursing is "easy" compared to other kinds of nursing, and I've seen some nurses from other areas take psych jobs because they want an "easier" job -- then, once they are working in psych, they find out it's not easy, it doesn't suit them, and they move on.

Oh my goodness.

After my weekend of 10 adolescents and only two nurses, I am mentally and physically drained. Like, "I can't get off my couch" drained. Granted, it's not always like this, and I totally attribute it to low staffing (big surprise, right?) I do honestly love my job, 99% of the time. When administration takes away our techs, that's when I'm not happy. I have only worked adolescent psych, and I honestly don't know what it is like on a "real" med floor, but sometimes I would really like to try out ED or ICU just to compare. I don't want to go anywhere else full-time, and I don't want to leave my position, but I am considering applying for PRN positions on in ED/ICU/med units. I am just completing a nurse residency program with my facility, and I feel that will help increases my chances of landing a PRN position. Buuuut then I consider how exhausted I already am, I really don't need the money, and I think "why bother?"

I think some nurses go into the field thinking it will be easy. It's not. I think there are also those who go into this field with idealized expectations of the work.

Mental health is a broken system at all levels, patient needs are high, the system is underfunded, understaffed, and underappreciated, if not outright stigmatized. There is limited funding, and limited resources, and it is a small community - much smaller than you realize, you will work with the same agencies, same hospitals, same court monitors, same police and jails, same people and same patients over and over again even if you change jobs/roles. Some days you'll be trying to brain storm discharge plans and realize your patient has been through every agency and facility in the system that reasonably makes any sense and there aren't options left.

You will have repeat customers; some frequently. You will find yourself having to fight with other areas of the health system to get your patients medical care, addiction services, and out-patient mental health care. You'll fight the stigma in trying to work with EMTs/police and EDs to treat your patients humanely and take yours and their medical/physical concerns seriously. You'll fight insurance agencies for medications and therapies. There are so many gaps in the system for your patients to fall through and there isn't a safety net. You'll discharge patients back to homelessness, poverty, dysfunctional families, and other untenable living situations that you know will trigger the symptoms that were stabilized in your care all over again - and best case scenario you'll see that patient again.

You'll have patients who are aggressive and violent, patients who are gaming the system, patients who push all your buttons, and patients who touch you deeply with their stories.You'll have patients you never see again and you'll wonder if they are still alive. It can be incredibly intense emotional, mental and physical work with little external reward. You have be able to celebrate the tiniest of victories and find your own meaning. It also takes an awareness of limits, of being able to let go, of recognizing what you can and cannot do for a patient, and of recognizing mental and emotional limits and making space for yourself.

All that said - I honestly can't picture myself working in a different field of nursing. These are my people and this is where I belong.

Yes! And sometimes they are so darn FUNNY! Like, REALLY funny.

I connect with my patients, and that's what warms my heart. I know they don't believe me, but I've been there. I was a crazy adolescent, once. I'm still occasionally a crazy adult. I think a part of us have ALL been there, either our own struggles with our own mental health, or family members who struggle with mental health issues.

I used to work in behavioral health. I loved it. I don't work there now, for a few reasons. 1) the pay is less than half (acute hospital union vs freestanding non union) 2) I want the experience in med / surg because it will allow more opportunities in the future for areas I'm interested in, such as ICU/ED/Cardiac 3) I want to work for a large organization with a pension, good health insurance, etc which I get in the hospital and didn't have at the psych facility

I loved the work though, and the pts when I worked in psychiatric care

1. Mental health is treated separately than the rest of the body and it should NOT be.

2. Mental health has traditionally been a taboo subject, much like cancer was called the big C back in the days (even before me). People do not wan to speak about mental health, and growing old. Just subjects that are not pleasant.

A bucket of YASSSSS on these points.

The lack of parity between mental and physical health is one of my biggest pet-peeves and one of the issues on which I am extremely vocal in my nursing classes. Part of that reason lies in that the trauma psych treats is not as visible, immediate, and part of the universal human condition which is seen other units like med/surge, L&D, ICU, rehab, etc. It's easy to feel connection with clients that have exhibit symptoms which we've all experienced, like episodes of bleeding/puking/poo/pee/snot. Psych is different: it takes a different skillset to feel connection with a person who is *clearly* seeing a six-foot tall pink bunny when you *clearly* are *not*.

The brain is an organ, and, like all other organs, is prone to fail and throw a client under the bus. We don't tell clients that have a malfunctioning pancreas to "just get over it" or "think positively" - nah, we give them an analog and empower them by helping them manage the symptoms associated with their condition. When they have an embolism and their brain is damaged from a stroke, we can see that, we treat it, and our clients rock on. Yet somehow, when their brains decide to act like total jerks and not make a neurotransmitter, we (as a society) tell these clients to "think positively" or "do something enjoyable." It's complete and utter tosh, and not empowering in the least.

I think some nurses go into the field thinking it will be easy. It's not. I think there are also those who go into this field with idealized expectations of the work.

Mental health is a broken system at all levels, patient needs are high, the system is underfunded, understaffed, and underappreciated, if not outright stigmatized. There is limited funding, and limited resources, and it is a small community - much smaller than you realize, you will work with the same agencies, same hospitals, same court monitors, same police and jails, same people and same patients over and over again even if you change jobs/roles. Some days you'll be trying to brain storm discharge plans and realize your patient has been through every agency and facility in the system that reasonably makes any sense and there aren't options left.

You will have repeat customers; some frequently. You will find yourself having to fight with other areas of the health system to get your patients medical care, addiction services, and out-patient mental health care. You'll fight the stigma in trying to work with EMTs/police and EDs to treat your patients humanely and take yours and their medical/physical concerns seriously. You'll fight insurance agencies for medications and therapies. There are so many gaps in the system for your patients to fall through and there isn't a safety net. You'll discharge patients back to homelessness, poverty, dysfunctional families, and other untenable living situations that you know will trigger the symptoms that were stabilized in your care all over again - and best case scenario you'll see that patient again.

You'll have patients who are aggressive and violent, patients who are gaming the system, patients who push all your buttons, and patients who touch you deeply with their stories.You'll have patients you never see again and you'll wonder if they are still alive. It can be incredibly intense emotional, mental and physical work with little external reward. You have be able to celebrate the tiniest of victories and find your own meaning. It also takes an awareness of limits, of being able to let go, of recognizing what you can and cannot do for a patient, and of recognizing mental and emotional limits and making space for yourself.

All that said - I honestly can't picture myself working in a different field of nursing. These are my people and this is where I belong.

An absolutely amazing comment!

Personally, 3+ years as a mental health tech made me swear that I never wanted to be a psych nurse. Not that some of the patients aren't great, because they are. And not that some of my coworkers didn't become lifelong friends, because they did. But when everything goes wrong, it goes so wrong that you seriously consider giving it up and going back to retail. And anyone who's worked retail can attest to the fact that psych patients are often better behaved than customers.

For me, its sad to see clients come back to inpatient care over and over again. But you must remind yourself you are doing an important role, even if you can't "fix" the issues with mental health care. I also have found myself occasionally frustrated with manipulative clients and the strain of having clients return only for them to go through the same obstacles and struggles to stabilize and then deal with homelessness, substance abuse, trauma, medical comorbidities, etc. It takes a certain person to see people in these states regularly and not let it get them down.

I came to psych almost two years ago. I love it. I previously worked in post partum, float pool, critical float pool, medical flyer, ICU and the ED. In all of these departments, many of my patients had mental health conditions. Especially the ED and ICU (at my facility). Working in psych allows me to take a holistic approach with the patient. Plus my pay and benefits are the same.

It's funny, I WANT to get into psych and am having a hard time because I have no psych experience.

In my time as a psych nurse, I've seen far more nurses ENTER the specialty than leave it. I work on a behavioral health unit at a huge hospital, and I honestly can't recall even one nurse who's left the specialty because they disliked it. If anything, I've worked with far more people who entered psych because they were tired of vomit, sputum, pressure ulcers, feces and other nasty aspects of med/surg. Sure, in the realm of psych, you get the occasional patient who flings unpleasant body fluids on you or at you, but that's not an everyday thing. Some people are cut out for ob nursing, some for dropping in PICC lines, some for assessing and treating wounds, and some for working with schizophrenics. We all have our gifts.