Why mental health nursing?

What does it take to be a Mental Health Nurse???

Why Mental Health Nursing?

Mental health nursing is a profession for you if you aspire to help vulnerable people while making a difference – to be there for a person when he or she is hard to care for;  to provide a listening ear and compassion; while enabling them feel more empowered in situations where they hardly have any control. 

Nursing in other disciplines is challenging; needs more hands-on skills; you are up on your toes administering medication, providing tracheotomy or ventilator care, while constant monitoring of the patient for any alterations in their status.   Nurses are often known to dress wounds or fix broken bones.

 However, in a mental health unit, you will often find yourself caring for people who have lost touch with reality; to whom lines between reality and the realms of imaginations have grown too vague to care anymore; where they might or might not be able to understand the need to seek help.   These are people often mis-understood by their own family and friends; detained after behaving bizarrely and erratically in their homes, in jails or in public; and there is no way; you can fix them up with a quick pill or a band-aid.

In mental health; your patients are often dealing with difficult diagnosis, the weight of stigma that they carry on a daily basis; and the mundane everyday tasks of day to day living are at times; too much of a burden to them.
When you step into this field, you will spend hours calming them down, offer medications knowing that they might most likely refuse; stay with them on one to one; knowing you will be called all sorts of vulgar names, be used as a punching bag, will be spit upon, scratched and hear profanities that could shame a devil.  It is a job that requires significant communication, compassion, empathy and sensitivity, to deal with clients at their most vulnerable moments.

Do you have it in you?

“They will forget your names; but they will never forget how you made them feel” — Maya Angelou

This is often the ‘mantra’ we mental health nurses go by.

Here, you will use your nursing skills in more ways than you ever thought possible!

You will use communication and collaboration to help them calm; to de-escalate and stabilize; to help them cope on a daily basis and to build a trusting, therapeutic relationship.  By experience, you will eventually learn not just to say the right things at the right time; but to use the right tone of voice, right body posture and language.    Moreover, there will not be a single day when your decision making, critical thinking and problem-solving skills will not be put to test.   You will learn to predict the unpredictable, learn to take cues from your milieu, and make sense of the most seemingly impossible situations.  If you persevere, you will eventually learn not to get into power struggles with your clients.  In addition, you will learn the most amazing skill of all; to say ‘no’.

No matter what discipline you work in; nursing is an amazing, rewarding career in more ways than one.  Mental health nursing, although not for everyone; is an incredibly rewarding career choice.  You will learn to observe, engage in self-reflection and introspection.

Over time you will learn to prioritize between patients who need your attention the most. While at the beginning of their careers, the natural tendency is to attend to the most loudest; the more seasoned mental health nurses realize that the silent ones are the ones who suffer the most; and in turn are the ones who need help the most.

In my two decades of mental health nursing; I have seen patients hide razor blades in between their gums; cell phones in the most unimaginable parts of their bodies; smuggle drugs into an inpatient unit using the most creative ways possible; and device escape strategies in ways that might be just unfathomable.  I have dressed wounds that were self-inflicted; applied pressure dressings after they tried cutting themselves; attended to a co-worker after he had his intestines slit following a stab injury, and seen things that left me sleepless for several nights.

A patient once said to me: “You can’t save a drowning person without getting wet yourself”. The question is, how much depth are you able to take before you start to drown, yourself?

Mental health nursing takes special people.  When I see my patients smile and they tell me I made a difference, that’s my reward. When my patients successfully beat their addictions, that’s success.  When my suicidal patient gives me three reasons why he wants to live, that’s pure bliss. 

After working for about 20 years in a variety of psych settings, I know when my boundaries; both physical and mental will be challenged; where any weaknesses displayed on my part will be out in the open for exploitation; where I am an angel without wings at one moment and a dreaded devil the next.  I am well aware that at all times I need to be alert, quick on my feet and able to notice things in the front, back and at the sides of my head. I need to be quick intellectually, understand psychotropic medication very well, know lab values and their implications, and learn to communicate with people who have thoughts more bizarre than anything you could dream up.

It is in this field, that I learnt the long-time implications of childhood trauma, that post traumatic stress disorders are not just for those who served in military services; that not all people suffering from mental illnesses are violent or a danger to society.  Mental illnesses can come in more subtle forms, often in terms of anxiety and depression that may not always be visible to the naked eye.  Mental illness is real; just like every other illness is real; it needs care and understanding; it needs nurses who are willing to take up the challenge to serve the most vulnerable people of our society.

Do you have what it takes?

Are you up for the challenge?

So Is psych nursing for you?

As a nurse aspiring to go into mental health discipline, you will be given several reasons why psych would not be ideal. I have even heard people saying ‘psych nurses are not real nurses’ for they deal only with minds; not bodies. Well, psych nursing is nothing less than holistic nursing where you treat a human being as a whole. There is no perfect body without a perfect mind; and vice versa.

Here are a few of the myths surrounding psychiatric nursing and the actual facts about the discipline:

Myths and facts:

Myth:

Psychiatric Nursing is ‘easy’ work; unlike med-surg nursing where you have countless procedures, IVs, tube feedings, wound care, admits/discharges.

Fact:

I’ve also seen a lot of those folk’s crash and burn working in busy medical surgical units; and fast paced environments.  Some of them switch to ‘psych’ because they think it is ‘easier’ but sooner later than later realize ‘it is not easy; it is not for them’.  It may look seemingly easy when you float to a psych unit once in a while; but working there on a constant basis could be mentally challenging and draining.

It’s a different kind of busy, not easy but in the end very rewarding!

Myth:

Psych nurses lose their nursing skills over a period of time.  You don’t need skills in psych!  All you need is to talk!

Fact: 

Psychiatric nursing indeed has to do a lot with both verbal and non-verbal communication, in addition to the gestures and body language.   Psych nurses communication skills are further extended to extensive health education, de-escalation techniques and maintenance of boundaries.

 That being said; Psychiatric Nurses also assess the mental status of patients, review care plans, spend considerable amount of time in multi-disciplinary team meetings including the psychiatrist, social workers, psychologists, mental health workers, and others.

In addition, depending on the hospital or the type of unit one works in, psychiatric nurses do deal with medical issues like diabetes, chest pain, asthma and incontinence, monitor blood glucose, administer insulins, and monitor extra-pyramidal symptoms.  They also prepare the patients for electro convulsive therapy, exercise suicide precautions, monitor for signs of withdrawal and check intake output levels.    Therefore, psych nursing is not all about losing a skillset but about developing a different type of skillset.

Myth: 

Mentally ill are always violent and can hurt healthcare workers at any point

Fact:

I’ve been asked several times by my peers of other disciplines and lay people alike if I am not scared of violence on the floors.   Violence does happen in psych units.  But so does it happen in ER, in the streets and even in homes.  LET ME SAY IT ALOUD; NOT ALL PATIENTS WHO ARE MENTALLY ILL ARE VIOLENT; AND NOT ALL VIOLENT PATIENTS ARE MENTALLY ILL.

 While psychiatric nurses are trained to diffuse situations and de-escalate, when because of the acuity of their illness, the patients may become agitated or aggressive, contrary to popular belief, people with mental health issues are not always violent or dangerous. Although I’ve never questioned my own safety, I’m often concerned for my peers who are new to the field.  Mental health nurses always look out for each other.  It is more of a team work where each one knows, their backs are covered by their peers. People suffering from various mental illnesses deserve our protection and respect, not our ill-advised judgment.

Myth:

  There is little opportunity for future professional growth

Fact:

Mental health nursing jobs are expected to be in high demand in coming years with opportunities for growth and practice in inpatient settings, outpatient clinics, community health centers, community service boards and the like.  It is a highly rewarding career, offer challenging where you get to make a difference each day in your lives.

All in all, psychiatric nursing is a beautiful profession.  Once you begin your day, there is no predicting how your shift will be like.  The job has its own stressors; it takes immeasurable patience, compassion, empathy and active listening.   Your capabilities will be tried and tested, not once but several times;

If you are new to the field, there is plenty to learn and experience; you will gradually have stories and memories to last you a lifetime, you will learn to observe and to discern, to serve will humanity and compassion while maintaining trust and boundaries

Also do not forget to read:

Psychiatric Nursing for the newbies!!!