What does it mean to be a mental health nurse and what are the challenges and rewards? Two RMNs explain what being a mental health nurse means, from their perspective.
Mental health / psychiatric nursing is sometimes the misunderstood nursing discipline.
So we wanted to ask some RMNs themselves what it's like to work in mental health nursing?
Charge Nurse, Psychiatric Intensive Care (PICU)
What’s your job title, and in what kind of mental health institution do you work?
I’m a qualified RMN, working as a Senior Staff Nurse in a PICU (Psychiatric Intensive Care Unit).
Is there such a thing as a typical day... Can you briefly describe how a day might pan out for an RMN doing this job?
One of the 'perks' of my job is that there is not a typical day. With ten patients and their myriad needs, ward rounds, documentation to attend to, staff to meet with and a team to manage one day can vary greatly from the next.
For those who may not know, can you explain when a mental health nurse may need to restrain a patient, and what skills are needed?
For many reasons patients can become agitated and/or aggressive and therefore compromise the safety of both the ward and themselves.In such instances staff may have to immediately 'lay hands' on a patient or, if there is time to forward-plan, assemble a PMVA team (Prevention and Management of Violence and Aggression) to approach the patient and restrain in order to either de-escalate or remove to a place of safety and low stimulus.
Such a team are also assembled to assist in the safe administration of medication should a patient’s presentation require it.
So that we’re under no misunderstanding, can you paint a general picture of what an RMN is required to do if it’s clear a patient is about to harm themselves or others?
Again, a PMVA team would normally engage with the mental health patient or, should the patient prove unmanageable, nursing staff may require the assistance of the police.
How important is the role of therapeutic care in your job?
A good question. The PICU is often the first point of contact for many mental health patients with in-patient acute care.
As such, it is often the role of the PICU team to ensure 'stabilisation' of the patients mental health before further treatments, or therapies, can be offered.
However, this work in itself is also regarded as part of the wider therapy process.
Is it possible for an RMN to build up good relationships with patients with mental disorders? And is this seen as unprofessional, or is it encouraged?
A healthy, boundaried therapeutic relationship is essential to promote recovery.
The manner in which this is 'dispensed' is varied and individual to each nurse.
Given what you’ve said, what personal skills should someone be sure they have before considering working in a secure psychiatric intensive care unit?
Good communication skills, an understanding of medication, an ability to work within a varied and multidisciplinary team, an understanding of mental health law, a sense of humour and common sense.
Of course, it’s important to ensure that proper procedure and best practice is followed, but is there a tendency in the NHS to over-report – and if so, how could this time be better spent?
All staff are of course obliged to adhere to mental health law and the policies and procedures of their NHS Trust and, of course, the responsibilities to their professional body.
Documentation goes hand in hand with the more 'hands on' elements of nursing but, to answer the question, I would imagine many nurses would like to spend more time with patients rather than attending to paperwork.
What do you enjoy about your job as an RMN on a PICU?
The responsibilities of being a qualified practitioner, the variety each day can bring and believing that I'm part of a wider team helping to make our patients lives a little better. (Ben explains the role of a psychiatric nurse in more detail here.)
The education you refer to encompassed psychology and even a degree in... divinity?
Is there anything to explain there as it's not the usual nursing career path?
“I’ve always enjoyed attempts to understand the human condition. Working with patients who have various mental health issues seemed to dovetail nicely.”
You make working as a PICU nurse sound appealing. Is it all about therapeutic care and psychiatric nurturing?
“No. That would be nice. No, it’s demanding and at times extremely challenging. But you’re supported by a trained, disciplined team. In fact, some years back, I could have moved to another ward but chose to stay because of the strong team ethos we have.”
What skills do you bring to that team then?
“It depends on the situation I suppose. But we all need to be able to demonstrate an ability to assess patients, provide clear and unequivocal boundaries to them, and monitor behaviour trends.
Patience can’t be over-estimated. Nor can a good, healthy sense of humour for the more trying days.”
So I can imagine you at work, what does 'work' look like?
“It’s a secure ward. It’s locked and has just 5 staff and 10 patients. At times it’s quiet, at other times... less so. I suppose just like any working environment. But in certain respects very unlike other environments.”
And do you feel that working as an RMN is satisfying? Do you feel you get a lot back?
“Yes. We're helping other humans and that's really rewarding. Of course, nurses are, to a certain extent, just doing a job, whatever specialism they happen to have followed. There’s training and paperwork and managers and staff to manage and chief executives and budgets.
But the fact that you’re here to help other people is something that you’re reminded of very often!
In answer to your question, yes it is very satisfying. And not just the social care aspect either.
I work as part of a team that includes allied healthcare professionals - psychiatrists, occupational therapists - as well as other nurses and healthcare assistants. You’re constantly learning and that’s important and rewarding too.”
So you'd encourage others to consider the job?
"They need to want to do it, and they need to feel they can do it. But, if that's the case, yes definitely.
It might be worth working in social care or healthcare first though, in an unqualified capacity. Test the water before spending time taking your nursing degree is the way forward."
Finally, your’s is not a typical job, or one that many of us can conceive dealing with on a day-to-day basis. How do you unwind from a day on a PICU ward?
The usual - trying to not think about the job too much, friends, sport and a subscription to Viz.
My partner’s also a nurse and she and I do our best not to talk shop too much..
Newly qualified mental health nurse
Chloe, can you explain your work setting?
I work in a mental health nurse job, working on a CAMHS ward (Children and adolescent mental health services). We have 15 young people at any one time, its safe to say that any empty beds which crop up don’t stay empty for long!
As a newly qualified mental health nurse, there are a lot of challenges I face - you can read more about that on another blog I wrote here on Nurses.co.uk.
So, very young right up to late teenagers?
Our young people range in age from 13-17 and they can be admitted for any number of reasons; self harm, suicidality, psychosis, ASD and more.
One thing that sets CAMHS units apart is that we often have a lot more informal patients (i.e. not detained under the mental health act) than sectioned patients.
Is it emotionally challenging?
You’re likely to see a lot more self harm than is typical on an adult ward, this can range from ligatures, cutting, ingesting toxic substances/items to self neglect.
My line of work is particularly challenging because our young people experience all the ‘typical’ teenage issues like puberty, mood swings, relationship and friendship difficulties, but then have the added complication of mental health problems.
We also have to juggle the importance of empowering them to make decisions about their own care, whilst involving family members/carers and recognising when decisions need to be made for them in their best interest.
So if you think the mental health nursing sounds like the right job for you then give it a go.
So long as you’re a caring person who has a passion for helping others I have no doubt that you will love your future career as much as I do.
Chloe explains in this video why she loves her job
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