The mental health of RMNs – are we looking after our practitioners?

Mental health nurses care for people with a wide range of mental health issues. Is enough done to support RMNs themselves from mental health stress?

Are we providing enough care for those that care?

Mental health nurses form a crucial part of Britain's healthcare system, positively affecting the lives of thousands of patients every day.

The role can be exhausting both physically and mentally, but has its rewards.

Grace under pressure

Mental health nurses must be resilient, calm and able to make quick and safe decisions in potentially life threatening situations.

I liken my job to being like a duck, calm on top, but one peek under the water and you can see the legs pedalling frantically.

In 2014 the Royal College of Nursing reported a 3,300 loss in mental health nursing posts, and a 15% drop in staffing numbers within mental health services.

These pressures and stressors are likely to impact upon a nurse’s mental wellbeing and make it harder to hire new mental health nurses for NHS or agency jobs.

Mental health nurses more at risk of stress

Currid (Currid,T. Experiences of stress among nurses in acute mental health settings, Nursing Standard, 23 (44), pp.40-46, 2008) identified that mental health nursing poses more challenges, due to its poor funding, inadequate staffing, bed shortages, workload and patients who are acutely disturbed and present a real risk of violence or self-harm.

Understanding stresses that general nurses may face and how these impact their mental well-being is widely researched within general nursing.

However, research about those working within mental health has been much slower in coming forward.

Maybe this is the expectation that because mental health nurses are experienced in dealing and treating mental health on a daily basis, that they are able to manage their own without the need for support, or recognition.

Maybe the stigma surrounding mental health is still present, even amongst those who are working within it.

RMNs daily work with people presenting challenging behaviour

Nurses have to work with a variety of people with various mental health diagnoses.

This includes working with those criminal backgrounds. This can pose a challenge and further stress on those professionals caring for them, as nurses will have to put aside their own pre-judgement, anxieties and fears to provide compassionate care.

This can often leave the nurse feeling uneasy and distressed.

Registered Mental Health Nurses (RMNs) deal with distressing situations on a daily basis throughout the day. Having to support and care for a patient who is making threats or becoming physically aggressive, or a patient that is taking numerous determined actions to commit suicide or self-harm, can be extremely distressing to see.

Due to staff shortages nursing staff often report on multiple 1:1 eyesight observations with distressed patients, leading to higher levels of stress and distress of the nursing team.

During my time working on an acute female ward, I was involved in numerous ligature cuttings, patients secreting razors, and various overdoses.

These events can create a significant impact upon the mental wellbeing of the nursing staff monitoring them.

Most of the time it comes down to staffing levels. Sufficient staffing levels are vital so that they can alternate any observations to prevent burn-out of staff.

Getting admissions wrong

Inappropriate admissions to specialist wards cause further stress to nursing staff.

During my time working in psychiatric intensive care, an admission came through for a patient with significant learning disabilities and Autism.

Staff had no choice but to nurse the patient in our seclusion room on a 1:1 observation for a lengthy period of time.

The patient could not tolerate the high stimulus environment due to their Learning Disability and Autism.

The majority of staff was not equipped to deal or manage an individual with autism. The patient’s admission was emotionally challenging, and had an impact on all the team who cared for them.

Supervision

Supervision is done to try and help support nursing staff, giving them an opportunity to talk through any concerns.

Supervision can fluctuate though. Whether it can be completed or not is often due to acuity on the ward and staffing numbers. The CQC (2013) states that supervision amongst professionals is vital, and that it can help staff to manage their personal and professional demands created by the nature of their work.

This is particularly important for those who work with people who have complex and challenging needs.

They also state that clinical supervision provides an environment in which staff can explore their own personal and emotional reactions to their work.

Reflective practice is valuable, but it requires adequate staffing levels to work

Reflective practice

Reflective practice also helps and supports staff by providing an environment where they can discuss any challenging patients on the ward.

But, again, this can only be facilitated if there are adequate staffing numbers on the ward.

It also heavily relies on staff openness, and a willingness to share thoughts, feelings or concerns.

It’s my personal feeling that there is an expectation that RMNs should be strong, emotionally resilient individuals, who must not present mental health issues themselves. This is despite the fact that many nurses who choose to specialise in mental health do so as a result of their own personal experiences.

What can be done to help look after mental health nurses

There’s much that can be done to improve the mental health of our mental health workers, and a large part of this lies with funding.

Insufficient funding forces nurses to work alone, causing high stress levels. Additionally, a lack of appropriate placements for those that need specialist treatment that cannot always be provided by mental health services.

The mental well-being of staff also requires good senior management up the chain in the hospital, ensuring supervision compliancy with the wards, as well as listening to their nurses.

Management need to strike a fine balance between enticing new nurses and keeping their experienced nurses in post, and there is no one way to do this.

Ultimately a nurse’s mental well-being lies with the individual.

It is the responsibility of every nurse to be forthcoming with management about their mental health, and take necessary steps to ensure they take time for themselves.

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