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Seeing the Value in Psychiatric Nursing

Published October 1, 2012 9:46 AM by Frank Visco
I suppose it's a common criticism that psych nursing isn't real nursing, and I can see the validity in that line of thinking. I've been working on a psych unit for several weeks now, and, based on my experience, I can tell you that psych nurses aren't required to do as much of the grunt work that the more traditional nurse will be tasked with. Still, at the same time, psych nurses are expected to act in a psychotherapeutic role, and, thus far, I've found that to be a far tougher task.

Needless to say, this experience has definitely been a change of pace. Usually in clinical rotations, I am assigned a few patients and am tasked with doing most of the bedside care for them -- things like med administration, collection of vital signs, bed baths, diaper changes, wound care, etc. But with psych, none of that has occurred. Instead, I have been set up with very little guidance beyond the direction to have therapeutic conversations with any/all of the patients on the floor. So instead of checking blood sugar or setting infusion rates, I'm basically just hanging out with mood disorder patients.

Despite having next to no training and very little knowledge when it comes to dealing with psychotherapy, I'm happy to report I'm holding my own, fostering active listening skills and developing a certain level of comfort with asking probing questions concerning suicidal ideation, planning, and so forth. During each week there are inevitably times where I feel pretty useless -- there was a 2-hour block a few weeks back where every patient was either sleeping or watching the Eagles in the community room, and so all I did in that time was watch football, which was simultaneously awesome and guilt-inducing.

However, I have noticed that this more relaxed chill time with the patients (as well as my participation in community meeting and the daily group therapy session) has made them comfortable with me, allowing them to open up about their various depressions and anxieties. As a result, I have had quite a few intense one-on-ones with patients that seemed to be therapeutically beneficial, and there has been some sort of a rewarding aspect to that.

Having said that, these intense conversations can be very draining. Yesterday, I spent a great deal of my morning listening to a woman unload all her various issues, including multiple suicide attempts related to her mental illness, a strained marriage, financial difficulties, and a traumatic tale of familial sexual abuse. I followed that up by an afternoon spent with a man who, due to crippling anxiety, has totally dissociated from life. In between, there were many other conversations that were equally intense, and while I do think there is a great value in having these interactions, helping patients work through such issues can be a lot to take on. By the end of the day, I feel encased in a cloud of depression, and it takes a considerable amount of effort to make sure to leave that at the hospital when going back to my personal life.

Of course, this is an issue we have to deal with in all forms of nursing. Caring for a terminally ill patient also can be quite depressing and will likely require a nurse to have some level of therapeutic conversations in addition to all the other practical nursing tasks. But, when it's as consistently intense as it is on a psych floor, it does seem to go to a whole new level. And so I think there's reason to respect the function of psychiatric nurses. Even though many people poo-poo the job as not being real nursing, there is a definite value in what they do, and it's certainly no easy task to do it.


Thanks to both of you for your feedback. I just finished my psych rotation this past weekend and I really enjoyed it. :)

Frank Visco October 17, 2012 12:46 PM

Been a psychiatric nurse for over 10 of my 16 years.

I can agree, that even though it isn't as task oriented,

it is definitely more mental and emotion. And it takes time.

Time to listen. Time to develop trust. Time to teach.

Time to care. Healing mental illness takes time. It takes

patience. And it takes heart.

Doris Pool October 16, 2012 8:57 PM

Good job Frank. I am a recently retired Psychotherapist. I taught Mental Health Nursing for 20 years in universities, both in N.Y. & in Fla. I had a private practice in both states as well. I believe you captured the essence of what we do & the joys & difficulties of our speciality. I highly encourage anyone with a desire to help our patients with their mental health to pursue psychiatric nursing. It has been so rewarding for me & my peers for many decades.  Dr Evelyn BohM

Dr. Evelyn BohM, Adult mental health - Psychotherapist, Retired Private Practice October 16, 2012 12:29 PM
Boynton Beach FL

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