Barbara Drew, Ph.D., APRN, BC, is the former president of the American Psychiatric Nurses Association and an associate professor in the College of Nursing at Kent State University, in Kent, Ohio.
What do you enjoy most about psychiatric nursing?
I most enjoy the interpersonal connection with clients and their families. I like the challenge of using my knowledge about the multiple influences on mental health to help a client explore ways of coping with their symptoms and life circumstances.
What can a new nurse in the psychiatric/mental health specialty expect in the first few months on the job?
Many new nurses are persuaded to not begin their nursing career in specialty areas like psychiatric nursing. It is suggested that they need to practice their “skills” (usually referring to tasks like IV insertion, dressing changes, etc.) first. This notion is based on at least two faulty assumptions: One, new grads will not be working with medically compromised clients in a psychiatric setting. However, RN staff in most psychiatric settings care for clients with very complex healthcare needs. And two, interpersonal skills, which are indeed the primary tools of psychiatric nursing, come naturally and do not need to be practiced. While some of us were accomplished communicators when we came to nursing, most are not. Caring for people whose illness often results in impaired communication requires careful listening, self-awareness, conveyance of empathy and respect and integration of knowledge about mental illness and attention to clients’ life stories. Learning from our clients, observing and modeling after experienced, effective clinicians, and reading the scientific literature will increase confidence in interpersonal skills. Some nurses forget that therapeutic communication is fundamental to all of nursing.
Within the first few months on the job, new nurses may find themselves justifying their choice to become a psychiatric nurse. (My grandmother said I was not a “real” nurse because I did not wear a uniform.) They will, though, find rewarding challenges in providing holistic care to people with mental illness while being reminded that there really is not such thing as a pure “mental” illness or a pure “physical” illness; strengthening their therapeutic communication skills; leading therapeutic groups; assessing effectiveness of treatments, including psychotropic medications; and keeping the environment safe and health-promoting.
What is the most challenging thing about being a new psychiatric nurse?
Because we are nurses we tend to feel compelled to “do for” and “do to” a client. It is pretty difficult, and generally more time consuming, to guide the client toward self-care, discovery of solutions for problems, and making choices. This is particularly the case when the illness and/or family experiences result in lack of motivation, indecision, apathy or inability to see oneself as capable.
Another challenge I faced as a new grad going into psychiatry was the realization that if I was going to expect my clients to be introspective and self-reflective, I had to do the same myself. That was sort of shocking, since I did not learn how to do that as I was growing up. The good news is that this is an ongoing process that can be facilitated over time by co-workers, loving friends and family, and sometimes therapy, a process that can accelerate self-knowing.
Finally, it is particularly draining to allow yourself to hear the stories of your clients. A disproportionate number of people with mental illness have had experiences of neglect as children, physical and/or sexual abuse, or exposure to other horrifying events during their lifetime. In addition, they may regularly experience discrimination because of the stigma attached to mental illness or substance abuse. When I first began working on a psychiatric unit, I would come home every day with a headache and great fatigue. It took some time and awareness of my need to separate my work from the rest of my life before I left work headache-free.
What advice can you offer a student nurse or new graduate looking for a job in psychiatric nursing? How can they prepare for their new career?
First of all, power on! Become a psychiatric nurse. Do not let others dissuade you. Find a mentor who is a psychiatric nurse who will support your decision. I have always been a psychiatric nurse (for 36 years) and I have never regretted it.
Second, when looking for a job, realize that experience in a psychiatric setting would be valued by the nurse manager and your potential co-workers. Consider working as a student or arrange an extra clinical, if possible, in a psychiatric setting. Word of mouth, as with any other job, is important. Talk with people who work where you want to work.
Three, look for a setting that emphasizes multidisciplinary teamwork, provides supervision of staff, has opportunities for RNs to conduct groups, values one-to-one nurse-patient interactions, has a strong culture of professionalism (emphasizes evidence-based practice, involvement in professional organizations, continuing education, etc.) and of course, has good staff-to-patient ratios.
Four, join the American Psychiatric Nurses Association. We are the only organization in the United States that represents all psychiatric nurses. See our Web site for more information about APNA. Look particularly for information about Janssen Scholarships for students who are interested in psychiatric nursing.
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