In the scope of history, those that work with those who have mental illnesses are seen as either great or terrible. Indeed, this has been reiterated time and time again in Hollywood movies, with the likes of Nurse Rachet and Hannibal Lecter being 2 of the most prevalent mental health professionals in cinema -neither of which you would want to have in charge of your care or the care of anyone you care about.
However, if you are considering a career in psychiatry, particularly psychiatric nursing, you may be a bit puzzled as to what the role requires and whether you have the right skill sets to not only get through the training but also to be successful in the role.
It can be tempting for those who have been in psychiatric care or for those who have been engaged in psychiatric care via a family member to want to undertake these roles. Indeed, many people who have been involved in either inpatient or community settings have often wished things were done differently and want to change the system for the better, which is great. Of course, it isn’t an essential requirement for mental health or psychiatric nursing that you have been involved in the system, but for many, it is what got them interested in the role in the first place.
Even if you are new to the area of psychiatric nursing, it can be one of the most rewarding roles there is, but there is more to it than simply having experienced the system from the eyes of a patient. So, with that in mind, what are some of the essential skills to have (or to develop) when looking to work in psychiatric nursing?
Empathy is an emotion that can be learned and enhanced, especially if you are looking to train for one of the post masters PMHNP online programs, but if you start with a lot of empathy for those who are mentally ill, this will be beneficial to your development and the wellbeing of the patients that you are looking after.
A registered mental health nurse or psychiatric nurse practitioner must be able to consider what it is like to walk in the place of their patients, which can be especially challenging if the patients you are caring for are belligerent, aggressive, or abusive.
Empathy also means not showering your patients with platitudes about their current situation and thinking about what may be best for them. If you have a patient who is threatening suicide after their partner left them, you should not think saying ‘time is a great healer’ is a good way to approach this person as they cry. You should also not aim to be a ‘fixer’ of your patients’ problems. They must reach that goal on their own with your support, which may take them into dark areas. Your role as a psychiatric nurse is to be there for them and to show them that you want to help them.
Many people are surprised at the behaviors that they may see in a psychiatric ward or a community setting. While, in the regular world, judging others is a part of normal human behavior, in psychiatric nursing, it is a big no-no.
The reality is that you will be working with people who are acutely ill and may have made some bad life decisions as part of their mental illnesses. They may not even be aware of why they do what they do, so your role is to be compassionate and non-judgemental. If that sounds too hard, but you want to work as a psychiatric nurse or psychiatric nurse practitioner, then you may need to explore if there are any problems in your worldview that are causing you to feel this way.
To give this issue a face, suppose you are working in a psychiatric intensive care unit, and someone comes in who has cheated on their partner, gambled away all their money, has a drug addiction, and is now living on the streets but has been brought into your care after attempting suicide. It is easy to point out the flaws with their behavior, but a core attribute of a good mental health nurse is being able to look past this and see why they have done these things. In most cases, the patients may be deeply unhappy and may be suffering from impulse control issues, which could be due to a severe mental illness, like bipolar disorder.
When you are working with a vulnerable population who are unwell, it is easy for what you say to be misinterpreted. Plus, when you are working on a ward with people who are mentally ill, you will need to communicate clearly with everyone you are working with, from the support staff to the cleaners on the ward.
So, much like regular nursing, psychiatric nursing requires top-notch verbal and written communication skills. This is important when it comes to writing notes in a patient’s folder, preparing reports for reviews, and when communicating with other members of a patient care team via email.
However, in this role, you will also have to listen to the patients under your care, more so than a regular registered nurse, alongside the members of their family or their partners. However, more than that, you will need to actively listen, which is a skill that can take time to master. This goes both ways, too; the patients in your care will need to be able to understand what you are saying to them, so avoid using technical terminology, especially when it comes to talking about medication. You will also need to work on your non-verbal communication too, especially when working with those who are vulnerable. If you are looking away, have your arms folded, or have a blank facial expression when a patient is talking to you, this is, at best, going to make them feel that you are uninterested and, at worst, will prompt them to become angry.
This is a skill that is tough to get right straight away, but it can be learned with the job and by practicing what you say and how you say it with other members of your nursing team.
So much of what occurs in mental health nursing is about observation. Not just relating to a patient’s behavior due to illness but also concerning other patients, their families, and even the medications that they are taking.
In the weekly rota of the standard psychiatric ward, you will need to take physical obs (blood pressure, oxygen level, etc.) and report these back to other members of the team, so that any unusual observations can be written down. However, if a patient has had their medications changed and is now displaying signs of high blood pressure, then this will need to be reported.
Any changes relating to medication and behavior will need to be spotted and reported too. Has a patient had their medication changed and is now showing higher levels of anxiety or is having trouble sleeping? In your role as a psychiatric nurse, you will need to understand that not all the patients under your care are going to be willing or able to report such changes to you, and so you will be responsible for noticing patterns in their behaviors relating to medication changes or other stimuli, such as bad news from family members or doctors on the ward. Not only that, but if the patient is showing worsening symptoms, you and the other members of the team will need to be able to act accordingly and in the best interests of the patient.
Ability to Advocate
This is where advocacy comes in.It is a very unfortunate reality that many people who suffer from mental health issues that are severe enough to put them in hospital will not have the support of friends or family. So, as a psychiatric nurse, you will be required to advocate on their behalf with other members of the team, such as psychiatrists, doctors, and psychologists. Depending on the level of function that the patient has, you may need to make decisions on the patient’s behalf relating to medication changes, psychiatric therapies, and even medical appointments. In extreme cases, you may even need to advocate for those who visit them on the ward or attends ward meetings with them, and there may be family members or staff members who they dislike and cause them to feel threatened.
Commitment to Care
Yes, you may have patients that proclaim you are evil or that you are the reincarnation of the devil (and they will probably mean this literally), but such patients do not require less care than those who are more amicable to you.
Indeed, an ability to remain committed to the care of all of the patients you are overseeing is what differentiates a standard mental health nurse from an exceptional one. You should always aim to make all of the patients you are caring for feel safe and heard, as well as offer care and compassion to the family members or friends who visit them on the ward or attend the outpatient community settings with them.
This can be tricky to manage on your own, and many mental health or psychiatric nurses do suffer from burnout. So, to continually provide a high level of care to all patients, you will likely also need to attend ongoing professional development classes to keep your skill set fresh. This is particularly important when it comes to areas such as placing patients into therapeutic holds, which can be updated every year. It may also involve undertaking refresher courses in psychopharmacology to ensure that your knowledge is up to date.
Ability to Remain Calm
It sounds easier than it is, especially in mental health care, but one of the most important areas that will help you to pass any training course and to work in this challenging area is the ability to remain calm.
Once again, this is a real challenge when you are faced with patients who may be in a psychotic episode and may be abusive or threatening. However, you, as the psychiatric nurse, will need to be able to remain involved enough to notice any changes and detached enough not to take insults personally or to be offended.
Not only that, but like most areas of nursing, there is a lot of paperwork that needs to be completed for set deadlines in psychiatric nursing roles. You need to be able to hit deadlines while also being able to offer therapeutic care to the patients that you are working with and offering advice to other members of the support team when they need it.
In an acute setting, such as psychiatric intensive care, this is perhaps the biggest challenge for those who are mental health professionals. While this skill can be learned, it is best to engage in self-care and professional support to help you remain calm if you are struggling. Alternatively, it can also be worth discussing with the ward manager or other staffing members additional training or therapies to help you remain cool and collected in challenging situations, which will inevitably occur in all psychiatric settings.
Was one of your patients meant to be attending a doctor’s appointment today, and now they are in a crisis? Or, have they had their meds changed, and now it is impossible to talk to them about their care plan? These are some of the scenarios that are likely to occur in psychiatric care, and as a psychiatric nurse practitioner, you will need to be adaptable to change, usually at a faster pace than other areas of nursing. This will mean being able to change patients’ daily regimens at the last minute, informing all the appropriate people about the changes, and ensuring that the patient is kept informed if you have personally made changes on their behalf.