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Mental health nursing - a day in the life

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Author Mental health nursing - a day in the life

ajv1975

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  • Joined: May 2010
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Tue May 18, 2010 12:05 pm

Hi all, I am hoping you can help me! I am a student nurse (Year 1, semester 1). Last year I studied Psychology and loved it, but did not want to study for 6 years to be registered. I decided to try nursing and take the mental health route instead. Now, along the way through my first semester I have been doing alot of research on what exactly the role of a MH nurse is. So far I have spoken to: * An ex RN (who is now a Psychologist) - who advised me that MH nurses don't really counsel patients at all, mainly give medication and ask the patient questions to obtain data for the doctor. * An ex MH nurse - who advised me that MH nurses actually run (and compile the program of) group therapies (specific experience of this in an eating disorder clinic). * A current MH nurse (in the community setting) - who advised me that in MH nursing, medication is the first line of defence instead of delving into the psyche ie: addresses the symptom with medication, not the cause with therapy. Also does not deal with eating disorders in this setting, presumably as medication is generally not given for these types of disorders. Of course I am really confused. I want to help people by working with them, giving them advice, running group therapies, not just give medication and ask questions to gather data. I am trying to decide on whether to transfer into Psychology. Can a MH nurse out there tell me what their day involves? Do you have the freedom to write and run programs for people? Or is it heavily focused on giving medication and building a relationship for the purpose of data collection? All the information I can find online says things like "mental health nurses support the patient", but I need to know if this is an active or passive role. Thanks so much!

noeline999

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  • Joined: Mar 2010
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Jun 24, 2010, 07:24 pm

Hi

I am an EEN who works in acute mental health. Unfortunately I agree with the person who told you we don't get to counsel patients. That is quite true.. mainly because we don't have the time. From my experience, medication is the main therapy (or ECT if medication fails)and yes, to report to doctors what we see and hear. I continually find myself frustrated along with some of my colleagues as I want to empower and help people. If that is what you want to do, then don't become a MH nurse. In some private hospitals there are group therapies which can be quite successful and rewarding but also this can be short lived.

I did however, recently work interstate and was impressed as that hospital offered CBT by a mental health nurse that completed a CBT course through uni.

I wish you luck in whatever you decide.

Lynn Thomas

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  • Joined: Jan 2011
  • Location: Stanmore, NSW
  • Posts: 2

Jan 11, 2011, 03:05 pm

Greetings,

it depends in which area you work. If you work on a crisis team the focus is on rapid symptom control to control behaviour that is problematic and that is usually via medication, though some counselling is utilised depending on the nurse (some nurses are not interested in advanced practice and only want to do the medication routine, they usually are less proactive and dont want to take responsibility so refer 'everything' back to a doctor - who may not want that level of info). You can work as a case manager in community mental health and have a variety of clientele some of whom will require counselling and psychotherapy. some clients dont want a bar of services and will only come for medication (but here your expertise in engaging them can lead to some therapeutic practice and 'healing' for the client ie not necessarily their illness but their expereinces with services which is preventing them from moving on in their recovery). AS far as CBT is concerned its a 3- 4 day course via various organisations. It doesnt take long to learn but practice is the essential requirement, though there are other practice modalities that are as useful (it really does depend on the client). You can work on a Rehab Team (MATTeam or similar) where you will have a chance to write programs for individual clients or groups.

MHNursing is a great job with many opportunities to branch out and practice - there are various beliefs about nursing scope of practice that are negative to our professional development and independence - as nurses we practice nursing not medicine, psychology, social work or occupational health but we utilise all those disciplines in our synergistic care of the client (not just the illness), vested interest and competing financial interests from other disciplines tries to limit what we do to just giving/overseeing medication (therefore 'doctors handmaidens') and many nurses accept these limitations but we cripple ourselves professionally by doing so. Benners skill development remains relevant for nurses as it gives us a framework to understand our own evolution as practitioners from novices to expert (not necessarily associated with academic achievement either but definitaly an aspect of professional development).

In other words - you will decide the type of nurse you want to become ... initially you may need to do the 'scut' work but as you become more competent and experienced you will develop your own style and begin to branch out. In Australia we dont have many nurses in private practice and I believe that is what we need to start doing, with or without a medicare provider number! Please ... stay in nursing and retain that interest in nursing therapeutic practice. <g> good luck either way .....

psychoRN

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  • Joined: Oct 2012
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Oct 09, 2012, 09:07 am

I work in a private psychiatric hospital, my average day (when not I/C of shift) looks something like.

Receive handover. Allocation of anywhere from 5-8 patients, and usually two major duties. Where I work the "major duties" for an RN will be a medication round (administration of medications), and visual observation round (documentation of the location and activity of patients on the unit).

I simply introduce myself to my allocated patients in the morning - develop a sense of presence and support, outline a safety plan (which is essentially that they remain in direct contact with me about any acute alterations), and assess their planned activity for the day. During this brief period, you also perform an initial mental state assessment and attempt to identify any potential issues for the shift.

Throughout the day, when you have time (between your allocated duties, coordinating pathology collection, reporting to psychiatrists, making necessary documentation changes as patient risk categories are altered, organizing medical review, ordering of medications from pharmacy etc etc) you may spend a further 5-15 minutes with each of your allocated patients to conduct a more "in depth" assessment of their mood, behavior, safety issues, progressing and current treatment plan. During this time, especially if a patient is distressed over a specific incident/issue - mental health nurses provide brief periods of counseling and advise the patient on various strategies that may assist them to cope with their issues. Nurses generally do not engage in extended, counseling sessions and usually steer clear of providing direct input RE: personal issues (such as: should I leave my husband? do you think I should change career? etc etc).

Essentially, your role in managing specific patients is that of assessment, crisis and risk management, deescalation (handling patients who become acutely distressed, psychotic, aggressive etc), and maintaining a sense of support.

Of course you have a period toward the end of the shift where you document in clinical files, produce a report for handover, complete various forms and tools, update care plans.

Furthermore there are a thousand other tasks that, you may not complete everyday, that permeate the role of a psych RN - such as facilitation of group therapy (depending on the level of your additional education/qualification), responding to duress alarms, completing incident reports, provision of medical care in the event of a medical emergency or self harm, completing admission assessments, preparing a patient for direct discharge, medical supervision of patients pre and post ECT, physical observations and AWS/OWS/BWS management, and presenting at mood disorder/psychosis meetings or patient treatment review meetings.

How much time you spend counseling patients or in direct "therapy" will depend on area in which you work and the capacity in which you are employed. Of course I provide counseling as part of my role - but it is perhaps 5-10% of what I do, and I would like to keep it that way. If you are interested in making it 90-95% of what you do, you certainly can achieve that within nursing - usually, this involves additional education - as previous posters have alluded to.

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Apr 16, 2013, 08:55 pm Last edited Apr 16, 2013, 08:55 pm update #1

Why don't you also try in some private hospital.That would be beneficial for you.

http://www.replas.com.au/products/bollards

modified: Tuesday 16 April 2013 8:56:56 pm -

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