What everyone should know about mental health nursing

Some jobs are definitely physically demanding. Some are extremely mentally demanding and some are acutely emotionally demanding. Get this — mental health nursing is all three.

But no matter how physically tiring, emotionally draining and mentally exhausting, lots of the mental health nurses I’ve had the honour of working with do an amazing job. They cared about their patients physical, emotional and mental well-being and often went way beyond the call of duty.

Boris Johnson lbc.co.uk

The government should recognise how difficult it is for nurses, working long days because someone hasn’t turned up for their shift (for whatever reason), working nights when they could be at home with their kids and families and working in difficult environments like mental health.

Local MP’s should spend a week on our wards (a day isn’t long enough), not just observing, but getting their hands dirty. Then they should shout from the rooftops of the Houses of Parliament or through Boris Johnson’s letterbox “Nurses deserve better wages!”

Current salaries for newly qualified nurses range from £22,128 to £28,746 (Band 5) with an annual 1% pay increase, NHS 2019. Our poor MP’s only receive around £79,468+, a 2.7% increase on last year. Boris Johnson’s promise of more money to the NHS, but let’s hope that includes salary increases befitting the job.

The NHS should also be thankful for these nurses, who often go short on breaks and who have to stay fifteen to thirty minutes longer most days. See, you can’t just walk out on a patient who’s upset, angry or crying, saying “that’s it, my shift’s done.” Following this interaction there’s the documentation to complete. You must document everything. I always taught nurses — if it’s not documented, it’s not done.

With regards to documentation the Nursing and Midwifery Council’s (NMC) The Code 2018; states:

10. Keep clear and accurate records relevant to your practice. This applies to the records that are relevant to your scope of practice. It includes but is not limited to patient records. To achieve this, you must:

NMC 2018

10.1 complete records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3 complete records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5 take all steps to make sure that records are kept securely

10.6 collect, treat and store all data and research findings appropriately

Our documentation and patient files are potentially legal documents whereby, if there was a serious untoward incident i.e. a patient died by suicide, they would be called for and used as evidence in the following investigation. You can’t just say afterwards i.e. “the patient told me they were happy and looking forward to visitors that afternoon, so I didn’t think there was any risk of suicide”. If you didn’t document it — it didn’t happen.

Whilst the above is one reason for appropriate documentation, it also informs colleagues on the next shifts or a nurse’s return to work from time off. It lets them know about the patient’s mood and mental state, what they may or may not have done the previous shift and any interventions you undertook.

Nurses are generally allocated around five patients each shift and after handover, the first thing a good nurse does, is read the last few entries in their patient’s notes and catch up on their care plans, which may or may not have been changed or updated.

Thegaurdian.com

However, the not-so-good and the downright lazy nurses had me tearing my hair out at time. Daily entries consisted of “Patient slept most of the shift.”

A nurse worked (well, they were in the building) an eight hour shift and that’s all they have to write?

Okay, so the patient might have slept most of the shift, but what did they do the rest of the time? Did the nurse try to wake them, encourage them to get up for breakfast/lunch, to attend an activity? And while the patient slept, did the nurse audit the patient’s notes to ensure everything was in order, i.e. patient name on each page, pages were numbered, care plans were up to date?

Even if the patient had slept most of the shift, surely you’d attempt some intervention, try to engage them. Even if they do tell you to ‘fuck off’, or yell ‘leave me alone’, write that — it shows that you have at least attempted to engage them. And don’t give up at the first hurdle, try again. And again. Then document it.

I’d tell patients that I was going to sing and tap dance in my heels if they didn’t get up, they’d half-laugh and eventually drag themselves out of bed. I also told them that we, as nurses, had a duty of care and that included providing a clean environment, followed with a cheery “Now get your bum up so we can change your sheets and clean your room!” I didn’t mind if they went straight back to bed once we’d finished but usually, once they actually got out of their bedroom, they tended to eat, engage with others or watched t.v. in the day area.

online.umn.uk

It really isn’t that difficult. And it also shows the patients that you care enough to keep trying. Patients really do know the difference between the nurses who just want an easy time or are bored and the ones that care, the ones who want to help, the ones who don’t mind getting their hands dirty. They noticed and had more often than not, experienced nurses dissociation and emotional distance on a daily basis. Quite simply, patients recognised poor nursing.

Some nurses I worked with appeared devoid of the critical ability needed to assess patients, to assess any risk and to provide appropriate care and treatment — other than medication. They lacked the observation, communication and interpersonal skills to engage with patients and they showed little or no empathy. They saw patient’s distress only as a set of symptoms (not a human being in pain), often calling them ‘attention seeking’ or ‘manipulative.’

When a patient became angry (appropriate to their current situation i.e. the nurse wouldn’t let them use the telephone when they needed to contact benefits etc.) nurses saw it as ‘kicking off’, ‘taking liberties’ or generally just getting on the nurse’s nerves.

Some nurses seemed to forget or ignore all the knowledge and skills they’d acquired at uni; their compassion, empathy and understanding had all but disappeared, or they’d just burnt out from all the extra shift they worked – through choice!

Let’s get something straight!

If you don’t want all the back-breaking physical work (left by bone-idle nurses on the previous shift), the constant demanding emotional interactions, the woefully tiring verbal onslaught that greets you each shift because their needs weren’t met on the last shift or the boring whining, repetitive complaints and the teeth kissing or tutting – and all that is from your colleagues only — then mental health nursing is not for you.

NMC 2010

Nurses have a responsibility to deliver consistent high quality care. They have a duty to promote good mental health and encourage healthy behaviours by building good relationships and gaining the trust and confidence of their patients, NMC; Standards for competence for registered nurses 2010.

Author: mentalhealth360.uk

Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

24 thoughts on “What everyone should know about mental health nursing”

  1. All true! And then – like you said – you need to clean up the actual mess or the mental mess your colleagues left behind.
    I once had an incident with a knife and two patients involved (and me) AND tree or four bystanders (patients!). Long long long story … my point is when I was alone on that shift and brought everything and everyone in safety and calm for the evening. I needed to … please sit down and hold your chair …. copy my own papers in the next bureau to fill the incident in. I was drained, had 26 others to care for in terms of medication and no I was not going to copy papers.
    And for me it wasn’t about the money at all (most nurses, health care workers don’t do it for the money) but when they invest less and less, the minimizing of the resources is being felt on the floor! It just breaks my heart.

  2. It’s always been the colleagues who lacked empathy that bothered me the most. Lazy was annoying, but lack of empathy just seemed so antithetical to the practice of nursing.

  3. Thank you for the work you do. I love the nurses I have come in to contact with throughout my life. When I was in active addiction it was their compassion that kept me from leaving hospitals AMA when I would feel the dope sickness kick in. Their compassion and honesty about what could very likely happen if I left with an active and severe skin infection or something related to my addiction that I let go too long because I was too fucked up to seek care in the first place. Seriously thank you!

    1. I agree Pete. I just hoped that nurses went into it because they cared. Unfortunately, many didn’t. We had the majority of foreign students in our cohort of 250, perhaps 70% and in later years colleague would report that they were the only British person in their class. While I appreciate immagration being good for the country, I wished Trusts sent teams of senior staff to schools and colleges in the UK to encourage locals (whatever colour, nationality or race) rather than sending them on a 3-4 week jolly to Africa for example. At the time I was studying, students were given a bursary and I think they need to bring that back. Caz x

  4. “If somebody is bad at a job, why would they even do it?”
    A counsellor many years ago told me she has found many nurses are attracted to the job for the wrong reasons (power and control) and some start off well but lose their way, maybe emotional fatigue/burnout.

    1. Thank you for commenting. I think your counsellor must have been right. I know it’s a tough job but it was the best job in the world – for me. I loved getting readyfor work, never knowing what the day would bring. I looked forward to seeing patients each shift would always let them know I was leaving to go home or if I’d be off for a day or two. I loved it and it’s such a shame that lot’s of nurses don’t feel the same – I thought they would? Caz x

      1. I was the same as you too. My best shifts were when someone was alone and afraid and I came alongside them to be with them and help them feel safe. I loved a shift where a crumpled, broken, patient in pain arrived and when I got to work I had the immense satisfaction of seeing them patched up in clean sheets, peacefully sleeping with all the furrowed lines in their face relaxed away at last. They looked like a whole new person!
        I was horrified at how people were treated when they had overdosed and made myself unpopular for sitting with them, silently just to be ‘present’ with them, or gently stroking their back as they vomit and cry (with their permission), offering them my services in any way that would help support them instead of punishing them by ignoring the obvious agony they were going through, not just that night but leading up to getting there in the first place.
        I suppose I wanted another human to come alongside me in my darkest, most scary times, to be ‘with’ me, remove my pain and give me comfort, and I know what that’s like to not get.
        To make a difference to another human in their darkest hour was an amazing honour and privilege, it was the best job satisfaction in the world. I was shocked by what I saw sometimes but on another level wondered what their journey might have been to end up in a place where there is no compassion left but replaced by a need to control and wield power over another fellow-human instead.

      2. Still no excuse though, of course! But does make it more explainable, especially when you see people who hurt people are hurting themselves. It’s harder to get your head around it when you can’t see any obvious damage, though perhaps it’s just very well hidden. Even if it’s a choice of: sad, mad, or bad, the ‘bad’ is still probably a damage of sorts (spiritual)?

  5. It may be a different system her in Australia. Here now we have to train as a general RN and then you can choose to work in mental health. You (at least when I was working in mental health five years ago) did not to be a qualified mental health nurse. I did a post graduate diploma several years after my nursing degree. I had worked though as a mental health nurse in community and hospitals without it. The problem I had when I moved to Tasmania, was I worked casually and as I would work in any ward and Emergency ICU Neurosurgery were usually areas most casuals did not want to work, I ended up there. Even though I kept saying can I please work in psych unit. I was told No because they could put an enrolled nurse (with no specialised training in mental health) down there on a night shift. I would be so disheartened, that in the end I did also do some community nights, which I loved. I recently asked the nursing board in Australia, if I did feel I was well enough to return to mental health nursing, if I would have to do a general nursing refresher course. (as after my breakdown my registratiion lapsed as I could not work the hours. I could not work full stop.) There was no answer. Mental health nursing is no longer a separated registration! Which in my mind says it all really that mental health nursing is not seen as a unique and specialised area. I loved my job in community, and especially on nights(12 hour shift 7pm=7am) as you were there when people were all back and sitting about watching tv or chatting or just sitting what ever. You could spend timewith them and have laughs and share. Then if someone was out of sorts or worried, anxious, sad you could spend quality time with the person. I always tried to write when things happened. ( I guess that was my training from ICU Emergency and Neurology. ) If I rang a doctor, and they did not come ect…Or if I did a round and I could hear someone moving about the room I would write patient or client up during night. (this was community units more than say a ward, or High dependancy units. I will never return to mental health nursing or any work now where i have to work with other people. I am triggered to easily by smells noises and pressure. I went to work on a night shift, in a rehab area, was due to work again the next night. Instead I woke up with a sodden pillow sobbing hysterically and unable to stop for hours got in to see a local gp, and never returned to work. Nothing happened that I can pinpoint at work that night..I was just left alone on the unit at handover and buzzers were going off everywhere and Ihad medications to give out. The morning Careres were late and all i could hear when I walked by the handover room was laughter, and a fourty minute handover!. That was the trigger for my breakdown.

    1. Aaahh, bless Tazzie. You too are one of the amazing people willing to lend an ear, an arm or shoulder to cry on when someone’s feeling so low. I don’t understand that mental health nursing isn’t a specialism – it is. It takes a different kind of nurses to look after people in their darkest moments and they need training to learn how to do this. And how you can be left alone on nights with all those patients. I thought we had it bad, only having three staff on. Do people really think that patients with mental health problems just go to bed and sleep all night? Wow, that’s an awful system and I do believe that would contribute to a nurse ‘breaking down’. Thank you so much for your comments Tazzie and though you’ll not return to work, like me, I’m glad you’ve found your gardening helps. Caz x

  6. I would have to say like many other places in the world Mental health nurses really are one in a million. I live in Canada and Mental health nurses as well as all nurses really do go that extra mile.

  7. I have many friends who are nurses and work in the mental health field. It is the hardest field to be in and I’ve heard stories from them. Stories of how some of their coworkers don’t empathize with the patients and how the good nurses get mistreated by the nurses who don’t care. My heart goes out to the good nurses. Thank you for another interesting and powerful piece!

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