The ugly truths about mental health nurses

Shocking ugly truths about our Mental Health Nurses

Coloured image of the Nursing & midwifery Council's The Code
Ugly truths about our mental health
nurses who neither meet nor maintain
expected standards

Have you ever been an inpatient on a mental health ward? Have you come across washed out nurses who’ve either lost the ability to care, or they never cared in the first place? I wasn’t a patient. I was a nurse. And unfortunately, I witnessed many shocking ugly truths displayed by some of our mental health nurses. More appalling however, was the response (or lack of) of their managers and their modern matrons.

Our Nursing and Midwifery Council’s (NMC) The Code (2018) contains the professional standards that registered nurses must uphold. This is a nurse’s bible, whatever your faith or religion, and all standards ought to be reached by the end of your three years pre-reg training. Moreover, you should be committed to upholding these standards throughout your nursing career. Essentially, through revalidation, nurses provide evidence of their continued ability to practice safely and effectively.

“The Code provides a clear, consistent and positive message to patients, service users and colleagues about what they can expect of those who provide nursing care.”

NMC, 2018

Who oversees our mental health nursing standards?

Black and white image of man with hands on a wall, head down
Patient experiencing mental illness —
ugly truths about our Mental Health Nurses

Now, I’m not sure the above-mentioned patients and services users ever get to see this Code; it’s not given to them on admission. Therefore, I don’t believe they do know what to expect. Okay, imagine for a second that they’ve seen The Code and the standards of care provided don’t match up. Do you think patients are in any fit state to ensure nursing staff uphold these standards? No? Me neither and I think it’s up to the profession itself to effect, maintain and monitor these standards.

While I agree patients ought to be able to expect certain standards, they’re often too unwell to notice. Many of our inpatients suffer from a wide range of mental illnesses including bipolar, schizophrenia psychosis, personality disorders, and depression. They might be confused, drowsy due to the effects of medication and sometimes angry because they’ve been detained. Expecting anything might be too much!

Most inpatients are on a section of the Mental Health Act (MHA 1985). This is a law that requires patients to remain on the ward for assessment and also treatment. Some patients are informal, which means they gave consent for admission and can come and go as they please.

Nurses should be doing more

As a new nurse I was excited and couldn’t wait to uphold the standards and expected the very same from my colleagues. Patient care and safety were, as expected, my (our) main concern. It was up to me (us) to ensure patients’ needs were recognised and assessed. However, how can patient needs be recognised if staff don’t actually spend any time with them?

While well aware that our wards were often oversubscribed and our patients could be chaotic, it p’d me off seeing how little time nurses spent with their allocated patients. Moreover, their half-hearted attempts at engaging with patients were sadly reduced to the odd casual nod or fake smile.

No wiggle room to meet everyone’s every need

Coloured image of lady in jeans and blue jumper taking notes. Female with pae trousers sitting with her hands on her lap
Mental health nurses — Image from Medpagetoday.com

Each shift, we’d be allocated five patients to look after, on top of which, one nurse would coordinate that shift. One nurse might be in Ward Round and one nursing assistant (NA) would hold the Rapid Response radio (attending to crises elsewhere). The fourth member of staff, an NA, would be on the floor, and completing the hourly checks (ensuring patients are safe).

Obviously, this didn’t make it easy for nursing staff to spend long periods of time with their patients. However, we were fortunate when we had good nursing students to help out by chatting to patients and feeding back to nursing staff. Or they’d help coordinate the shift, releasing the coordinating nurse to spend time with their patients. Students would be answering telephones and constantly unlocking the door to let people in or out of the ward. Patients loved having good students on the ward because they usually had the time to chat.

Nurses could work smarter

Staff ought to have allocated tasks to students which would then free them up. They could have used that time to spend with a patient and to document more than a line or two in their notes.

Still, even with time to spare, we’d see staff flicking through patient’s magazines or settling themself in front of the t.v. Then you’d see a one line entry in patients’ notes saying “Mary had a quiet day. Stayed in her room throughout the shift.” Did this nurse speak to Mary? Had they asked if she wanted breakfast or lunch? Did they ask Mary how she felt or whether she needed any support? Who knows, because if it’s not documented, it didn’t happen. So — not only did they not speak to that patient, they obviously didn’t give any care either.

Not every day you get to see such sights

Coloured image of lady at her computer
Ugly truth about mental health
nurses — planning holidays

I think because I was older than your average new nurse, I got away with tongue in cheek remarks directed at lazy staff. “Are you on shift today Monica?” when she was clearly organising her whole year’s holidays on the only nurse computer we had. Or “There’s beds to be changed if you’re bored Ade?” I’d say with a grin. That got them of their backsides, and their tutting or heavy sighing never deterred me, “…….. and Sidney needs support with his toileting when you’re done,” I’d chuckle.

Harsh? Maybe, but like I said to my colleagues, if I’m cleaning up shit, so are you! I wouldn’t expect staff to do anything I’m not prepared to do myself. And for the nurse who said of a patient who’d spent her night rolling around in her own excrement, “No, she didn’t do it deliberately.”

And like, “Just to get attention and pee you off?” Duh! Evie had faeces up her nose, in her ears, dangling from her eyelashes and under her nails. Safe to say, she was covered poo. I’m certain this unfortunate young female would have been horrified to know she’d been rolling around in her own mess.

“No, I’d never seen a sight like it either but you didn’t have to yell at her. The girl didn’t know who or where she was. Yes, I also gagged as I donned plastic bags over my feet and hands before rolling Evie onto a sheet. My back hurt too as we dragged her out of the bedroom, into the shower room. But I didn’t make it obvious by heaving dramatically in her face every five seconds.”

And to our manager “Nice of you to retch theatrically then walk on by when you came in late that morning, for the millionth time.” Ha! Now that’s another post — what’s the point of ward managers?

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Over to you

Large red question mark with little white character leaning against it - pondering
Clipart.com

As a new nurse, what would you have said or done? Would you feel able to call out your colleagues? What might a new nurse learn from this post? I look forward to hearing what you think and any questions are welcome.

This is a true account from my perspective and all names have been changed to protect the lardy arsed staff and save them from any embarrassment.

Testimonial

 “If you’re looking for a hard-hitting evaluation of the mental health profession with a sharp wit, please stop by Caz’ blog. She writes pieces revealing the challenges and problems in mental hospitals from first-hand experience as well as examining different mental health diagnoses and taking on the myths around them. Not the kind of myths I cover, the kind that hurt. Thank you, Caz. You are an amazing, courageous person.”

Kindly written by Ceridwen at Illuminating the fools mirror, 2020.

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.

39 thoughts on “The ugly truths about mental health nurses”

  1. To tell you the truth that though I am not a doctor or a nurse that you can not give of something you do not have …You could not uplift the mood and emotionally help anyone in the hospital before you care for your own well-being and balance first …
    This is why in developed countries like Germany and Sweden , the law allows employees to get at least 20 to 30 days of paid leave to refresh their energy ( I do not know if nurses do get a paid leave as well there ) …

    1. Thank you for your comments, appreciate, as always. Yes, I agree – you must look after your own well-being first! You’re no good to anyone if not.
      We had what was called ‘Duvet Days’ but the amount was at the discretion of management. And it was paid 🙂 Caz

  2. I hope that hospitals would be also built in places outside cities though not far from cities but clise to nature that has a relieving and refreshing effect …
    If you agree or disagree , it would be good to share your point of view …

    1. Oh, I definitely agree. Of course both patients and staff would benefit from being in such surroundings. However, I think then you would get complaints from patients and visitors that it’s too far from home 🙁 What do you think?

      1. It could be another option as a plus for people who live nature while leaving the the other option within the city itself as well for people to choose what they love the most …

      2. I have read that in San Francisco in California are growing fresh fruits and vegetables on rooftops as natural remedies and cures from vegetables and fruits that could help balance our energies and so our psychological well-being…
        I told you or not that I do not remember now …

      3. Nope you haven’t told me before 🙂 That sounds like a great idea. We were lucky in one area I worked in – the Day Hospital. We had a massive garden and used to grown plants, flowers, herbs and small vegetables with patients. We’d use them to make lunch to share with everyone. Patients loved it 🙂

  3. I had no idea a nurse’s work with these patients. First-hand information as you are experiencing it live for your profession. I regret what happens in the cases you report. A complaint that must raise awareness.
    It’s a very interesting article. I hope you are well.
    Manuel

  4. That is consistent with my memories on the stroke ward. Some very good care, some very bad. Unfortunately, it is the bad stuff that sticks with me – the good was nothing more than expected. But that’s how it should be, isn’t it? Another observation was that it generally boiled down to people. If something bad happened, it wasn’t just a good nurse having a bad day – you could pretty much guarantee that nurse would be crap, whenever they “helped”. The interesting thing was how the other staff picked up on this – so-and-so would be trusted to do such-and-such a job, but so-and-so wouldn’t.Looking forward to your next post, that is something I experienced too!
    I’ll never forget I met a couple of Italian nurses there who were excellent nurses, and I can’t help but wonder what became of them because of Brexit. It breaks my heart that the people they want to get rid of are the same people who would care for them when they were ill.

    1. It’s dreadful isn’t. The ‘good’ is how it should be! You’re right. And of course – it boiled down to the people! I really don’t think any of them actually gave any thought to patients when they went into nursing. It appeared to just be a job for many and we know, nursing isn’t like that. You’d hope they all go into it because they care and want to look after people?

      It was just laziness of nurses and managers who couldn’t bothered to ensure their staff provided the care needed.

      I agree also, that it wasn’t all the nurses all of the time and we had many great nurses from around the world. Yes it will be a shame if they can’t continue because of Brexit. But I would think that if they’re good, their managers would want to keep them and fight for them to be allowed to stay. 🙂

  5. Be the change you want to see in the world as Mahatma Ghandi has said…
       Sending prayers of peace , prosperity , love and justice to the world including all …

  6. It’s always puzzled me why nurses who don’t appear to actually care about patients would choose to go into mental health nursing in the first place.

      1. I don’t know. I’m sure some people got cynical over the years and didn’t start out that way, but there’s others who don’t dappeared to have ever cared.

      2. That’s true. But most people would seek other employment if they hated their current job? I know many staff stayed with the NHS because of the benefits and their pension!

      3. I think nurses should take paid leave for at least 30 days per year …
        Nurses should also be monitored to check if they are really well before going to work …They are human beings who have like any person light and dark side and ups or downs .They have the right to live in a convenient way and be taken care of like being encouraged ,taken care uplifted and treated well to in return give back to society what they can …
        I feel grateful to people who offer services especially when done with love and for the general good of all …

      4. We had lots of annual leave, duvet days, paid sick days, other paid days if a family member died etc. I think we had lots of paid leave in the NHS.
        Because we worked for the NHS mental health trust, there were lots of support systems put un place for staff – so that shouldn’t be the problem. What was problematic was getting staff to understand they needed time off – most wanted to work lots of overtime to make more money. When I was made a manager, I stopped that. I wouldn’t allow them to work more than normal hours if I didn’t think they were fit. Also, staff complainedd if you dared to suggested they needed support or to look after themselves – they would get really angry.

        No, it’s not all the nurses. But having bad nurses impacts on everyone’s workload and the patients 🙁

  7. I’ve seen and experienced both good and bad in places.

    As ones have said, for some it seems like just a job to pay the bills.
    To others, it’s not about money, it’s about the care of the patient and you can literally tell the difference by their quality of care.

    I also think it’s a shame that because of some bad nurses or doctors, sometimes all the actual decent ones then get painted with the same brush.

    (However that’s not to say that the bad examples do not need to be made aware of, because they do, as this could directly involve somebody’s wellbeing and life).

    I would think in such a job, their own self care is also essential so that they can care without wearing themselves out too thinly. It must be a difficult balance to reach.

    1. I’m glad you’ve had some good experiences too. And I’ve no doubt at all that patients can tell the good from the bad. They don’t have much of the day for sometimes weeks on end so they’re able to observe staff!

      Yes, I agree, staff need to look after their own well-being too but you try telling them that or even suggesting it. You get “Why what’s wrong?”, “You’re picking on me.” Yelling “You think I’m not capable to do my job?”

      Within the NHS, they have all the opportunities in the world to be able to approach their managers or HR to say they need a break or more support. You’ll find that the staff who don’t care won’t even look out for their own mental health. They stay stuck – and everyone suffers! 🙁

  8. Interestingly, as a patient, the worst nurses were the ones who’d get angry at me in the ER for overdosing. They always acted as if I was a nuisance who didn’t deserve medical care compared to the other ER patients, who couldn’t help their car wrecks, or whatever. At one point, some nurses were so negative to me that I developed a many-years nurses phobia that didn’t end until I went to the ER with pneumonia and, surprise surprise, the nurses were freakin’ nice to me. Geez Louise.

    But once on the unit, I never had any really bad nurses or encounters that were too upsetting. Mostly the staffers were nice and helpful, especially the times I was a teenager on the teen unit. They’d take an interest in us and try to boost self-esteem. I still remember one who complimented me on my ability to whistle the theme song to “Murder, She Wrote” (which we watched on unit) quite well. They’d show us videos about how to be assertive and keep us entertained with fun activities–stuff like that. As an adult, the two times I’ve been on the unit were more boring and less stimulating. Just, like, well get better so you can go home already. Still, though, no terrible nurses or anything, but they’re out there!! [Nods.] Maybe they’re all in the ER!! Not sure!

    1. Yes, ER nurses have a lot to answer for. I went over to ER one day before work cos my GP sent me. I could barely breath and the stroppy nurse saw my mental health badge and said “oooh, what’s up love, tired of sitting around smoking and chatting up patients. Come over here to see how it’s really done.” I couldn’t breath otherwise he’d have a got a mouthful!.
      Ha, he soon shut up when he saw my sats (ogygen) was way too low and I was admitted for two weeks. The nurses weren’t good over there either.

      I’m glad you had good experiences on the mental health wards. Particularly as a teen cos it must have been very frightening for you. They generally have more activities and join in with patients there too.

      The adult wards can be boring and yes, the nurses just patch you up and let you go 🙁

      Obviously it’s not all the nurses all the time…………. Thanks for your thoughtful and honest comments Meg, much appreciated. Caz x

  9. It does seem like from a patient’s perspective, visiting or staying in any medical facility these days is mostly about waiting for someone to show up. Even in the emergency room, it can take an astonishingly long time to get any attention. I realize this is in large part because of under-staffing that leads to burnout that only worsens these issues, but it is very frustrating. From the sound of it, from both sides.

    1. oh yes, the waiting………………
      it can take forever…………………… just to be seen, let alone get the treatment you need. There is the short-staffing and burnout. But in some nurses, I think there’s an element of ‘power’, a lack of understanding, empathy and compassion 🙁 Caz x

  10. I was inpatient in a hospital in the States once, it was a Behavioral Health ward but everyone referred to it as the psych ward when I was there. I think overall my experience was on the positive side, but one thing I noticed about my nurses is that some of them seemed like they actively did not want to be there. And that’s not when I could spot them, I noticed it during my interactions with them! Since I didn’t know how nurses ended up working on that floor, I didn’t know if they were forced to be there, but some nurses made me feel like they didn’t have a choice.

    1. Sorry to hear that you spent time on a ward, but it seems you had a positive experience, which I’m glad about.

      Wow, maybe it’s different in the the States Nathan. Here in the UK, you study to be either a general nurse, a midwife or a mental health nurse and you go on to apply for jobs in your chosen field. I could imagine if nurses were forced to work in an area they hadn’t chosen or didn’t like, no wonder they appeared like they actively didn’t want to be there.

      That’s what I don’t get in the UK. They trained for the job but they appear not to want to be there and work with patients. That makes me cross.

  11. Oh I know! When I used to be interested in a story of a patient I was told that I was too much of an ’empath’. I’m a psychologist for crying out loud.
    I used to watch tv too, but together with the group and I observed how people reacted (or not) to certain topics, what they understood and what not, how their world melted together with reality and rapported on that. But yes, I watched a lot of news on certain wards 🙂
    Working with mental health is like the X-factor, you get it or you don’t.

    1. Lol 🙂 Too much of en empath? What the?

      Yes, watching tv with patients is great, especially in the same way you were doing – observing and assessing both mood and mental state. Of course this is fine. It was the nurses who sat down to watch their own soaps and programmes, not the patients, that p’d me off.

      X-factor lol x

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