What makes an excellent mental health nurse?
A fellow-blogger is considering a career in mental health nursing and asked what skills they would need in order to become a good mental health nurse. Forget skills for a moment, I’d suggest that certain attributes are required of good mental health nurses (RMN’s).
Perhaps you are or you’ve been a patient and you’re not sure what to expect of RMN’s? Whether or not you’re engaged in the mental health field, wouldn’t it be amazing if everyone had these attributes? Okay, that’s a big ask. But having these attributes can help make a difference; even in your own lives and relationships. ..
MH nursing is the most rewarding job ever, trust me. It’s a highly respected career and there’s always a demand for skilled RMN’s. It’s often demanding, challenging, stressful, and exhausting, but it’s never boring. If you’re considering a career in this exciting, ever-growing area of nursing, you’ll need to think about the attributes needed for mental health nursing.
Attributes of a good mental health nurse
It’s a given that RMN’s need a sound knowledge of the theories of mental health and illness. They also need to understand and apply current legislation, paying attention to the protection of those who are vulnerable. Furthermore, nurses must use their knowledge of patients to handover to multidisciplinary teams effectively, to ensure continuity of care.
However, there’s so much more needed to nurse patients who experience mental illness, and who are often distressed or confused. So now it’s time to put the knowledge books aside and think about the attributes of a good RMN.
Empathy helps patients with mental illness
Good RMN’s must have the ability to put themselves in someone else’s shoes, walk a mile in their shoes. Imagine the single parent being admitted to hospital and her children having to be fostered out? Or the married man whose wife leaves him — because of his clinical depression. What about the man who dresses as a female and everyone laughs at him? Try putting yourself in any of their shoes.
Try not to use platitudes like “Time is a great healer.” to someone who’s just lost their mum/dad or “It will all look brighter in the morning.” to someone who’s depressed. At best you’ll sound insincere and at worst, condescending.
Don’t offer unwanted or ill-informed advice either. Who wants to hear “Oh my mum’s neighbour’s grandson had that and he used to ………..” Or “When my friend had depression, she ……..” then go on telling your own story. This isn’t empathy. It’s not about you, or your friend! It’s for and about the patient, or the person standing in front of you.
Being Non-judgmental is essential
Of course, it’s in our nature to judge, and it can be a good thing, it’s how we make sense of our world. Sometimes we all make snap decisions about a person; based on their colour, race, religion and even small things like how they’re dressed. But doing so is not an attribute of a good mental health nurse.
Being judgemental alienates us from others, which is no good in a mental health environment because patients need to be able to trust that you’ll do your very best for them, regardless.
Good mental health nurses, and indeed people, need to look beyond the presenting facade and immediate appearance, behind which they’ll often find very human and tragic struggles.
You can help your patients by providing kind, nonjudgmental care that acknowledges all aspects of their makeup. Nonjudgmental, holistic care affirms the dignity of your patients and helps them have a voice in their healthcare, (Arkansas University, 2017).
You can disagree with a patient’s or friend’s choices or strong opinion but do it in a non-judgemental way. You could say something like “I hear what you’re saying and I appreciate your opinion, but I see it differently. Tell me why you think …………”
Communication skills are a key requirement for every good mental health nurse
Excellent communication skills are a must when working with confused, maybe angry, depressed, manic, or psychotic patients and their families. In fact, I think we can all learn about better communication skills.
We all, especially mental health nurses, need to be able to actively listen, to stay in the moment with the patient or their families. So, don’t immediately start preparing your answer to their questions — listen to the end of their ‘story’. The clue is often there; a small add-on from the patient —right at the end — but it may actually be the problem causing them the most grief.
Remember, there is so much going on for say a newly admitted patient, and their needs may be complex, often requiring support in several areas. They may be too fatigued to deal with things like finances and bills or pets, so you’ll need to communicate these needs to the multidisciplinary team.
You must be able to speak clearly and concisely to the patient, asking if they need clarification or more time to think about what you’ve just said. Active listening and paraphrasing what the patient just said, makes them feel heard, understood and cared for. This is crucial attribute of a mental health nurse.
You need to be able to look, to see the patient, and sometimes the family dynamics, in order to gather information.
Observe facial gestures to see whether they’re smiling, nodding, frowning. Observe their posture; are they slumped, sagging shoulders, dressed appropriately for the weather. You might observe that the patient smells unclean and his teeth haven’t been brushed. You might notice that the patient is sweating or has a fever, and understand that you have to take action.
“By using your eyes, ears, nose, touch and knowledge of what is ‘normal’ for the people you care for, you can identify potentially serious changes in mood and mental state and take action early on.”The Royal College of Nursing (RCN)
“Compassion is usefully described as a sensitivity to distress together with the commitment, courage and wisdom to do something about it.”Cole-King & Gilbert, 2011
It’s a genuine sympathy for hardship or suffering. It’s kindness and the simple act of showing it can make a world of difference in a patient’s day. RMN’s come into people’s lives when they are in distress and vulnerable, and how they treat patients, and their families can leave a lasting impression.
Accepting differences and finding things in common help you relate to a patient/person, and what they might be going through. You’ll be showing them a kindness they might not get elsewhere, and despite them being mentally unwell, they will appreciate and remember it.
Leaving your own world at the front door, and just being there in the moment with a patient encourages openness and mutual trust. These small acts impact on a patient’s emotional responses and their view of the care they are to receive.
Sometimes mental health nurses are the only person they have to listen to them and take their illness seriously, which is why compassion is key. It’s always at the forefront of what nurses do.
Treating yourself and your colleagues compassionately goes a long way too. If we can’t look after ourselves, how then do we look after patients?
If you are a nurse commitment must be on your list
Commitment in nursing is about providing the best care available at all times. You must commit to building positive and trusting relationships with colleagues and patients and their significant others to promote continuity of care.
A nurse must be able to make the patient and families feel valued and cared for, and feel safe in the nurses knowledge and skills. Therefore a good mental health nurses must stay up to date with all relevant practice and be committed to lifelong learning.
Continuing professional development that focuses on compassion will enable delivery of excellent patient-centered and evidence-based care. Moreover, good mental health nurses must commit to taking good care of their own physical, emotional and mental health. If a nurse is not okay, how can they expect to look after their patients
How a good mental health nurse must have the ability to stay calm in a crisis
If you can keep your head when all about you are losing theirs ………. by Rudyard Kipling comes to mind. It’s imperative that qualified mental health nurses have the ability to remain calm when dealing with emotional outbursts or challenging behaviour.
Being calm will be beneficial to both you and the patient. If you’re panicking or flapping about, the patient will feel it and they too might become distressed.
Knowing how to interact effectively with different types of people will help to de-escalate or diffuse a potential risk situation and avoid having to use ‘Control and Restraint’ techniques on a patient.
Emotional intelligence: A mental health nurse must have the ability to understand her patient’s emotions
Emotional Intelligence (EI) is described by two researchers (Peter Salavoy and John Mayer) as the ability to
- recognize, understand and manage our own emotions
- recognize, understand and influence the emotions of others
In practical terms, this means being aware that emotions can drive our behaviour and impact people (positively and negatively), and learning how to manage those emotions – both our own and others – especially when we are under pressure.
An RMN, must remain calm and use their EI if there’s ever a challenging situation where a patient becomes aggressive or physically threatening. You’d need to take in everything and everyone around you immediately to ensure the safety of the patient and others.
Noticing, understanding, and managing one’s own and other’s emotions can be used to effectively engage the patient and bring calm to the situation. You might say to the patient “I hear what you’re saying……. I can see that you’re angry. What can I do to help? What would you like me to do?” “Would you like to sit with me and I can listen?” What else might you say?
Adaptability – Nursing in a fast paced environment
Adaptability or willingness to change in order to suit different conditions is necessary in an ever-changing work environment, particularly in nursing. An RMN will meet people who are often misunderstood by society, including their friends and family. Therefore, RMN’s need to adapt quickly and easily to new patients, different disorders and changes in moods.
There’s also new students, new mental health nurses, change in Junior Doctors every six months, new procedures and policies…………… The list is infinite end ever-changing, as is mental health environment. RMN’s must be flexible, be curious, be open-minded, and able to see ahead and have a plan B.
The above attributes are essential though this list is not exhaustive. There are are many more personal characteristics such as being warm, engaging, and considerate.
Over to you
I wish I could say I observed all the above in practice during three years of study and fifteen years of working within mental health. What do you think? I’d be interested to hear your thoughts and I’m happy to answer any questions.