Nursing Interview: Field Veteran Lends Advice on how to Flourish as a Psychiatric Mental Health Nurse

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Interview with Donna Luongo

Q. What is your current position? How did you come to be in this position?
A. I am a charge nurse at a behavioral health hospital. [The hospital] includes adolescent and adult psych as well as detox and drug and alcohol rehabilitation. We are also cross-trained to handle any admissions evaluations to make sure we are admitting patients that are medically stable.

Q. What is psychiatric nursing?
A. Psychiatric nursing is dealing with patients that appear to be healthy but suffer from various mental health issues. Some that we deal with are behavioral issues, depression, post traumatic stress disorder, bi-polar disorder, dissociative identity disorder, schizophrenia, borderline personality disorder, OCD and many many more. More often then not these psychiatric conditions co-exist with some sort of drug or alcohol dependence. These are our dual diagnosis patients. Unfortunately we find that since there is still such a stigma associated with mental health issues these patients try to self medicate using drugs or alcohol before they realize that this does not work and only then do they seek out help. Also we find that sometimes even the patients themselves are not able to accept the psychiatric diagnosis and therefore it makes treatment for the underlying condition even more difficult.

Q. What did you do as a PMH nurse on an average day?
A. There is no average day. For the most part, as the nurse you can be doing anything including meeting with the treatment team to come up with a treatment plan, patient assessments, dispensing medications, evaluating patient safety levels, ordering labs, 1:1 processing with patients, getting extra blankets, running groups, and just listening to patients.

Q. What is the most fulfilling aspect of working as a psychiatric nurse?
A. Seeing a patient who may have come in disheveled with poor ADLS (activities of daily living) in a manic state be able to just shower and brush their teeth by themselves. When we get patients that are psychotic all the “normal” tasks a person completes in a day are just too overwhelming and they are not able to do these things. Seeing them come to the point that they can have a conversation, or just sit still for five minutes gives you a little sense of “Wow, we are helping.”

Q. What are some of the challenges of working as a psychiatric nurse?
A. There are really two main challenges: remembering that while our patients look well they are in need of our help and staying out of power struggles. I hate hearing our patients called “crazy.” Just because they are not post-op recovery patients doesn’t mean they aren’t sick. Unfortunately, it’s not the kind of sickness that you can test for.

They are mentally ill and there is no vital signs that will show this. We have to realize that when our patients come in, we take away everything. We take their phones, their shoelaces, their underwire out of their bras, we tell them when to eat, when to wake up and when to go to bed. Sometimes when a patient asks for something as simple as an extra creamer for their coffee it is vitally important that we help them because this may in fact be the only thing on that particular day that the patient feels they have control over still.

The other thing that we fail to realize is that a person who wants to harm themselves will find a way to do it with virtually anything. We go into healthcare usually because we have the desire to help people. Our patients are special people and we as the healthcare professionals have to remember that even just giving the patient a rubber band or something equally as trivial, we may just have handed them a weapon that they can use to hurt themselves. That was probably the hardest thing to get used to. When a patient asks you for something you have to step back and evaluate “why?” before making a decision.

Q. What traits make for a good PHM nurse?
A. You have to be able to leave your judgment of others at the door. Regardless of what a person has done in their life, it is your duty to care for them the same as you would any other patient. You have to be patient, kind, and true to your word. If you tell a patient you are going to come back to talk to them in ten minutes, you have to do it. It’s easy to get busy or sidetracked, but most of our patients have been “wronged” in their mind by everyone in their life so you have to be true to your word and as honest as possible.

Q. What advice to you have for someone who is considering going into psychiatric nursing?
A. If you don’t love it, don’t stay. The only worse than a nurse who doesn’t care is a nurse who is jaded. This is not therapeutic to the patients and you would be doing them a great disservice.