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Just as a patient with severe mental illness often has to deal with great stigma because of public misunderstanding of mental health challenges, psych mental health nurses have to deal with stigma in their chosen specialty. Some common misconceptions (and the corresponding truths) include:

Myth: Psych nurses are not “real nurses:”

Truth: Patients don’t leave their pre-existing medical problems at home when they have a mental health crisis, so psych mental health nurses deal with common nursing problems every day. As Angela Best-Boss, an Indiana psych mental health nurse says “Of course, I do IVs, catheters, enemas, assessments, I call codes. I manage seizures and other crises.” Patients with mental illness present with co-occuring diabetes, cardiac problems, non-healing wounds and host of other acute and chronic medical conditions.

In fact, according to the National Alliance for Mental Illness, adults with serious mental illness die 25 years earlier than people without serious medical illness, most often due to under-treated, underlying medical conditions. Because of this, psych mental health nurses actually need finely tuned specialized assessment skills in order to support patients with severe mental illness in efforts towards health.

Myth: Nurses are attracted to psych mental health nursing because they are a “little off” themselves.

The Truth: Trudy Best, a psych mental health nurse who works in a California psych emergency room has a simple explanation for this myth: “people are afraid of psych patients, so they’re afraid of psych nurses too.”

Because severe mental illness is mostly based on observation and patient self report, the general public and specifically the health care establishment, can be especially judgmental of mentally ill patients and even those who work with them Health care providers often can’t see that there is an actual nursing process at work on the behavioral health unit, so it remains mysterious and unfathomable and seemingly random.

“Sometimes nurses on med surg floors have to deal with a psych patient who isn’t medically cleared to come to us and they’ll be literally at wits end having to deal with them for a single shift” explained Ruth Bowens, a psych mental health nurses from Illinois, “so they just can’t imagine doing it all the time. They don’t realize that we have procedures and processes to try and maintain a therapeutic environment. They think we’re Nurse Ratcheding all day.”

Myth: Every behavioral health floor has at least one Nurse Ratched.

Truth: A nurse who acted like the character Nurse Ratched in the 1975 film One Flew Over the Cuckoo’s Nest would most certainly be fired and would probably lose her license as well.

Regardless of the over the top portrayal and its non basis in reality, the Nurse Ratched character did more to harm the reputation of psych mental health nurses than probably any other media portrayal of nurses.

For example, Nurse Ratched, a manipulative controlling character who commits HIPAA violations at the rate of approximately one per minute (the movie was made pre-HIPAA but certainly not before patient confidentiality) responds to a gruesome patient suicide with a shrug.

“The best thing we can do is go on with our daily routine,” she adds, using none of the therapeutic communication techniques she would have learned at least in nursing school. She also didn’t fill out any paperwork, putting her actions firmly in the realm of complete fiction.


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