Nursing Interview: Insight Into the Role of a Psychiatric Mental Health Nurse at a Major Hospital

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Interview with Angie Best-Boss

Q. Where do you work? What is it like?
A. I work in one of the largest multi-site hospitals in Indiana, there are a total of nine psych units, which is really unusual. We have 110 beds attached to the regular hospital.

I work primarily in the affective disorder unit but I float all the time to other units. My second favorite unit is the psych intensive unit. On a med surg unit, a nurse is assigned a handful of patients, and they do all the care for those patients. On psych floors, we have far fewer nurses. For example, we have 20 beds and two nurses but we also have a mental health tech to help.

Q. What is a typical day for you?
A. Typically, we divide up our responsibilities so we have a charge nurse and a med nurse. If you’re the med nurse, that can easily consume your day. If I’m passing meds for 20 patients, it’s a two hour job. People don’t leave their medical problems at the door of the psych unit. If you’re a brittle diabetic coming in, you’re still a brittle diabetic.

The truth is, people die on the psych unit. We had five deaths in the last year. Sometimes patients’ physical conditions are exacerbated by their mental illness. We had a brittle diabetic patient who always had blood sugars over 500, no matter what we did. We found out he was hoarding sugars from the kitchen, it was part of his suicidal ideation. It’s much more complicated than simple medical management.

Or we might have people on the addictions unit who are actively detoxing and the trick to figure out, is this symptom from the bath salts, or the ice or whatever they were taking, or is this part of the detox process, or is this their baseline.

Q. What do you like about your job?
A. I love my job because every day is different. I might get called to a code, someone is acting out and aggressive, suddenly it’s a crisis situation, and it’s very high intensity high adrenaline rush. Or, I might have an opportunity to sit and talk with a patient for half an hour, process through old stuff, issues from their childhood.

Q. What are some of the challenges of being a PMH nurse?
A. Well, I don’t love it when the person with the colostomy bag throws their feces. And there are some units I can’t wear my hair in a pony tail, because it’s a handle. Of course, there are patients I don’t like, patients who have made choices that hurt other people in their lives, sex offenders. There are times when difficult patients are hard to feel compassion for.

Q. What traits make for a good PHM nurse?
A. Definitely having a thick skin, I always say my shift hasn’t started until I’ve been called a fucking bitch. Especially in the psych ICU or on the addictions floor, patients feel horrible and out of control or if they’re detoxing they’re really physically miserable. So they feel out of control and they are going to call you names and they’re going to pick on your most obvious physical aspect. I’ve seen more than one student nurse leave our unit crying.

At the same time, you can give patients a real gift, by listening and helping them to be healthier. I get to be a part of someone’s life at the worst part. That’s a gift and honor and privilege and I want to do right by that.