By Emma Smith, ED/Critical Care Nurse and author of the blog ‘The Other Shift’ Interview with Mental Health Nurse Sarah
The ‘Other Shift’ is about creating a place for shift workers like Emma who might be battling sleep fatigue, struggling to exercise and stay healthy or finding the right balance between ‘you time’ and managing your relationships.
Emma’s interview with Mental Health Nurse Sarah.
In 2015, an estimated 4 million people experienced a common mental health disorder. With that number continually on the rise, more and more mental health nurses are needed to meet the demand.
As an emergency nurse, I’m frequently exposed to the acute challenges of mental health where emotions are often high and fear is prominent.
I want to share with you what really happens in the Emergency Department for patients who might be suffering from a common (or not so common) mental disorder and how a mental health nurse deals with the numerous challenges presented.
Today we interview graduate mental health nurse, Sarah, about her challenges, accomplishments, experiences and advice to those looking to venture into mental health nursing.
What kind of facility are you working in and how many beds are there?
I’m working in a hospital environment where we admit patients generally during an acute episode of psychosis, stress, depression, dependence or due to extreme situational events.
In our particular unit, we have 25 beds in total. There are 5 beds for intensive care patients needing 1:2 to 1:1 nursing ratio support and a further 20 beds in our lower dependency area.
These patients can stay with us for an average of 7-9 days, however, it can extend longer in accordance to their risks. They are then either discharged home or to places like supported community housing.
Follow up appointments are organised with Allied Health and similar outpatient services to ensure they are safe, supported and to help avoid re-admittance for an event preventable in the community.
What makes mental health nursing different from the ‘mainstream’ nursing you’ve done in the past?
Our patient assessments are heavily focused on patient presentation. This includes observing their mood, speech, determining risks, responses to different stimuli, medication compliance and behaviour.
Mental health nursing is not task orientated like a general ward. We don’t check drain tubes; measure urine output or auscultate lungs regularly. None of that matters in mental health nursing. What counts is communication and one-to-one time with patients – it’s a totally different ball game.
What are the main challenges you face working in mental health?
Three main things come to mind:
-To never underestimate a person according to their presentation. Plenty happens underneath the surface of a patient in mental health, so turning up to each shift prepared and ready for whatever a patient might throw at you (literally!) is crucial to your safety.
-I am constantly confronted physically, emotionally and mentally and that, at times, can be exhausting. Physically, I am caring for people who are sometimes much bigger, stronger and heavier than me and it can be intimidating. It’s during these times I need to be smart about my positioning in a room and always wear my personal alarm.
-I am also challenged emotionally and mentally. In the beginning, manipulation and being influenced by some of the ‘long term’ patients (patients who had multiple admissions in and out of hospital) got the better of me. I learnt quickly from more experienced nurses and from my own involvements what is tolerated and what isn’t. For example, when I should use my words to communicate or when I should use actions and touch for example to make a point. There is no handbook for every situation ‚ that’s what I like about it.
It’s really had to define what mental health nursing is all about. This makes it tough when explaining my job not only to my family and friends but also within the healthcare industry. I think the community is becoming more aware of mental health and help is more readily available, however it still remains a taboo subject.
How do you continually expose yourself to an environment when there is constant discussion about suicide, self-harm, violence, drug, alcohol, psychosis and remain so upbeat?
It’s true, I am continuously exposed to individuals who say or have done things which go against my own beliefs and ethics.
As challenging as this can be, I seek support from my peers and have learnt to compartmentalise my emotions and leave it at the door. Of course, sometimes stories and events make it past my internal ‘filter’ and it can effect me more than I’d like. But I try to leave everything at work.
I find comfort in the fact that pretty much everyone I have worked with has either felt the same or experienced a similar situation as me. It may seem a little twisted to say, but we bond through the not so happy times and it makes us stronger, both personally and as a team.
But honestly, the thing that helps me the most, allowing me to continually show empathy and care, is my amazing supportive life at home. A warm, secure place with close siblings and loving parents, is everything.
What do you enjoy about mental health nursing?
I’m utterly fascinated with the way the brain works and how it responds to different situations.
Before mental health, I had no idea how differently the brain could respond to medications and drugs, stressful experiences, emotional or physical trauma and even the good things in life!
When I was working in the general ward I was too busy giving analgesia, taking bloods, performing weight checks and documenting vital signs among a plethora of other jobs. I couldn’t pay attention to these vital cues.
The thing I love most about mental health is monitoring a person’s response to different stimuli and understanding what is on going physiologically. Being required to use different communication and de-escalation strategies is something I’ve learnt to embrace to ensure safety.
Once the acute phase has passed, I also really enjoy working with Allied Health to set up adequate discharge plans involving community services. The last thing our patients need is to be readmitted during their ‘crisis’ because we didn’t adequately set a plan for them, considering all potential pitfalls.
Our patients are often the isolated members in society with generally a realm of tricky issues, each requiring delicate consideration. I enjoy this process, despite how emotionally ‘heavy’ the issues can be, because you can be the difference maker that helps turn their life around.
What has been your most eye-opening mental health nursing experience so far?
There are a handful of confronting stories I have experienced in last six months which I simply cannot repeat. They are too emotional and thought provoking, so I’ve chosen to leave them at work.
But there was one experience that I can share that showed me a different side to mental health nursing.
I was doing my third night shift in a row and in the middle of the night the emergency button started shrieking from inside the fish-bowl-looking nursing station.
The emergency button is meant to be used by the nurses, so when we heard the alarm, we all ran out, because mental health nurses don’t just press the button for no reason. On our way out, we were confronted by one of our very experienced charge nurses who was standing in the hallway.
Holding onto her arm was a tiny lady, recently diagnosed with schizophrenia, who was refusing to let go. Her grip tighter than you can imagine in comparison to her small frame. This woman was terrified. The look of fear in her eyes was disturbing and a sight I won’t forget.
We ended up sitting with this woman, learning about her story and what horrible things she had experienced in her life. Suddenly, all her admission, delusions, psychotic episodes, outburst and previous behaviours we all observed started to make sense.
I thought we would have given her medication to calm her down, sedate her and simply wish her a good night. But we didn’t. Instead, we (as in every nurse on our unit) sat with this woman all night long. All she needed (at that moment) was company, support, touch and to feel safe.
This small, seemingly insignificant event showed me there is a person behind these diseases and delusions and it’s interesting what happens if you approach something differently.
How do you manage your shifts and what’s essential for your own self-care?
We work a rotating roster of 8-hour day shifts and 10-hour night shifts. I work 8 shifts across 2 weeks. This is a pretty common roster amongst our workplace and relatively easy to manage. Late-early shifts are tough to swallow though!
In terms of my self-care, talking about my job, particularly after a shift, is critical for me. Even if my audience (friends and family) cannot relate, it’s important for me to debrief and gain clarity. I also think I’m doing my part (even if small) to educate the public about mental health and to remove the stigma commonly attached to these patients.
Most days driving home from work, I will reflect in silence and think about the day I have just had. This is to ensure when I do get home I’m ready to kick my legs up and wind down. I often use oils like lavender and vanilla through a diffuser to help me relax, plus using a small fan in my bedroom to keep it cool and enable me to sleep.
Life outside work is a nice balance between exercising (boxing is my go-to), eating a healthy diet, catching up with my friends and watching total rubbish on TV like Married at First Sight. This is my down-time and is much needed for my brain to relax.
What has being a mental health nurse taught you, which you didn’t realise before?
This may seem a little morbid, but don’t assume just because somebody looks ‘normal’ or says they are ‘okay,’ that it actually means they are. You really have no idea what’s going on inside a person’s head unless you take the time to pay attention, observe and ask. My job has taught me to practice non-judgemental tactics, while picking up on discrete signs others may miss and figuring out what to do next.
It has also taught me how prevalent mental health is in our community. Every single day we have multiple patients waiting for a bed in ED or needing to be admitted by police. Mental health is a huge part of our society, more than I thought, therefore being more aware of mental health in day to day life is something to be mindful of.
Do you have any advice for nurses looking to start a career in mental health?
The public, your friends and even your family will not fully understand how or what you do in your job. It’s hard to define and explain when so much of what you do is observe, communicate, document, try a different method of treatment and observe again.
They will listen to your stories and try to empathise and rationalise your experience, but it won’t be the same as talking to another nurse.
My advice is to find support and a group of friends in the workplace you can confide in. Debrief, explore your feelings about certain events and seek help and guidance if feeling lost. If mental health is something that interests you, try it out. You might surprise yourself with how much you enjoy it. Mental health nursing may have a stigma associated with it from people who haven’t worked in the area, but don’t let that put you off until you give it a go.
Healthcare Australia has mental health nursing positions all over Australia. Register online to find a role that suits you – https://www.healthcareaustralia.com.au/registration/