01.06 Day in the Life of a Mental Health Nurse

Today we’re going to talk about what a day in the life of a mental health nurse looks like.

Let’s talk about how mental health plays such an important part of our lives. Mental health determines the choices we make, how we hold on to relationships and how we cope with different situations. It also affects our emotions, behaviors and our thoughts. I used to tell my patients that there was a fine line between my side of the nursing station and theirs.  I’m one bad coping skill and a traumatic event away from where they are on the other side of the desk. That helped put things into perspective for them when they felt like I thought I was better than they were because I’m mentally “healthy”, and it also kept me grounded. So, when the nurse in me sees someone making terrible life choices or things just don’t match up, I immediately question mental stability and it changes my approach.

There’s two different places where mental health nursing and treatment can take place. The first place is in the community. Bear in mind that mental health treatment includes substance abuse, mental health, or both. Usually in community mental health, nurses work in outpatient clinics. We work 8 hours a day, Monday through Friday, unless we work in a Methadone or Suboxone clinic, where nurses dispense these medications from dawn until noon every day. These clinics are designed to provide stabilization for opioid addictions, to reduce cravings and prevent relapse.

In the clinic we administer oral or injectable medications. Most of the injectable medications are IM for increased compliance, especially for those who are unsuccessful with taking oral medications. We also collaborate with the psychiatrist on staff, social workers and therapists assigned to the case, particularly for any changes that might be needed. We make a lot of pharmacy calls, especially when we fight the insurance company. And we need family to communicate about what’s happening outside of the clinic as well. Some patients are great at showing us what we want to see until they can’t fake it anymore, so we like to hear what’s really working and what’s not when we can. In some cases we may be required to visit a patient at home, depending on the situation and the person.

For every patient that walks through the clinic doors we monitor and document everything from vital signs to the kind of treatment they are receiving. Most mental health patients have medical issues as well and they tend to overlap. We want to make sure we are treating them in the safest way possible so we don’t aggravate any medical co-morbidities.  As we make changes, the patient’s care plan gets updated, so this can be regularly or once in a while depending on stability.

The other place mental health treatment takes place is inpatient. Nurses at inpatient mental health facilities also work 8 hour shifts because when we are working, we are responsible for the entire unit, so 8 hours is enough. Most people hear mental health facility or hospital and immediately see these images. These are not accurate anymore, we’ve come a long way. These days, the facilities look like a regular building with some safeguards in place, like locked units or furniture that’s too heavy to lift or fixed to the floor, or they are locked units in a hospital. We also try to discharge patients within 3-7 days, so being admitted is no longer a life sentence.

We have to get and give report just like any other facility. We are discussing each patient’s behaviors, moods, any medications they took or refused (PRN or standing), emergency codes and their supervision status. Let’s talk about the codes for a second. These can be medical (Code Blue), in which case the patient is sent out to the hospital with a staff member by ambulance, or they can be what you may know as Code Gray, where it’s typically an overly aggressive patient and it’s all hands on deck. In a psychiatric facility, we just call “Code” and the unit. We differentiate between a Code and Code Blue so that everyone knows who should respond. Medical personnel go to code blue, everyone available goes for a regular code.  We send Code Blue patients to the hospital because we are not equipped for medical treatment. There are no rapid responses in psychiatric facilities, but we do have what’s called a soft code where we make a phone call to another unit to send additional staff over if we see something coming. Supervision status lets us know who has what privileges. We have those who need a 1:1 sitter, those who need to have eyes on them at all times, and those who are free to roam the facility as long as staff is present.

During the shift, nurses perform both medical and mental assessments. Again, most mental health patients have medical co-morbidities, so we monitor both to ensure optimal care. Medication passes are a staple in the hospital and it doesn’t change because it’s mental health. Group activities are held by support staff and aides, however sometimes as nurses, we run education groups like medication and symptom management and positive coping skills. Working in a psychiatric facility means sometimes things can get a little chaotic. We try to de-escalate situations before they get to a full blown code but it’s not always possible. There are times where we have time and see warning signs, and then times it seems to come out of nowhere.

Our nursing notes document a lot of the things we report on for the next shift. PRN medications given, if any, patient behaviors, their attendance and participation in groups, supervision status and how it all relates to their discharge plan. These notes should be non-judgmental. Remember any note you write becomes a legal document. Everyone has an opinion but they shouldn’t be shared there. Keep it factual and to the point.

Mental health nursing takes on an entirely different set of skills. Assessment and interpersonal skills need to be on point! Great communication and observation skills are needed because most of our patients give off more non-verbal cues than they do verbal. Sometimes they don’t match so you need to have a good eye to know what’s really happening. If you don’t have empathy, patience and confidence, it’s extremely easy to get lost, frustrated or find yourself taken advantage of. This is also not a field that allows you to be judgmental or emotionally sensitive and still be successful. Be good at problem solving too. Understanding when and how to intervene can save you a mountain of code paperwork if everyone else is busy and you can step in to do what’s necessary. Lastly and probably the most important point is that mental health is emotionally and mentally exhausting sometimes. To be a mental health nurse you absolutely have to have a true interest in the field if you want to be successful.We love you guys! Go out and be your best self today! And as always, Happy Nursing!