"I'm so happy that I'm here . . . my prayers have been answered. I will retire from here." Such are the sentiments of Nora Fabrigar, RN, Charge Nurse at White Memorial Hospital in Southern California, regarding her career in psychiatric nursing, also known as behavioral medicine. Psychiatric nursing offers an abundance of intrinsic rewards, but is not without significant challenges, including the stigma of mental illness and lack of public awareness. Other frequent challenges are non-compliance in patients with their medications and other directives, which sometimes may result in violent acts among patients or even towards staff. This doesn't deter nurses who are passionate about psychiatry, however. To these devoted nurses, the benefits of psychiatric nursing far outweigh the drawbacks of this often intensely challenging field.
After eight years working in emergency medicine, Nora was inspired by a family member who ran a 71-bed "board-and-care" (residential) facility for recovering psychiatric patients. "She treated her residents like family," Nora explained of her Aunt, who managed the facility before retiring. She gained mutual respect from her very ill patients, enabling her to provide the best care for them.
Ironically, Nora states that she really didn't care for psychiatry and psychology courses while in school, and she didn't even consider psychiatric nursing as a career initially. But her experience with some psychiatric patients in the emergency room, coupled with her Aunt's inspiration, ignited a passion to work with these challenging patients.
However, having no significant amount of experience in psychiatric nursing, getting hired in the field was tough at first. After applying for several psychiatric positions and being turned down due to lack of experience in psychiatric nursing, Nora began studying the field in detail and researching the skills and knowledge she would need to succeed. Then she found White Memorial and just clicked with the team there. Although Nora had eight years of nursing experience in emergency medicine, she still had to convince the management team at White Memorial that she was qualified for the job. "I begged and begged and they interviewed me for a very long time." Nora also agreed to additional training and studying to further qualify herself for the role. That was five years ago. "White Memorial has an excellent management team, support system, and training," Nora explains, "I have learned so much here, and now I am Charge Nurse too."
Nora's promotion to Charge Nurse gave her added responsibilities in her role. "I am a team leader, I help with staffing and scheduling, and also we do the treatment plans and reports at the beginning of the shift." As Charge Nurse, Nora also consults with the medication nurse, the psychiatrist on staff, and the social workers and other members of the treatment team.
Working with psychiatric patients is not for everyone, Nora advises. "Your heart must be truly in it, and you must sincerely want to help these patients." One of the greatest challenges for psychiatric nurses, according to Nora, is when a volatile patient becomes violent. It doesn't happen often, and you learn to assess the verbal and non-verbal cues and signs to prepare for an outburst, but "I was scared at first," Nora admits. She feels that this is a common fear that may deter some nurses from pursuing careers in psychiatric nursing. However, with teamwork and guidance from a strong nursing and management team, nurses learn how to prepare, and how to manage a potentially dangerous situation for a positive outcome.
For nurses like Nora, a patient's breakthrough is the ultimate reward. When a patient who hasn't spoken for a year, for example, suddenly says "Hi" and compliments your new haircut or asks for a hug, these are moments of utmost satisfaction, Nora explains. Psychiatric patients are often regarded poorly by society, so treating them with respect, as fellow human beings, goes a very long way.
Nora advises prospective psychiatric nurses to gain experience in medical-surgical nursing, because many psychiatric patients also have medical issues that are causing or contributing to their psychiatric condition. Additionally, Nora recommends attending conferences and conventions to stay current and to network with others in the field of psychiatric nursing. "The career options for psychiatric nurses are wide open," she states, with a strong job outlook due to the high number of patients suffering from depression or other illnesses, as well as a growing aging population experiencing dementia. The promising job market includes a variety of employment options such as outpatient clinics, assisted living facilities, addiction/rehabilitation centers, and home health care.
Psychiatric nurses must be willing and able to accept challenges and overcome them while maintaining a calm demeanor. Remaining calm under pressure is imperative, so as not to escalate the patient's mood. Empathy is another key trait - one must be able to put themselves in the patient's shoes and treat them accordingly.
Additionally, ask a lot of questions on the interview and look for a good fit. Ask the interviewer about training and support, how the administration handles conflict and emergencies, and learn about the core values and approach of the facility. White Memorial is a Christian instituion which was a good fit for Nora. Prayers each morning and daily team huddles provide added support and reflection, which helps her through the day. The acknowledgment she has received for her good work has helped her build confidence over time, and helps keep her motivated for continued success.
Making a Difference - One Patient at a Time
"My job satisfaction really does come from my interaction with my patients. If I can make a difference in their lives, I get satisfaction from that. Psych nursing allows me to get to know the whole person, not just. . .a symptom or illness," says Sunnie Dishman, an Administrative Nurse I at the Resnick Neuropsychiatric Hospital, a 24-bed inpatient unit at UCLA. She adds, "Being a psychiatric nurse requires one to build a relationship with the patient. Unfortunately, mental illness affects all walks of life: all age groups, all races, creeds, and colors." Therefore, Sunnie feels that her career has changed the way she views people in general, not just at work. "I'm able to see people without judging them...I feel like being a psych nurse makes me a better person. I learn from my colleagues and my patients."
Sunnie's interest in psychiatric nursing began early in her career. "I enjoyed my psych rotation in school. I originally wanted to be an ob/gyn nurse, but after I finished my psych rotation, I just felt more comfortable in that field."
In addition to her Bachelor's Degree in nursing and public health certification, Sunnie also completed a fellowship at UCLA where she implemented an Evidence-Based Practice for the Assessment of Self-Injurious Behaviors (SIB). She is a nurse educator and charge nurse at Resnick. "A typical work week has our unit completely full (24 patients), a mix of acute patients suffering from a variety of psychiatric illnesses."
Sunnie works an eight-hour shift, Monday through Friday, while her fellow staff members work a mixture of eight- and twelve-hour shifts, including some weekends. She supervises the day shift and develops group programs, attends daily treatment rounds, and various meetings and committees to discuss ways to improve the practice. "I complete daily staff assignments, and ensure that the unit programs (groups and activities) are functioning, and that the patients are being attended and treated. I also lead a 50-minute exercise group three times a week for my patients."
Sunnie shares several pieces of advice for nurses considering a career in psychiatry. "As a professional nurse, it's always important to remain current in your field. Follow the latest practice trends, since new ideas and new treatment methods are constantly being developed to treat patients and their illnesses." She goes on to suggest that nurses remain compassionate and empathetic, while maintaining a certain amount of professional distance in order to provide the best care possible. It's also important that psychiatric nurses not allow themselves to become jaded or judgmental. "Your patients are sick - regardless of the reason for their illness. Treat them with dignity and respect. You will be better for it, as will your patients," Sunnie concludes.
Caring for Patients 'No One Else Wants to Care For'
Cathy W., Director of Nursing for a free-standing psychiatric facility in southern California, describes psychiatric nursing as "A calling - you either love it or hate it," and she obviously loves it. She has worked in a variety of nursing specialties, including several sub-specialties within psychiatry. She is drawn to roles working with the most severe, acute, and psychotic patients, which can often be the most challenging cases that "nobody else wants to take care of." Cathy's interest in the field of psychiatry developed during her clinical rotations, and she has worked in psychiatry since 1995.
"Each diagnosis is different. You don't see the same signs and symptoms for each case as you do in medicine," Cathy explains, and most psychiatric nurses thrive off the added challenges. If you want immediate gratification, however, psychiatric nursing may not be the best fit for you. The progress takes longer to develop in psychiatric cases. Unlike an emergency room setting, where a person comes in with a broken bone or a ruptured appendix, and goes home "all better" after surgery or other treatment, psychiatric improvement often takes a minimum of three to five days. The upside to this, Cathy explains, is the continuity of care, enabling nurses to see patients improve and respond to medications and treatment over time.
In addition to her passion for the field of psychiatric nursing, Cathy attributes her success in the field to her "thick skin" and tough love. Additionally, like Nora, Cathy recommends obtaining experience in med-surg nursing, which helps understand medical issues in psychiatric patients.
Achieving Success in Psychiatric Nursing
As a Director of Nursing with 15 years of experience in psychiatric nursing, Cathy W. can provide a great deal of insight into obtaining and fostering a successful career in this challenging field. She is responsible for interviewing and hiring her staff, and listed the following as critical characteristics she seeks in her team members:
- Active listening skills (with no biases - check all pre-conceived judgments at the door)
- Critical Thinking
- Teamwork and conflict resolution