What everyone should know about mental health nursing

Some jobs are definitely physically demanding. Some are extremely mentally demanding and some are acutely emotionally demanding. Get this — mental health nursing is all three.

But no matter how physically tiring, emotionally draining and mentally exhausting, lots of the mental health nurses I’ve had the honour of working with do an amazing job. They cared about their patients physical, emotional and mental well-being and often went way beyond the call of duty.

Boris Johnson lbc.co.uk

The government should recognise how difficult it is for nurses, working long days because someone hasn’t turned up for their shift (for whatever reason), working nights when they could be at home with their kids and families and working in difficult environments like mental health.

Local MP’s should spend a week on our wards (a day isn’t long enough), not just observing, but getting their hands dirty. Then they should shout from the rooftops of the Houses of Parliament or through Boris Johnson’s letterbox “Nurses deserve better wages!”

Current salaries for newly qualified nurses range from £22,128 to £28,746 (Band 5) with an annual 1% pay increase, NHS 2019. Our poor MP’s only receive around £79,468+, a 2.7% increase on last year. Boris Johnson’s promise of more money to the NHS, but let’s hope that includes salary increases befitting the job.

The NHS should also be thankful for these nurses, who often go short on breaks and who have to stay fifteen to thirty minutes longer most days. See, you can’t just walk out on a patient who’s upset, angry or crying, saying “that’s it, my shift’s done.” Following this interaction there’s the documentation to complete. You must document everything. I always taught nurses — if it’s not documented, it’s not done.

With regards to documentation the Nursing and Midwifery Council’s (NMC) The Code 2018; states:

10. Keep clear and accurate records relevant to your practice. This applies to the records that are relevant to your scope of practice. It includes but is not limited to patient records. To achieve this, you must:

NMC 2018

10.1 complete records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3 complete records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5 take all steps to make sure that records are kept securely

10.6 collect, treat and store all data and research findings appropriately

Our documentation and patient files are potentially legal documents whereby, if there was a serious untoward incident i.e. a patient died by suicide, they would be called for and used as evidence in the following investigation. You can’t just say afterwards i.e. “the patient told me they were happy and looking forward to visitors that afternoon, so I didn’t think there was any risk of suicide”. If you didn’t document it — it didn’t happen.

Whilst the above is one reason for appropriate documentation, it also informs colleagues on the next shifts or a nurse’s return to work from time off. It lets them know about the patient’s mood and mental state, what they may or may not have done the previous shift and any interventions you undertook.

Nurses are generally allocated around five patients each shift and after handover, the first thing a good nurse does, is read the last few entries in their patient’s notes and catch up on their care plans, which may or may not have been changed or updated.

Thegaurdian.com

However, the not-so-good and the downright lazy nurses had me tearing my hair out at time. Daily entries consisted of “Patient slept most of the shift.”

A nurse worked (well, they were in the building) an eight hour shift and that’s all they have to write?

Okay, so the patient might have slept most of the shift, but what did they do the rest of the time? Did the nurse try to wake them, encourage them to get up for breakfast/lunch, to attend an activity? And while the patient slept, did the nurse audit the patient’s notes to ensure everything was in order, i.e. patient name on each page, pages were numbered, care plans were up to date?

Even if the patient had slept most of the shift, surely you’d attempt some intervention, try to engage them. Even if they do tell you to ‘fuck off’, or yell ‘leave me alone’, write that — it shows that you have at least attempted to engage them. And don’t give up at the first hurdle, try again. And again. Then document it.

I’d tell patients that I was going to sing and tap dance in my heels if they didn’t get up, they’d half-laugh and eventually drag themselves out of bed. I also told them that we, as nurses, had a duty of care and that included providing a clean environment, followed with a cheery “Now get your bum up so we can change your sheets and clean your room!” I didn’t mind if they went straight back to bed once we’d finished but usually, once they actually got out of their bedroom, they tended to eat, engage with others or watched t.v. in the day area.

online.umn.uk

It really isn’t that difficult. And it also shows the patients that you care enough to keep trying. Patients really do know the difference between the nurses who just want an easy time or are bored and the ones that care, the ones who want to help, the ones who don’t mind getting their hands dirty. They noticed and had more often than not, experienced nurses dissociation and emotional distance on a daily basis. Quite simply, patients recognised poor nursing.

Some nurses I worked with appeared devoid of the critical ability needed to assess patients, to assess any risk and to provide appropriate care and treatment — other than medication. They lacked the observation, communication and interpersonal skills to engage with patients and they showed little or no empathy. They saw patient’s distress only as a set of symptoms (not a human being in pain), often calling them ‘attention seeking’ or ‘manipulative.’

When a patient became angry (appropriate to their current situation i.e. the nurse wouldn’t let them use the telephone when they needed to contact benefits etc.) nurses saw it as ‘kicking off’, ‘taking liberties’ or generally just getting on the nurse’s nerves.

Some nurses seemed to forget or ignore all the knowledge and skills they’d acquired at uni; their compassion, empathy and understanding had all but disappeared, or they’d just burnt out from all the extra shift they worked – through choice!

Let’s get something straight!

If you don’t want all the back-breaking physical work (left by bone-idle nurses on the previous shift), the constant demanding emotional interactions, the woefully tiring verbal onslaught that greets you each shift because their needs weren’t met on the last shift or the boring whining, repetitive complaints and the teeth kissing or tutting – and all that is from your colleagues only — then mental health nursing is not for you.

NMC 2010

Nurses have a responsibility to deliver consistent high quality care. They have a duty to promote good mental health and encourage healthy behaviours by building good relationships and gaining the trust and confidence of their patients, NMC; Standards for competence for registered nurses 2010.