Mental Health Nurse?
Hello,
I am just wondering if anyone knows what is involved in the role of mental health nursing. I have looked into it online but it seems quite vague, just that they speak with patients and encourage them to do certain things. Does anyone have experience in this role who could give a bit more insight into it?
I am just wondering if anyone knows what is involved in the role of mental health nursing. I have looked into it online but it seems quite vague, just that they speak with patients and encourage them to do certain things. Does anyone have experience in this role who could give a bit more insight into it?
Mental health nursing is an incredibly varied role. Very briefly from my limited knowledge:
- Community CAMHS (edit: I wrote CAMHS because that's where I work, there are of course, adult and older age teams too!) working as a Community psychiatric nurse (you support individual's living in the community, providing guidance, support and interventions), There are also a variety of specialised teams, such as crisis, personality disorders, drug and alcohol, forensics and so on.
- Inpatient wards. This can be anything from open wards with young people with self harm behaviour, right up to high security mental health hospitals (Broadmoor, for example). This can involve significant challenging behaviour, self injury, psychosis, personality disorders and can be much more 'hands on'.
- Community CAMHS (edit: I wrote CAMHS because that's where I work, there are of course, adult and older age teams too!) working as a Community psychiatric nurse (you support individual's living in the community, providing guidance, support and interventions), There are also a variety of specialised teams, such as crisis, personality disorders, drug and alcohol, forensics and so on.
- Inpatient wards. This can be anything from open wards with young people with self harm behaviour, right up to high security mental health hospitals (Broadmoor, for example). This can involve significant challenging behaviour, self injury, psychosis, personality disorders and can be much more 'hands on'.
(edited 8 years ago)
As mentioned it really varies depending on setting.
- In the community MHNs are often those who primarily assess patients in crisis. So they will take a brief history, perform a brief mental state examination and determine whether a patient needs to see a psychiatrist or not
- Deliver medications to patients and observe them taking them
- Generally checking in on patients to see how they're doing
- Ward work involves a lot more traditional nursing type roles e.g. routine drug administration
- More forced drug administration e.g. rapid tranquilisation of patients or administration of depot injections in noncompliant patients
- Interacting and supporting patients e.g. performing therapuetic activities with them, taking them on day trips
- Performing observations on patients. Many high risk patients will need to be checked on every 5 minutes
- Personal care matters if working on an old age dementia ward
It is worth mentioning that in mental health services generally there is a lot of admin whether you work in the community or in a hospital setting. In the community for example you may take 15 minutes to drive to a person's house, spend 15 minutes speaking to the patient, then take 15 minutes driving back and then spend 30 minutes writing your report/entry on whatever system they use. So you've spent almost 90 minutes in a task, only 15 minutes of which has been clinical.
- In the community MHNs are often those who primarily assess patients in crisis. So they will take a brief history, perform a brief mental state examination and determine whether a patient needs to see a psychiatrist or not
- Deliver medications to patients and observe them taking them
- Generally checking in on patients to see how they're doing
- Ward work involves a lot more traditional nursing type roles e.g. routine drug administration
- More forced drug administration e.g. rapid tranquilisation of patients or administration of depot injections in noncompliant patients
- Interacting and supporting patients e.g. performing therapuetic activities with them, taking them on day trips
- Performing observations on patients. Many high risk patients will need to be checked on every 5 minutes
- Personal care matters if working on an old age dementia ward
It is worth mentioning that in mental health services generally there is a lot of admin whether you work in the community or in a hospital setting. In the community for example you may take 15 minutes to drive to a person's house, spend 15 minutes speaking to the patient, then take 15 minutes driving back and then spend 30 minutes writing your report/entry on whatever system they use. So you've spent almost 90 minutes in a task, only 15 minutes of which has been clinical.
Moved to Nursing
Hi _Sinnie_, I'm wondering if you still work in the community as a mental health nurse?
Original post by JonathonRandstad
Hi _Sinnie_, I'm wondering if you still work in the community as a mental health nurse?
I'm an Assistant Psychologist, not a mental health nurse. But I work with them, so may be able to answer your questions
I'm a 3rd year MH nursing student. It really is a very varied role and is dependent on what the service needs and what you want to give as well. (you can have extra training in all sorts of things)
Having said that, a standard band 5 position (where every nurse starts out) will typically be in an inpatient setting (though it's becoming more common to go straight to the community). I'll give you a run down of a potential shift on a 16 bed acute ward from the perspective of the nurse in charge:
You start your shift at 7am and go straight into handover. There was a new admission late last night, who went straight to sleep. The night staff have done as much of the admission paperwork as they can, but most of it requires talking with the patient. One patient has not slept at all. One had been palming their medication and took an overdose of it a week ago. They have been on a 1:1 since returning from the general hospital.
At 7.30, handover finished, you go to the office and check through the ward diary, making a list of actions for the shift. One very timid patient is due to go for overnight leave for the first time today. Another, who has been displaying clear psychotic symptoms, has a meeting with his solicitor regarding a tribunal (legal process to appeal a section). Two patients are due to be read their 132 rights (need to be read monthly to sectioned patients). One patient is due her depot injection, but you happen to know that she prefers specific staff doing the injection, one of whom will be on the late shift. Three patients need various physical observations. You write the shift planner, organising who is due to cover the different levels of observations and when people will take their breaks. You allocate staff to certain patients, bearing in mind the skills of your team and the challenges each patient presents. You ask the other nurse to take care of the 132 rights and a support worker to take charge of getting the physical obs done.
At 8.00, you check your emails. Whilst you do this, a patient repeatedly knocks on the office door asking to go out on leave. You remind them each time that part of their care plan includes that they must have showered and eaten breakfast before they can leave. The patient is frustrated with this answer and is heard shouting down the corridor. You have an email asking you to call one of your patient's care co-ordinators regarding a discharge plan. Your manager has also sent an email requesting that everyone check that they are up to date with online training. You discover that you have training outstanding and manage to complete one small module before meds.
At 8.30, it is time for meds. You set yourself up in the clinic room and patients start to arrive to get their meds. You work your way slowly down the list, chatting to each patient to briefly assess their mental state and plans for the day. You make extra sure that the patient on 1:1 has swallowed their medication. You let the patient with the depot know that it is due and ask when they would like it. They would like the late staff to do it. Once people stop arriving of their own accord, you ask a support worker to prompt specific people to attend. Three of them eventually come to the clinic, but one remains in bed refusing to move. This patient is on Clozapine, a powerful antipsychotic, and becoming established on it is a lengthy process. Missing a dose is not an option. You lock up the clinic room and find the patient. Initially they are rude and irritable, but you use the therapeutic relationship you have already established to reason with them, explaining the importance of taking clozapine and how stopping it could mean a whole lot of hassle for everyone, especially them. Eventually they agree to get up and take their meds.
At 9.30, you return to the office, read up on the notes for the patient being discharged and call their care co-ordinator.
at 9.45, you find the new admission and introduce yourself. You take them into a side room to work through the admission paperwork, discuss initial care plans and assess the level of risk. They appear very anxious and you try to reassure them that they are safe. You establish that they are hearing voices telling them to jump off a bridge. They appear distracted, looking around the room a lot and not always paying attention to what you are saying. You leave them with an MRSA swab and instructions on how to swab themself.
At 10.15, you begin to write up the care plans and risk assessments for the new admission. Whilst doing this, a support worker who has been doing physical observations reports to you that a patient with type 2 diabetes had slightly high blood sugar levels before breakfast. You speak to the patient and find out that they have been eating normally and feel well. You ask the support worker to repeat the blood sugars before lunch.
As you return to the office at 10.45 the patient from before has now eaten and showered and would like to go on leave. You check the paperwork to make sure they have been granted section 17 leave. You ask them where they're going, how they're feeling and what they're planning to do. You write down what they are wearing and agree a time that they will be back. You sign them out on the system, noting the risks that have been considered and documenting the conversation you had with them.
At 10.55, you realise you are supposed to be taking over the 1:1 observation at 11. A support worker agrees to start the observation to give you time to finish the paperwork for the new admission.
At 11.15 you take over the observation. You take the opportunity to assess the patient's mental state and discuss the events leading up to the 1:1 being implemented. It seems that continuing 1:1 obs is appropriate at this time. You also chat with them generally and improve your therapeutic relationship.
At 12.00, somebody else takes over the observation and you find the patient who is going out on overnight leave. You check that they have everything packed and ready and ask them how they are feeling about it. They are nervous but excited, and you reflect together on how far this patient has come and how well they are doing.
At 12.30 you dispense afternoon meds. There are fewer of these and people take less prompting as they are already awake.
At 12.50 you find each of the staff on the shift in turn so that they can hand over to you what their allocated patients have been doing and what their mental states are like. You find out that the diabetic patient still has elevated blood sugars. You ask them for a urine sample to test for ketones and make a note for the late shift to let the consultant know when they return in the afternoon.
At 1.00 you give handover to the late shift.
At 1.30 you start writing your progress notes for the shift.
At 1.45 you receive a phone call from a member of staff telling you they are unwell and will be unable to make the night shift. You record this in the appropriate place and then put the shift out as bank on the system.
At 2.15 you finish your notes. The patient going on overnight leave is ready to go, so you assess their mental state etc. and ensure they know where they're going and when they are coming back. You record this all on the system.
At 2.30, you are able to get away early, as you didn't have a break and the late shift have it all covered.
Generally, there's a lot of time management involved and the skills you need are hugely interpersonal and observational. When interacting with patients, you are constantly assessing their mental state and reacting appropriately to any concerns. People with mental health problems can be unpredictable and uncooperative, but that's where being empathetic and approachable can really help. You also need to be really flexible - as much as you can plan a shift, there are always things that crop up, and knowing what your priorities are and what can wait for the next shift or the next day is really important. I hope that makes it a bit clearer anyway. It's true that a lot of what we do is talking to patients and encouraging them to do things, but there's actually a lot of skill behind it, a lot of which I'm only starting to feel kind of capable in now that I'm in my third year as a student.
Having said that, a standard band 5 position (where every nurse starts out) will typically be in an inpatient setting (though it's becoming more common to go straight to the community). I'll give you a run down of a potential shift on a 16 bed acute ward from the perspective of the nurse in charge:
You start your shift at 7am and go straight into handover. There was a new admission late last night, who went straight to sleep. The night staff have done as much of the admission paperwork as they can, but most of it requires talking with the patient. One patient has not slept at all. One had been palming their medication and took an overdose of it a week ago. They have been on a 1:1 since returning from the general hospital.
At 7.30, handover finished, you go to the office and check through the ward diary, making a list of actions for the shift. One very timid patient is due to go for overnight leave for the first time today. Another, who has been displaying clear psychotic symptoms, has a meeting with his solicitor regarding a tribunal (legal process to appeal a section). Two patients are due to be read their 132 rights (need to be read monthly to sectioned patients). One patient is due her depot injection, but you happen to know that she prefers specific staff doing the injection, one of whom will be on the late shift. Three patients need various physical observations. You write the shift planner, organising who is due to cover the different levels of observations and when people will take their breaks. You allocate staff to certain patients, bearing in mind the skills of your team and the challenges each patient presents. You ask the other nurse to take care of the 132 rights and a support worker to take charge of getting the physical obs done.
At 8.00, you check your emails. Whilst you do this, a patient repeatedly knocks on the office door asking to go out on leave. You remind them each time that part of their care plan includes that they must have showered and eaten breakfast before they can leave. The patient is frustrated with this answer and is heard shouting down the corridor. You have an email asking you to call one of your patient's care co-ordinators regarding a discharge plan. Your manager has also sent an email requesting that everyone check that they are up to date with online training. You discover that you have training outstanding and manage to complete one small module before meds.
At 8.30, it is time for meds. You set yourself up in the clinic room and patients start to arrive to get their meds. You work your way slowly down the list, chatting to each patient to briefly assess their mental state and plans for the day. You make extra sure that the patient on 1:1 has swallowed their medication. You let the patient with the depot know that it is due and ask when they would like it. They would like the late staff to do it. Once people stop arriving of their own accord, you ask a support worker to prompt specific people to attend. Three of them eventually come to the clinic, but one remains in bed refusing to move. This patient is on Clozapine, a powerful antipsychotic, and becoming established on it is a lengthy process. Missing a dose is not an option. You lock up the clinic room and find the patient. Initially they are rude and irritable, but you use the therapeutic relationship you have already established to reason with them, explaining the importance of taking clozapine and how stopping it could mean a whole lot of hassle for everyone, especially them. Eventually they agree to get up and take their meds.
At 9.30, you return to the office, read up on the notes for the patient being discharged and call their care co-ordinator.
at 9.45, you find the new admission and introduce yourself. You take them into a side room to work through the admission paperwork, discuss initial care plans and assess the level of risk. They appear very anxious and you try to reassure them that they are safe. You establish that they are hearing voices telling them to jump off a bridge. They appear distracted, looking around the room a lot and not always paying attention to what you are saying. You leave them with an MRSA swab and instructions on how to swab themself.
At 10.15, you begin to write up the care plans and risk assessments for the new admission. Whilst doing this, a support worker who has been doing physical observations reports to you that a patient with type 2 diabetes had slightly high blood sugar levels before breakfast. You speak to the patient and find out that they have been eating normally and feel well. You ask the support worker to repeat the blood sugars before lunch.
As you return to the office at 10.45 the patient from before has now eaten and showered and would like to go on leave. You check the paperwork to make sure they have been granted section 17 leave. You ask them where they're going, how they're feeling and what they're planning to do. You write down what they are wearing and agree a time that they will be back. You sign them out on the system, noting the risks that have been considered and documenting the conversation you had with them.
At 10.55, you realise you are supposed to be taking over the 1:1 observation at 11. A support worker agrees to start the observation to give you time to finish the paperwork for the new admission.
At 11.15 you take over the observation. You take the opportunity to assess the patient's mental state and discuss the events leading up to the 1:1 being implemented. It seems that continuing 1:1 obs is appropriate at this time. You also chat with them generally and improve your therapeutic relationship.
At 12.00, somebody else takes over the observation and you find the patient who is going out on overnight leave. You check that they have everything packed and ready and ask them how they are feeling about it. They are nervous but excited, and you reflect together on how far this patient has come and how well they are doing.
At 12.30 you dispense afternoon meds. There are fewer of these and people take less prompting as they are already awake.
At 12.50 you find each of the staff on the shift in turn so that they can hand over to you what their allocated patients have been doing and what their mental states are like. You find out that the diabetic patient still has elevated blood sugars. You ask them for a urine sample to test for ketones and make a note for the late shift to let the consultant know when they return in the afternoon.
At 1.00 you give handover to the late shift.
At 1.30 you start writing your progress notes for the shift.
At 1.45 you receive a phone call from a member of staff telling you they are unwell and will be unable to make the night shift. You record this in the appropriate place and then put the shift out as bank on the system.
At 2.15 you finish your notes. The patient going on overnight leave is ready to go, so you assess their mental state etc. and ensure they know where they're going and when they are coming back. You record this all on the system.
At 2.30, you are able to get away early, as you didn't have a break and the late shift have it all covered.
Generally, there's a lot of time management involved and the skills you need are hugely interpersonal and observational. When interacting with patients, you are constantly assessing their mental state and reacting appropriately to any concerns. People with mental health problems can be unpredictable and uncooperative, but that's where being empathetic and approachable can really help. You also need to be really flexible - as much as you can plan a shift, there are always things that crop up, and knowing what your priorities are and what can wait for the next shift or the next day is really important. I hope that makes it a bit clearer anyway. It's true that a lot of what we do is talking to patients and encouraging them to do things, but there's actually a lot of skill behind it, a lot of which I'm only starting to feel kind of capable in now that I'm in my third year as a student.
There's also pretty 'specific' roles. I am interested in looked after children's mental health nursing which by all accords is very limited as children's nurses often take a lac nurse role but don't specifically specialise in mental health. I've come across a handful of positions usually in community teams specialising in looked after children or an outreach from camhs, but in this role you may be required to work in a different way to other roles such as involvement in care proceedings and courts (usually via reports etc). I'm sure that there are other roles out there that are few and far between.
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