No, I am not Nurse Ratchet from “One Flew over the Cuckoo’s Nest.”
Yes, I have worked 20 years as a nurse and a tech in the field of behavioral health care and now orient others to the role of nursing on inpatient units for individuals with mental illness.
No, care for such patients is not an authoritarian, one-size-fits-all approach and, yes, I see patients leave better able to manage their diagnoses and therefore their lives. Much advocacy has been done to dispel stigma and misinformation around mental illness in recent years, but less so on misconceptions that linger in the public mind and that I hear frequently around perceptions of nursing on behavioral health units.
Nursing on such a unit is not about altercations with patients. It is not about enforced routines. It is not about checking off boxes for tasks done. It is about listening to patients, sitting with patients, bringing our clinical expertise and, most importantly, our empathy, to support them at a very vulnerable time in their lives. I have sung with patients. I have danced with patients. I have been silly and cried with patients.
We try to help them see mental illness as a treatable, medical condition for which there should be no feeling of guilt or embarrassment in getting care for their diagnosis.
It is nursing that has been referred to as both a science and an art, and it is. We are not the patient’s therapist. We are not the patient’s psychiatrist or pharmacist. Nor are we bedside just to take vital signs.
We are often there in the moment when patients are the most vulnerable mentally. We get to support them and allow them to speak their truth without judgment. What I reiterate to staff, old and new, is that all behavior is a form of communication. What is the patient trying to communicate that they are not able to verbalize? Are they anxious about being in the hospital, do they want to leave, did they have a bad phone call with family or a loved one?
It is nursing that takes critical thinking, problem-solving and detective work to determine what is behind behavior and to address it in a way that recognizes the person is upset, allows time to get whatever it is out of their system and the space to talk about it calmly. When someone is needing a lot of support, it is the nurse who attempts to determine how best to help them work through their thoughts and behaviors.
Nurses in behavioral health work at making patients feel good about receiving care for their mental illness and normalize what they are going through in receiving such care. It is no different from inpatient care for any other serious medical condition that will not improve on its own, and it is routinely multi-faceted care involving education about lifestyle, medication, and therapy.
There are times when you will have a patient who is completely decompensated, that is, their mental health seriously deteriorates to the point where they have no interest in life or ability to function. Yet, once they start on medication and you form a relationship, their recovery is amazing to see. They begin to interact, engage in self-care and feel good enough within a short-time to leave the unit.
Seeing such improvement with individualized, trauma-informed care is what is so rewarding about what we do as nurses on a behavioral health unit and it is what feeds my soul.
We also work with families, too, teaching them what mental illness means, what are the warning signs and symptoms and how they can support their loved ones as they go through some really difficult times.
My choice of career specialty as a registered nurse began in my early 20s, working, at the suggestion of my mother who is a nurse, as a certified nursing assistant with dementia patients and has broadened since to receiving my bachelor’s degree in nursing and supporting patients of all ages with a range of mental and behavioral health diagnoses.
It is nursing care that is needed more than ever today to ensure those with acute mental illness benefit from their hospitalizations and return with hope and healing to their families and their lives in their community.
Research and better imaging technology has added to growing understanding of how the brain communicates within itself, how this molds to experience and responds to treatment aimed at changing behavior impacted by trauma or injury and that this reorganization continues through much of our lifespan.
I have seen lives change for the better and for the long term because of the measurable and meaningful difference a nurse has made. Yes, there are staffing shortages. However, there is no shortage, for those of us in this field, of compassion and care.
Erica L. Trudell is Director of Nursing for Inpatient Behavioral Health Services and Education at MiraVista Behavioral Health Center in Holyoke.
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