ProNurse

About twenty five years ago, I worked as an N/A on an acute mental health ward and really enjoyed it.  I left to start a family.  About three years ago, I went back to do the same job, not in the same hospital, but found that things had changed, generally for the worse.  I was actually afraid of some of the patients, and the senior staff were far too busy to give me any support.  Needless to say, I stuck it for six weeks, and then left.

I feel terrible about leaving; a real failure.  Now there are bank N/A positions available on an acute mental health ward in yet another hospital, but in the area we are moving to.  I would like to apply, but in the unlikely postion of being offered a job there, would I cope any better?  Part of me says that, yes, things are different, so I will know what to expect this time; the other part of me says: DON'T TOUCH WITH A BARGEPOLE!!

I would like to work bank hours, and would like to prove to myself that I can do this.

I would just like some support, really.

Thanks for reading.

Thanks for your reply; very interesting.  I had to attend an induction course for four days before being let loose on the ward.  I had hoped to learn something useful, but no, 'equality and diversity' seemed to be the big thing, closely followed by 'manual handling', which, although useful if one is working with elderly and physically frail patients, was not really of much use to me.  Learning how to manage challenging behaviour, de-escalation and restraint techniques would have been better.

On my third day in the job, I was put on level 3 obs, looking after a very aggresive and abusive woman.  I was threatened with physical violence by a woman with BPD.  There was always an atmosphere of tension on the ward, as if someone, or indeed more than one would kick off at any moment.  I felt desperately sorry for the patients who were very depressed; if I felt scared, God only knows how scary it must have been for them.

I think that I have answered my own question; I don't think I'll be going back to the MH arena anytime soon!

Wards all differ and the fast changing population of an acute ward ensures few days will be alike.  There are good days and bad days, delightful patients and unpleasant patients, violent patients and patients who will come to your aid if you're in trouble.  The majority of patients are fine.  Unfortunately it only takes one or two to change the whole atmosphere of a ward.  I was never trained in de-escalation techniques by the NHS or as a student, or if I was I don't remember much about it which means it must have been fairly perfunctory.  God forbid they'd teach us something useful when there's mental health promotion, equality and diversity training and positive regard for others' religious beliefs courses to get through.  I did get some training in the private sector (for a medium secure unit) and I did do C&R (it's called MVA now, although everyone still calls it C&R - I'm not sure if it's an urban myth, but I was told at some point they were going to rename it Care and Reassurance or other such nonsense).

   However, if i say so myself, I'm pretty good at de-escalating tricky situations, but that's a skill gained through life experience and not taught, and so I was never personally assaulted or really had much of a hard time at all, although I have found myself in the odd very tricky and truly dangerous situations which could have gone either way.  Or maybe I was simply lucky as much better nurses than me were hit and were targetted by patients.  Some nurses, sadly, enjoy C&R and use it far too much.  You'll spot them: they're the ones who're inflexible and follow the rules to the letter, and who need to prove they're the boss.  Incidents will occur more often when they're in charge.  I've taken part in C&R but never ever called it when I was in charge (though again, I might have just been lucky).  Most situations can be de-escalated without the need to lay hands on anyone, though it may involve acceding to requests for medication.  I'd guess the majority of incidents on the ward occur over medication, or at least that's what I found.

   Verbal abuse is endemic.  You will get that and you will need a pretty thick skin as some patients are very good at tweaking just the right nerve to make you angry or upset.  If you're less than perfect in appearance, an ethnic minority, pretty, handsome, or in any way different, that is what is likely to be picked up on and used against you.  But that's part of the job and the reaction is what they're after.  

   A lot also depends on where your ward is situated.  If it's in a "nice" area, it tends not to be quite so unpleasant as if it's in the inner city.

But, and it is a big but,  some people love the buzz they get from an inherently unpredictable working environment.  It can be very rewarding; it's one of the few areas where people "get better" quite quickly so you do get to see a result.  I met some people who were utterly chaotic when they came in, only to leave a few weeks later a changed person.

I enjoyed some of my time on acutes and PICU, though became increasingly disenchanted with the way it was all going so left.  I've no desire to go back.

Sorry if I have given you doubts about mh nursing....., but it is best to find out as much as you can about it, good and bad.  you obviously have some understanding and insight through your job as a Mental Health Support Worker.  No-one wants to be insulted or hit, but then even if you choose the Adult branch, that will not necessarily shield you from stroppy patients!

I am comparing two different 'ages' of mh nursing; nowadays everything is about 'human rights'.  For example, in my most recent employment, there was a very depressed lady who would not get up in the morning.  I was told just to leave her in bed; if that's what she wanted to do, then that was her 'right'.  Comparing the situation to twenty -five -odd  years ago, the same lady would be gently encouraged to get up, and if she didn't, then maybe a bit of gentle (and I mean gentle) force would be used.  Find her some clothes, help her dress, and take her into the dining room so that at least she gets a chance to eat something.  And to try and give her some structure to the day.  But these days, that is breaching a patient's....sorry...CLIENT'S human rights.  What about their right to come into hospital to get better? 

I think a lot of the problem is that mh wards are chronically understaffed which means that patients....yes, I WILL call them patients...are unable to access various therapeutic activities because there are no staff to accompany them.

But this work can be immensely satisfying; I just think that now I am too old to adapt to all the changes that have been made.

Good luck whatever you decide to do. 

As I say.... you guys are not selling this to me....  ...!  So what is the answer....? Did there used to be enough staff before...? if so, what has changed....?  Are less people going into MH nursing?  Why..? Maybe because of the reasons you are both talking about... ummmm..

I have always been fascinated by MH issues but I don't fancy going to work or a placement to be insulted or hit etc... as the 'patients' are not on medication or not on enough medication... because they were supposed to attend a series of therapy sessions & never did..... it does make me cross... for the patients & for the  staff.... 

It also makes me doubt my choice... as even on placement I am sure I would have to work in an acute ward... I have three young children & would not wish to put myself in a positon of danger... I  have been talking to my husband about all of this and let's just say he is not very keen on me going into MH....

Should I sacrifice my onw preference ie. MH  for my safety...?  that sounds very dramatic!      but you know what I mean!

Take care

You will, as I said, definitely be verbally abused, and that's a fact.  Chances are it'll happen so often you'll get used to it.  You probably won't get hit, but you might do.  Don't forget if you're on an acute ward you will at some point be involved in restraint.  Now you might be the nurse who gets to rapid tranquilise the individual while he or she is held down, and some patients will remember that and will hold a grudge (not that I blame them for that, it's unpleasant after all). And as I say, medication is a real flashpoint, as are the times a patient decides they want to leave, but because they're sectioned they're not allowed.

    A percentage or nurses and carers get hit and that's a fact, too.  I don't know if it's a majority or a minority over the course of a career.  I think  most of the people I know who work on acutes have at some point been attacked or hit.  Some were injured, some were just a bit shook up, some just brushed it off.  It's not something that happens every day, but over a year a few of us will be hit, and that's a fact, too.  You are given an attack alarm - though they don't always work and even if they do they're not going to stop the unprovoked attack.  You will eventually get a feel for who is likely to hit out, and who is beginning to escalate and so you'll be on heightened awareness around some people.  You'll also try and ensure your own safety: don't go in a room first with the patient between you and the door or an escape route.  If someone is escalating, don't be alone with them (easy to say, but if you're on obs and you're short of staff the chances are you'll be doing it on your own when really there should be two of you); learn their triggers, and avoid them. 

I doubt there was ever a time when staffing was sufficient.  Almost every ward nowadays works on minimum numbers (1 or 2 nurses, 2-4 HCAs seems about average).  Acute wards have 20-ish patients, PICUs between 6 and 10.  Some (most?) wards have a drug (cannabis, coke, benzo etc) problem - human rights means visitors, and patients, can't be searched, so they can, and do, bring in any amount of illicit drugs.  Someone who's mentally ill and off his head on coke can be a serious problem, believe me.  It's a bit of an exaggeration perhaps, but acute wards seem to be filling up with young men suffering from drug-induced psychoses, and those with personality disorders.  Neither are the most pleasant of client groups to deal with.

In the past it was recognised that while far from ideal, medication was used as a chemical cosh.  Challenging patients were sedated for their own, and everyone else's safety.  But that is rarely the case nowadays (they get hugs and a cup of tea and a chat instead - the results of this vary to say the least).   And staffing levels have dropped while patient numbers, and severity of illness, have increased, while medication has decreased.  Little wonder then that things can get a bit hairy now and again. 

But again, this has become a kind of one-sided conversation - if only these boards were a little more lively!!

You really need to get the views of someone who loves working on acute wards (and there are plenty of them).  I don't think they'll tell you I'm feeding you lies, but they would be able to tell you why they enjoy acutes, whether their experiences have been different to mine, and why they don't think it's as bad as I've made out.

And as has already been said, nurses and carers get abused and hit on general wards as well.  I reckon A&E is far more dangerous than almost any mental health ward. 

Anonymous says ...

I trained in mental health fairly recently.I had to do a forensic placement in a state hospital as part of my training.Scary, yes but I knew because of the environment I was working in, I would be physically safer than in any other enviroment in nursing.Why?Because they expect the worst and risk assess to the hilt-rightly so. They have maximum staffing levels at all time and their vigilance could never be criticised.

 

Can I ask if you're talking about the UK or some other country?

When i was a student I did a medium secure forensic placement and one day we were down to two people to look after 20 patients, some of whom had murdered, some who'd raped, some of whom were diagnosed as psycopaths.  That two people consisted of me, a student on his first placement, ie 4 or 5 months into my MH nurse training, and a nurse who'd been brought in from another ward and so knew no-one but was there just to do the meds.  I was in charge of the ward because I knew the patients better.  

 

I concur with you about the elderly boxers - most units seem to have one or two of them.  It's a complete myth that those in care homes are frail old gentlefolk.  It's also a myth, certainly in the earlier stages of dementia, that they are as they are because they don't know what they're doing.  Many know exactly what they're doing.  Old people were once young, and violent young men tend to grow into violent old men.  I think statistically elderly care is where staff are most likely to be hit, and some of those old guys are pretty strong, and very dangerous.

yes you're right about mental health elderly wards-they have the highest rates of aggression across the board.But I can live with that a lot easier than working on an acute ward and getting assualted by young drug-user.People with dementia are confused and will react in the way they did when they didn't have a cognitive impairment.If they are an ex-boxer, they will react to a threat in the same way they always did.However, I dont believe they are calculating, far from it.They dont want to be detained and see us as a threat, and react accordingly.

As for the comments about the forensic ward-I was talking about the only state hospital in Scotland-.the equivalent of Broadmoor in England.Sorry I didnt clarify that enough.I can assure anyone reading this that staffing is always at an optimum- and then some.

Vigilance is second-to-none.Perhaps the poster was talking about  a low-medium secure unit, (where people have been risk-assessed etc)shocking all the same but complacency like that would NEVER happen in a real high secure unit.

My dear if you want to return to nursing. I suggest become a proper fully fledged nurse and do RGN.At the end of the day the career opportuntities are far greater than for those with just an RMN qualfication. I have both. Trust me there is a very huge war between RGNs and RMNs. RMNS hate RGN nurses.

Anonymous says ...

My dear if you want to return to nursing. I suggest become a proper fully fledged nurse and do RGN.At the end of the day the career opportuntities are far greater than for those with just an RMN qualfication. I have both. Trust me there is a very huge war between RGNs and RMNs. RMNS hate RGN nurses.

 

Nice generalisation. As an RMN, I certainly don't hate RGNs; I get along with the ones I come across in day to day practice very well, very well indeed.   If we are going to make sweeping statements, I'd argue that nurses (across all proficiencies) have a general ditain of each other... we are one of the most non political, non unified and unsupportive of each other, professions in the UK, managed by nurses poorly trained in management skills, who appear to think at an autocratic approach is the ONLY management style in existance. 

 

Anonymous says ...

My dear if you want to return to nursing. I suggest become a proper fully fledged nurse and do RGN.At the end of the day the career opportuntities are far greater than for those with just an RMN qualfication. I have both. Trust me there is a very huge war between RGNs and RMNs. RMNS hate RGN nurses.

Proof if it were ever needed that one can have a room temperature IQ and still make it as a nurse.

My first job ever was a a nurse in a mental health institution and i remember having great difficulties at first. It a special place with special patients and it was nothing like I would have imagined. After a couple of years I decided to move as I just couldn't handle all the pressure. Now I work in a California drug rehab center and, although I still have contact with patients with mental suffering, it's something different. It's much better as far as my morale is concerned. I really don't think I would ever be able to go back to mental health nursing!