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WORKING NURSE: Please tell us about your nursing title and specialty.

LIZ HARRELL, RN, BC: I’m a certified psychiatric RN and my title depends on which hat I’m wearing when asked. I’m a Clinical Manager at Banner Good Samaritan Medical Center and also an Associate Faculty member at Arizona State University (ASU).

What first led you into this specialty?
I got into the specialty during my senior year at ASU. My financial needs motivated me to apply for a nurse extern position at the Maricopa Medical Center. Psych was what they had available and, in retrospect, I believe it was meant to be. I have been a psychiatric nurse for 13 years.

How long have you worked for Banner?
I have worked for Banner for four years. I originally worked at Banner Desert because, at that time in my career, Desert offered a chance to enter into management. I wanted that challenge after working the “front lines” for 10 years. Banner is a good fit for me. The mission of the organization—“We exist to make a difference in people’s lives through excellent patient care”—as well as the vision statement—“Smarter, Faster, Better, Together”—resonate with me. I also had wonderful mentors who taught me not only about leadership, but also increased my knowledge of psychiatric care in general. When Desert closed its psychiatric programs at the end of 2006, I was able to transfer to Good Samaritan in January 2007. A Magnet facility, Good Samaritan has continued to provide me with excellent opportunities, including letting me job-share my position so I am able to teach psychiatric nursing in clinical settings as an Associate Faculty member at ASU.

Is there any such thing as a typical day for a psych nurse?
I like that my days are not typical. That's one of the greatest aspects of nursing, no matter where you work. I think people who like predictability probably don't go into nursing. My days do have structure, though. At Banner Good Samaritan, my day starts between 6:30 and 8:30 a.m., when I check in with staff to see how the day has started. A lot of my job involves listening to staff concerns and celebrating their successes. My role also involves being a problem-solver. Staff who are busy with patient care will let me know what needs to be done so I can resolve any issues.

Another big part of my job is working to ensure the right staffing balance. I also work on projects involving other areas of the hospital, such as the implementation of suicide risk assessments throughout the facility (a national safety goal), as well as projects involving our unit only. Currently, our unit is looking at program and staff development in Shared Leadership. This is one of the most exciting aspects of my job; it is a true pleasure to see c, oworkers become excited and engaged in their work. As I am given a forum to contribute my knowledge and talents, my own engagement level rises and I see the benefits of both of my positions: a leader and a teacher.

Speaking of your position as a teacher, what do your duties involve at Arizona State University?
During the acute portion of the students’ rotations, my days start at 7 a.m., no matter what. I meet 10 students at a designated hospital for two to three days per week for four weeks. I set up schedules to move students through all experiences the hospital has to offer, such as time in adult psych, adolescent psych, and in a chemical dependency unit.

Most people are afraid to enter a psychiatric unit, so I initially work to lower the students’ anxiety levels. I am their confidante, mentor, and a partner in their learning experience. At first, I literally push them onto the units and, within two days, they are amazed they ever felt afraid. I have been teaching for a year and a half and, thus far, have never had a student dislike psych rotation. I feel a huge satisfaction in successfully introducing them to psych and watching their thoughts and attitudes change. Soon they understand that psychiatric patients are just people who experience disorders of their thoughts or feelings, and not "bad" or "crazy" or "weird" people.

Teaching allows me to share my passion and motivates me to be the best example of a psychiatric nurse I can be. It makes me strive to master the latest advancements in practice, and blends both my positions since I have firsthand knowledge of "real floor" nursing to share with students.

What are the challenges you face in this specialty?
My main challenge is dealing with my frustration over lack of educational programs for the public and the under-funding for those needing psychiatric treatment. Approximately every 18 minutes, someone commits suicide and some sources name it as the leading cause of death worldwide.

What would you tell nurses who want to pursue psychiatric nursing?
Advice I would give a nurse considering the psychiatric field would be to do a thorough introspection of their attraction to psych. The greater the caregiver's insights into his or her own thoughts, feelings, and actions, the better potential as a psychiatric nurse. Psychiatric nurses also need a high level of empathy to work successfully with patients. Nurses tend to want to "fix" problems, we want to make people all better and often we become frustrated when our actions don't lead to our own ideas of health. Psychiatric nurses need to respect people’s inherent ability to "fix" themselves and understand that their ideas of health may not be the same as the patient's ideas or abilities.

Another good step is for a nurse to contact the psych unit or hospital they are interested in working for and talk with the manager. No manager would turn away a nurse seriously considering psychiatric nursing if the nurse is a good fit and the manager has the position and resources available to support a novice RN pursuing this field.

FURTHER REFERENCE

Organizations:
Arizona Chapter of American Psychiatric Nurses Association, www.apna.org

Books:
Psychiatric Mental Health Nursing: Understanding the Client As Well As the Condition, by Lawrence E. Frisch and Noreen Cavan Frisch
Basic Concepts of Psychiatric-Mental Health Nursing, by Louise Rebraca Shives
Psychiatric Nursing: Biological and Behavioral Concepts, by Deborah Antai-Otong