Psychiatric Nursing: Interview with Maxine Sands, RN, MSN
Assessing and treating the mind and body
Maxine Sands, RN Supervisor
Gateways Hospital and Mental Health Center
Can you tell us about your workplace?
Gateways Hospital is very unique and has many different programs within the Los Angeles area, including the Residential Re-Entry Program (for clients in the process of federal offense sentence completion), a Mentally Ill Offender’s Program, a Conditional Release Program, and others.
I am the nursing supervisor for the Inpatient Adult and Adolescent Programs on the day shift. These are “locked” units due to the fact that the majority of patients are on involuntary holds for danger to self or others, are gravely disabled, or a cluster of other criteria. Our census includes an average of 28 adults and 17 adolescents per day.
Gateways has a rich history and longevity in the community for that very reason. The patients are truly cared about, and there is a continuum of learning and an atmosphere of enthusiasm. We also have programs for our medical students, social service and psychology interns, and nursing students.
In my current position, I’m in charge of approximately 30 employees and I assist in the hiring process. I have the responsibility of evaluating these employees on a yearly basis, but I also work with them in an ongoing learning process to provide them with feedback and on-the-job education. My door is always open for discussion and meetings to resolve conflicts (an unavoidable part of any organization), and to enrich the experience of my staff. In return, I expect progress, effort, and pride in what they do.
In the course of a day I assess both units for safety, interact with any especially acute patient in order to gather my baseline clinical information, assist the charge nurses with their duties, and attend treatment planning. I evaluate the staffing for the next shift and make changes as necessary. I assist the medication nurses with orders, transcriptions, and medication administration. In fact, at least once a week I find myself wearing the hat of charge nurse as well as supervisor.
Please describe your career history as a nurse
I’ve been a nurse since 1981. I originally worked as a surgical nurse, and then moved to surgical ICU. In 1983 I was working as an oncology nurse in Houston, Texas, and this served as my personal bridge into psychiatric nursing. This occurred because I noticed through my oncology work that I was very responsive to what patients were going through physically, emotionally, and spiritually. I applied for a psychiatric nursing mentorship program, and I’ve been a psychiatric nurse since that experience.
When my husband and I moved to Los Angeles, I worked at Coldwater Canyon Hospital in North Hollywood, where very cutting-edge psychiatric treatment was pioneered. I also worked at an outpatient day treatment center in Burbank and assisted in research at another facility in Los Angeles.
One of my best experiences was being on a Mobile Psychiatric Response Team, where I visited homes, schools, or emergency rooms — sometimes in the middle of the night — assessing patients for involuntary holds. The hard part was then finding the appropriate facility to send them to if they could not be sent to the hospital where I was on staff.
What do you love about psychiatric nursing? What keeps you coming back to work? What feeds your spirit?
For me, the respect for the human experience and the compassion for every individual are what keep me interested and focused. I believe that you should not sympathize with patients — you can’t own their experience. But there are techniques of “therapeutic communication” that can make things click and you know you’ve done something and have made a change in that patient’s life. This may or may not take them to a new level of self-understanding, but it’s a tool that can help the patient start recognizing what they need to work on. An effective therapeutic relationship makes all the difference in our ability to care for an individual.
What do you find most challenging about your work?
Mental health treatment is suffering so badly because of economic circumstances, and the funding for mental health has been consistently cut back at every level. The funding is just not there like it was in the past. Untreated mentally ill people affect our society in so many ways. Due to lack of treatment, they can be on the street, committing crimes, developing other co-morbidities, and becoming an economic strain on society.
The stigma about mental illness is still very strong, and it’s difficult for people to reach out for help. Depression, anxiety, and other undiagnosed mental illnesses are rampant, and we don’t have a system of care in our communities anymore that actively provides help.
What special certification or training, if any, is needed to become a psychiatric nurse?
I recommend the ANCC (American Nurses Credentialing Center) psychiatric nursing certification. There are also many wonderful seminars that offer CEUs, enriching the knowledge base for nurses in this field or others who want to augment their scope of awareness. Anyone working on a master’s degree can find out ways to specialize in this area as well.
Bearing in mind HIPAA regulations, is there a story or anecdote about a patient that you would like to share?
We had a patient with a history of sexual abuse who was escalating in her behavior by throwing things, banging the walls and scratching herself. Someone called a “code” which indicated the possible need for seclusion and restraints in order to keep her safe. There were a lot of people around her. At this point, I intervened and said, “Are you remembering something right now that scares you?” Immediately, this person broke down crying, was able to verbalize her feelings, and was able to stay safe without restraints. When you help a person through a difficult moment with a therapeutic intervention, it makes the work so rewarding.
Do you have any advice for nurses who might want to explore psych nursing as a potential career track?
I remember when I was in nursing school and a professor told me that I was born to be a psych nurse. She seemed to know me better than I knew myself. But you can’t be a good psych nurse if you don’t know the systems of the body. Everything comes into play: from endocrine to orthopedic, it all impacts the patient. Also, the difficulty in obtaining proper healthcare and the rise in chronic illness in general has caused people with psychiatric problems to also have other co-morbidities such as diabetes, seizures, MRSA, cancer, HIV/AIDS, and other illnesses at a rate much greater than it was 30 years ago.
We cannot take the risk of segregating the person’s emotional and psychological issues from the physical. Use critical thinking skills and formulate a plan that includes the assessment and interventions to treat the “whole person.” Learn to be respectful of what that person may be experiencing, get that solid medical experience, and then ask yourself: “Am I a psych nurse?” You will know the answer.
Did You Know? Psychiatric Nursing
Psychiatric nursing is a complex nursing specialty wherein nurses may work in a variety of facilities with an array of patients across the life span. Psychiatric nurses are employed in community-based outpatient agencies, inpatient psychiatric hospitals, home care agencies and other facilities, and may involve clinical work with children, adults, and the elderly. This particular specialty requires in-depth knowledge of psychotropic medications, including their use and side effects, an understanding of various psychiatric disorders and their treatment, as well as comprehensive understanding of all body systems and general health.
On the Job
Whereas psychiatric nurses in the 19th and early 20th centuries may have simply administered medications and carried out treatments strictly prescribed by physicians, today’s psychiatric nurse is significantly more involved in the therapeutic process. Psychiatric nurses are integral members of the treatment team, using critical thinking to assess patients, utilize nursing diagnoses, plan a course of nursing care, implement appropriate interventions, and evaluate the effectiveness of those interventions.
All sources agree that good communication skills and interpersonal skills are essential for any nurse who wishes to work in the field of mental health. A broad understanding of behavioral sciences is necessary, as is a thorough grounding in human physiology and the systems of the body.
The American Psychiatric Nurse Association designates nurses who work in the mental health field as Psychiatric-Mental Health Nurses (PMHN). Advanced Practice Registered Nurses (APRNs) can function as Clinical Nurse Specialists (CN-S) or Nurse Practitioners, diagnosing and treating mental illness and assuming prescriptive authority for medications and treatments. APRNs can further specialize in various aspects of mental health practice, including geriatric and pediatric practice. Although most facilities do not require certification as a psychiatric or mental health nurse, many nurses committed to this specialty pursue Psychiatric and Mental Health Nursing certification through the American Nurses Credentialing Center (see side bar).
Salaries and Demand
Based on data available online, the median salary for staff psychiatric nurses in the United States is approximately $66,000 per year, with the median in Los Angeles County reported as approximately $73,000. However, the American Psychiatric Nurse Association reports the average starting salary as $35,000 to $40,000 for staff nurses and $60,000 for APRNs. Salaries obviously vary widely from region to region based on current economic circumstances.
Psychiatric and mental health nursing is widely viewed as a growing field that is open to all nurses. Although some new graduates move directly into psychiatric nursing after completing their education, one or two years in a medical or surgical setting is often recommended.
American Psychiatric Nurses Association (APNA): www.apna.org
Journal of the American Psychiatric Nurses Association: jap.sagepub.com
Archives of Psychiatric Nursing: www.psychiatricnursing.org
American Nurses Credentialing Center (ANCC): www.nursecredentialing.org
(Psychiatric and Mental Health Nursing is one of many widely recognized certifications offered by ANNC. Review seminars are offered around the country throughout the year, and free interactive sample tests can also be found on their website.)
International Society of Psychiatric and Mental Health Nurses (ISPN): www.ispn-psych.org
Divisions of ISPN include:
1) Association of Child and Adolescent Psychiatric Nurses (ACAPN)
2) Adult and Gero-Psychiatric Mental Health Nurses (AGPN)
3) International Society of Psychiatric Consultation Liaison Nurses (ISPCLN)
4) Society of Education and Research in Psychiatric Mental Health Nursing (SERPN)
Keith Carlson, RN, BSN, is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is editorial contributor to BlackDoctor.org. His own blog can be found at digitaldoorway.blogspot.com.
This article is from workingnurse.com.