Confessions of a Psychiatric Nurse

By Angela Brooks on Wed, Nov 05, 2014

Confessions of a Psychiatric NurseThere is no way to work as a psychiatric nurse on a psych ward of a mental hospital and not learn something about life.

I have met some of the strangest and most original individuals. When people find out where I have worked for the last 22 years, their mouths hang open in awe. Most of the time the phrase, "I don't know how you do it" is mentioned, as they shake their heads.

Yes, this is an incredibly interesting career path. Still, there are things about working in a mental health institution that I don't like. You just have to bite your tongue and grit your teeth through it.

3 Things I Dislike About Psychiatric Nursing:

  • Someone who comes into the hospital just so they can get a check (aka crazy check) when they are clearly healthy but truly too damn lazy to work. Prisoners who come in and break furniture, trigger violence, share their rude and unintelligent slurs to the staff and demean them, because they have nothing to lose and will be going back to jail.
  • Restraining someone in the bed. It makes my heart hurt to see someone, or have to place someone, in that situation. Even though I know at the time it has to be done, because all other options have been exhausted, sometimes it is necessary to protect the staff and the patient. 
  • Staff who forget how blessed they are because they have a place to go home to, when a patient is crying because they are homesick and can't return to their home.

We often forget that the people we serve had a life before they arrived in the unit. They attended school, had some kind of home, have a mother, father, wife, husband, and/or children. When a new patient comes, I always make sure to learn about who they are, not who the chart says they are. I want to know where they used to work, where they went to school, how many brothers and sisters they have, and whether they are married and/or have children. I realized that whenever I approach a patient as a person, rather than as a patient, they open up and let down the walls that they come in with. I get to peep inside of their lives for just a moment and that's the true essence of patient care.

Life Lessons from Patients

I have not always liked working in chaos and in hazardous and dangerous situations, but I have always liked talking to the ones I meet. They have shown me that we are all one step away from the admissions office when life hands us more than we can bare. They have taught me that just because I can't see delusions and hallucinations doesn’t mean they are not real. They have taught me the feelings of real compassion for another human when they can't help themselves. They have taught me that being with family is not always the safest place to be. At times, families hurt family members deeper than a stranger does.

What part of being a psychiatric nurse don't you like? Tell us in the comments below.


Anonymous 3 days ago
There is a pt that is in and out of the unit all of the time. She has an Axis 2 Diagnosis, is extremely histronic, fakes seizures and makes accusations aganist staff all the time. The other night she was acting out so bad, Loud, cursing, threating, nonredirectable and refusing to take her po medications. She is Conserved and has orders to be given IM medications if she refuses her po medications. She was not my pt but she usually will listen to me and take her meds. I went to talk with her and she continued to be loud, argumentative and refusing to take her po medications. her primary Nurse was givin he Im injections as other staff including me gently held a hand on hetr legs. she then started to fight staff so we had to hold her tighter to prevent her from hurting herself or us. The next day she told he DR that I held her left knee down so hard that I hurt her. the prior shift stated that she did not complain to them of any knee pain and was walking about the unit without any difficulty. The Dr was going to send her for an Xray but discovered that she had a similar complaint the prior week and was checked out. all x rays were WNL. I was concerened about this pt s accusations so I wrote a letter describing the incident and the nurses ,Csts that were involved wittnessed it and signed so if they needed to be talked with would be willing to do so. Early the next morning the pt called me by name and in a nice tone of voice asked for a coffee cup, I gave it to her and asked if I could talk to her. She said yes. I asked her why she told the Dr I was putting essive force on her knee and had hurt her. the pt said loudly"thats a lie. I never told her that.She is lying.: my peers heard her response. I also included this update in my letter to Management.. When I turned it in and explained what it was reguarding one of the shift Managers stated :since when do we confront Delusional, Psychotic pts?" My response was it is more behavioral as last pm she was faking a seizure and refused to get up off the floor. I thought this comment was rude and wanted to say"we accept all of their pt satisification surveys as well as all of their complaints. We get dinged for all the comments and complaints. Why not do a little reality therapy and make someone responsible for their actions?" What does anyone else think?

Anonymous 4 weeks ago

I would advise you to be more conscience about what you are writing on these blogs.
"Someone who comes into the hospital just so they can get a check (aka crazy check) when they are clearly healthy but truly too damn lazy to work.".

This completely contradicts your statement that you approach each patient as a person. Advancing the nursing profession to have our opinion hold the same weight as other healthcare professionals, does not begin by writing to the public about "Three things you dislike about Psychiatric Nursing". You are very open about experiencing burnout, which is understandable. However, to improve this problem and truly help others, it must be done in an educated, formal, and structured way. Otherwise it will continue to exist as your articles get lost among the other millions of other internet blogs that have only accomplished taking time away from a person's day.

jimmy lee 3 days ago
Lets see if I can help Angela out here
When a pt comes into the hospital frequently after using Meth for weeks and states "im hearing voices. I need help." It is our job to try nd help them. They have 2 legs, 2 feet with all toes present, 2 arms 2 hands with all fingers present and all other body systems are WNL. After about 3 days of crashing off Meth which means sleeping, eating and snacking only, refusing to bath or attend groups and the only medication that they wil take is either Seroquel or Ativan they wake up clear and start demanding Double portions,pain medications,sleeping aids and are now saying that they are suicidal and are going to commit suicide. Most of these type pts have been shunned by their family, friends and burned all their bridges. So now the only place they have to go without being sent out to look for work to get money is either the Hospital or the Streets. They really do not like to go to shelters because you have to be sober to stay in one and must leave them early in the am and show back up early in the pm with the uncertinity that you will have a bed for the night. In the hospital they can to sleep all day, resist any help and do not have to attend any groups. They do not even have to get their labs drawn and get mad when they are awakened to do it. They have a urine cup at their bedside and are reminded frequently that we need a urine sample but never give one. However right after lab are requested Breakfast is served. The next thing you know they are all up drinking coffee and eating. as soon as they finish breakfast they go right back to bed and get angry when the Nurse attempts to talk with them about how their day has been or educate them on positive coping skills. These type paetient lack motivation to change and have no desire to do so.Sometimes they will tell you they are trying to get on disability because they can not work due to their drug habits. I call these type pts 3 hots and a cott.And they do come into the Hospital often times to get on Disability. What is so disturbing to me is the ones that finally do get a Disibality check continue the cycle only they do not stay as long, They come in after they run out of drug money ,stay until their check is being mailed out because they will truly kill themselfs if released then when check date time comes they are healed and ready for discharge. Its a miricle how that works. And no it is not BURN OUT... It is frustration at the system plus the fact that hard working people likr me and Angela are paying for their stay at the Hospital, take their abuse and we are the ones paying for it out of our tax dollars.I hope you can understand our position as it is very irritating to be verbally and physically abused at our expense.

Anonymous 1 month ago
I am currently studying nursing and would like to specialize in psychiatric nursing when I have my degree. I have experienced both sides of psychiatric care. I have bipolar disorder (manic depression) and I have been hospitalized twice before being given the correct diagnosis. I have to agree with the "crazy check" comment; I have seen it myself. I have seen nurses who don't care about their patients and have even heard them making fun of patients. The first time I was hospitalized was in a county run hospital and the care was horrendous. My second hospitalization was at a highly regarded university research hospital and they saved my life. The nursing staff was excellent because they knew what they were doing and they WANTED to work in the psychiatric field. Like Angela they saw the whole person, not just the patient. It is due to nurses like Angela that I am pursuing psychiatric nursing. Thank you for what you do and how you do it.

anonymous joanne 2 months ago
what about the lifes you've wrecked from giving medication approved by drug companies causing memory loss of precious memories, weight gain, liver problems, sudden death from low blood count, diabetes, inability to talk, slowed speech, shrinkage of the brain, restraining someone against their will held down with 6 nurses, allowing yourself to work in a place which destroys the natural spark that people have why bother getting to know them when youre going to change who they are from giving them mind altering medication. Please spare the bullshit story about major things you've learnt being in a psych ward I'll tell you what you learnt you learnt how to be a cold hearted nurse who doesn't give a shit about human rights to even work in that place longer then a week, this is like the fluffy version of working in a concentration camp, try and tell your altered nice version of what you do to god who sees all.Tell god you had good intentions when he looks down at the peoples lives you've wrecked with good intentions knowing they'll never have a future and their souls are gone just empty shells of who they used to be this is insulting that you are saying you want to get to know them what before you take away their personality, I went through hell with being in a psych ward where I no longer can follow my interests that make me who I was as a person unable to work or study due to basic brain damage from being trialed on a number of drugs from brief 30 minute diagnosis from the psychiatrist on the ward, who on the first visit said I had dementia and needed shock therapy then 2 days later said I had parinoia. Listen your whole existence as a proffesion is pointless these institutions provide no solution but to drug up people who are mentally ill wreckless and then as a result they live their life having to goto groups that the hospital runs on how to cook food, one guy in the hospital I was at used to be a it major and he needed instructions on how to get to a local hairdresser in a shopping mall. Every single one of the patients in the ward spend all day watching tv and if you try and have a conversation they wouldn't be able to respond and you might say how am I able to talk and communicate my ideas after being medication that might be due to the fact that I lied to a psychiatrist about not having a history of mental illness playing the system so I could be prescribed with congnitive enhancement drugs such as adhd Ritalin medication which ironically given the fact that im apparently paranoid should be giving me dellusions and paranoid systems since my main problem was to address my high levels of dopamine which my medication lovely increases to a normal level after people like you fucked around with my brain. Unfortunately most people who have been medicated will never be able to reverse the effects because the psychiatric system doesn't allow for patients with a mental health history to take that medication due to problems with being sued. Well you remember being on a power trip and saying in your statement that you wanted to see them as a "person" not a patient well given the fact that im anonymous and you really have no control to effect who posts whatever on the internet you can kiss my arse and I hope one day you some how manage to end up in a psych ward but god will never forgive you for the lives you've wrecked so sleep easy tonight.

Anonymous 3 days ago
Believe it or not ..some people need to be changed and they are so delusional they do not even realize it. I think that you might be one of them.

Hazel Elliott 1 month ago
Also, if you are against psychiatric medication why would you lie to a doctor to obtain a prescription for a highly addictive medication for a disease that you don't have? That behavior is a red flag for addiction.

Hazel Elliott 1 month ago
It sounds like you were in one of the badly run psychiatric hospitals (unfortunately there are many of those). I had an experience in one as well. On my second hospitalization I was fortunate enough to be admitted to one of the best psychiatric hospitals in the U.S. I have my life back and I am the same person as I was before manic depression reared its ugly head. I hope you find healing and peace.

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Anonymous 3 months ago
Interesting. I want to share my experience with you as one labelled as a "health check". After years of suffering from depression, low self esteem, social anxiety, many failed interpersonal relationships, I asked for a psychiatric evaluation. I wanted to know why I was so different and i wanted help and support to live a normal life. My disability advisor- I was in receipt of sickness benefit- advised me to apply for additional support. The reaction of the Psych nurse when I asked her for help with it took me aback. It was clear to me from the lack of support offered and her attitude to me after that, was that I was attempting to play the system. For a while this drove me into deeper suicidal ideation and self harm and I felt even lonelier and now stigmatized and judged. I lack social skills and am from a background of physical and emotional abuse so the confidence to get out and live in the world wasn't there for me. But I wanted it to be. I thought by asking for help and admitting I am unwell was the first step, but it wasn't. I still can't leave the house; I still struggle with relationships and I still self harm on occasion. I have self image issues and I mirror check all day until I cry with exhaustion. My gp is the only person who has helped and I wouldn't be alive without her help and intervention. There is a bit of a witch hunt right now on the long term sick.....sad but then I suppose the vulnerable have always attracted this. I am grateful for professional people who see beyond the surface and don't judge. I trained in mental health myself, ironically, and judging distressed and socially marginalized people never came into the equation for me. No one wants to be stuck in doors and living off welfare....or be harassed because they struggle with mental health. I feel very much on my own now....but at least there is my gp who believes me. It is the most awful thing to break down and tell someone what you're going through and to not be believed.... it is like pure hell.

Anonymous 3 months ago
I was in and out of two Psych wards for a month and in outpatient care for over six. Schizophrenia changed my life when I was merely 18 years old. Being admitted to the Psych Ward I found I was safe, finally. The delusions of the Devil sending people to get me were at the least unbearable. I couldn't function in society as a human without the medication that was prescribed to me while I was there. I am so thankful to the staff and people like you for being understanding, even if you fake it. The workers joked and laughed with us like we weren't out of our minds. Some, of course, were there for depression, which is just as serious of a condition. I learned laughter is contagious, boundaries are necessary, and that it's okay to depend on others.
I plan on pursuing my passion for the brain with a career as a mental health technician.
God bless.

Megan Smith 9 months ago
There needs to be more like you. Thank you for your true service.

Anonymous 11 months ago
You shouldn't prescribe meds if you think this, "Someone who comes into the hospital just so they can get a check (aka crazy check) when they are clearly healthy but truly too damn lazy to work." Your would be unfit and more than likely insecure. Clinical nurse's you describe are often ugly inside-out.

Anonymous 10 months ago
1: It's not nurses that prescribe - and we still have discretion to give medicine or not.

2: We have no say as to who gets admitted in to the hospital. That is an external assessment team and if someone is telling you the right things to get admitted, you might not be able to say 'no' to admission. Nobody can fake it for more than a few days at best no matter what you've seen on tv. At that point we can tell they're just blagging the system but there's nothing we can do on the ward to stop them being admitted,

You do get people EXACTLY like Angela described.

Anonymous 4 years ago
Excellent post, Angela! I loved it! Keep up the good work!!

Anonymous 4 years ago
I worked in adult acute psych for 6 years, starting out as a tech and then a charge nurse I truly understand what you refer to. I've worked in critical care since and find my psych nurse skills to be very needed at times and am always thinking outside the box of a normal staff nurse when dealing with difficult situations. I love nursing for allowing me to use all these skills on a daily bases.

Gina Birt 9 months ago
What type of critical care have you worked in? I've heard psych nurses are in demand in the Emergency department settings as the rates of psychiatric pt. admits have gone up substantially in the last 10 years. Is this true?

Anonymous 4 years ago
Being a psych rn I can definitely emphathize the frustraction of patients abusing the system. Great post Angela.

Anonymous 4 years ago
This is awesome! This is my favorite comment when you said: "I confess – my psych patients have taught me a lot about life. I have not always liked working in chaos and in hazardous and dangerous situations, but I have always liked talking to the ones I meet. They have shown me that we are all one step away from the admission office when life hands us more than we can bear. They have taught me that just because I cannot see delusions and hallucinations doesn’t mean they are not real. They have taught me the feelings of real compassion for another human when they cannot help themselves. They have taught me that being with family is not always the safest place to be. At times, families hurt family members deeper than a stranger does."

Anonymous 4 years ago

I work in an acute psychiatric hospital and am surrounded by judgmental staff and it has become so disheartening I want out. It is absolutely unbelievable what comments have come out of the mouths of these "professionals" the latest most disturbing was an RN who was making derogatory comments about a patient who came to us for an assessment and I asked her what she had just said because I felt I must have misunderstood her and she said "oh this stupid patient" I looked at her and said really a stupid patient? how is that so and she attempted to back peddle and excuse her inappropriate, judgmental and rude reference to someone suffering. Another situation was an intake staff who was saying that the patient who had a government funded insurance and owned a recreational vehicle had mismanaged their money...WOW really, so all those people having financial issues are just poor money managers. I would actually like to be around when life teaches her differently. What happened to walk a mile in my shoes before you judge me... and if any information is faxed to the triage department from another facility requesting review for admission I have heard on more than one occasion "oh that one is a borderline" making reference to the many medical problems...that nurse is proud of her advanced degree and judges patients by how nice or not nice they are... next thing you know the DSM will have a diagnosis of "NOT NICE" however it is just a projection of the amazingly NOT NICE so called professionals who are more the norm. They come into the profession for the money and their arrogance and misunderstanding of the most basic of human needs and how when they are out of balance all kinds of behaviors manifest. I am just about finished with the whole medical community. The other day a staff filed a complaint against a patient with a chronic mental illness and the hospital supported it. I have years of experience and if I had the power to correct some of this I would and the first thing I would do would be terminate anyone who made reference to "Crazy Check" etc and they would have to go through a simulated mental illness experience even the personality disorder, endogenous etc. until humble pie was flying out of your entire existence then you would be able to return on probation only if you demonstrated genuine compassion, empathy, non judgment and a 1000 word essay about your experience and how now you will mind your own business and be the healthcare provider you are suppose to be not a judge and jury.What happened to true compassion and empathy, grace and an attempt to assist in the healing process. I could give hundreds of examples however I would rather not feed the monster! I think I am going to change careers and write how to avoid the entire healthcare system which is nothing but a giant business posing as something else. When you have to put up giant billboards to say how great you are, it tells me to turn around and run for my life. There are alot of us out here thinking and acting on that idea, check out, google, utube, library processed people,Dr. Mercola, EFT,American Holistic Nursing.\, and many other modalities where I think the compassionate have migrated.

Anonymous 4 months ago
You have assessed the game correctly. Those who stay either must develop notions that the game is a valid one or must live with their valid observations. It is a huge business hiding behind sanitized notions. Anyone can defend Abu Gharib or Guantanomo Bay military prisons also as glibly as folks prefer to defend the mental illness system. It is still a system of torture, adding injury, and death. It is the biggest disinformation campaign in this nation--which is as successful as any disinformation about a system that runs behind closed doors by people who have vested $$ interests in keeping its machinations secret. And we all know what goes on there.

Anonymous 4 years ago
Angela, as a fellow psych nurse I really enjoyed your post!

Anonymous 4 years ago

Very disappointed with this article. I'm really saddened to see that no one has commented as of yet. You choose Nursing, It didn't choose you. I don't understand how come you have all this negativity towards your assumptions of what your patients do, and why they do it. As a Nursing professional, it's not our role to determine why people do what they do, it's our role to advocate, teach, and provide...not judge or discriminate against those with any sort of diagnosis, not just the ones with a mental health origin. Your wording is inappropriate, and I don't know why it's even published on here to tell you the truth. Mental Illness, is just that, and Illness. For you to make such statements "aka, Crazy check", among many other inappropriate statements, is not in the best interest patients rights as far as discrimination, and your role to be a provider and professional. Mental Illness is an acknowledged disability, therefor, you should watch how you approach this topic. Especially when there are other impressionable students and experience nurses that you are having an influence on. You are conveying that you have a lot of reasons to be dissatisfied with the job that you have chosen. Which in my opinion, opens the door for further misunderstanding, patient rights violations and discrimination. If you have a patient with cancer, or Aids do you think it's ok for you to pass judgement too ? These are diseases, and diagnosed illness? So why is it so different? Because you think it's acceptable? Shame on you. I can go on and on here....but I won't.

Samantha Jones 7 months ago
I think the article went completely over your head...

Anonymous 4 years ago
Angela, Great insight into a tough field.