nursingforsocialjustice

Sometimes I wake up in the morning (before my little kids wake up and barge in asking if they can watch a show on Netflix) thinking about work. I think that this has been happening more and more lately, perhaps because I have again returned to school (and by again I mean, never left) and am deep into thinking about the philosophy of nursing. I think about why I am pursuing a doctorate in nursing. I think about why I consider myself a mental health nurse. I think about what I accomplished the previous day or the previous week. Lately, I have been feeling like there is so much opportunity to educate and facilitate learning, but my sense of accomplishment is less and less. Is this the ebb and flow of life? Maybe. Does it stress me out? More than a little bit.

What strange paradox, this explosion of reflection paired with a seeming paralysis of what I perceive as meaningful action.

I used to wonder if some of the challenges that I am facing in the workplace are emerging because of some lack of clarity about what it means to be a mental health nurse on an acute inpatient mental health unit. I now wonder if these challenges grow from deep frustration about the state of the healthcare system and nurses role within it.

A question that I has proving significant in my doctoral research (and in my personal contemplation about my place in nursing) is: what is psychiatric and mental health nurse identity? Is it different? Does it matter? I think that this answer may be easier to answer for nurses who graduate from Bachelor of Psychiatric Nurse programs than for nurses who graduate from Bachelor of Nursing programs. Looking back at my own career, I think that I may have been unclear about everything that entailed being a mental health nurse. As a whole, nursing is so much more than the tasky-types of things that some of my undergraduate nursing classmates seem to long for so many years ago; it is more than starting an IV, doing a head to toe assessment, changing a dressing or monitoring for medication side effects. But, it’s also more than doing a mental status exam and keeping track of 15 minute observations.

My experience is mental health and community nursing of adults, primarily adults facing multiple barriers such as substance use, poverty and chronic illness. Critical care nursing or oncology nursing seems more straightforward in what it means to be a nurse in these areas. I think, with respect to the short amount of time that is spent on mental health nursing in some undergraduate nursing programs it can be a challenge to know and understand exactly what being a mental health nurse entails. Everyone has mental health issues right? Are there special skills that are needed to work in mental health nursing?      

Looking back, I think that something that has been useful to me in helping me understand how being a Registered Nurse has change my life is reflective journaling. I have reflective journaled almost my whole life anyway. I think that if someone explained the utility of it to me early on in my career in a way that linked it more to developing my nursing practice then I would have been able to focus it more on developing my competence and skill as a mental health nurse. I think that it is unfortunate that, at the undergraduate level, mention of the concept of reflective journaling gets major eye rolls and constant questioning about it’s purpose. Is it the fluffy stuff or is it the heart of nursing?

It is true, writing in a journal about the challenges and successes that one has had in a shift, or throughout the week will probably not help get an IV started in one try or help remember the medications that are most used on a particular unit and their side effects, but it will help in increasing understanding about why these things are important, how certain interventions and pieces of the care that is being given effect the patients and their family and how they effect the nurse. I think that reflective journaling does help with the care piece of nursing, as well as the critical thinking piece.

In mental health nursing we do things that are morally tough. Sometimes patients have to be admitted against their will. Sometimes patients have to be given medication that they adamantly do not want. Sometimes patients are locked in rooms or put in restraints to maintain their physical safety as well as the safety of others. These are all not nice things to do. However, these are all things that deeply impact a mental health nurses. These are things that I think about almost on a daily basis when I am at work because over time I have come to understand that these things deeply effect the patient deeply effect their family and deeply effect everyone that I work with.

We look at patients holistically. Let’s look at ourselves and our practice through a holistic lens as well.

Landeweer, E., Tineke, A., & Widdershoven, G. (2010). The essence of psychiatric nursing: Redefining nurses’ identity through moral dialogue about reducing the use of coercion and restraint. Advances in Nursing Science, 33(4), E31-E42.

McCrae, N., Askey‐Jones, S., & Laker, C. (2014). Merely a stepping stone? Professional identity and career prospects following postgraduate mental health nurse training. Journal of psychiatric and mental health nursing.

Love,

Michelle D.

P.S. Melanie Mark is inspiring