DiversityNursing Blog

While physical health is undoubtedly important, so is Mental Health. Millions of Americans are affected by mental illness each year. Psychiatric Nurses have the specialized knowledge and skills needed to treat these illnesses. 

According to the American Psychiatric Nurses Association (APNA), Psychiatric Nurses make up the second largest group of behavioral health professionals in the U.S.

In the United States, suicide is a leading cause of death and in 2020, about:

• 1 in 5 American adults experienced a Mental Health issue
• 1 in 6 young people experienced a major depressive episode
• 1 in 20 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression

The pandemic has increased the need for Mental Health care. According to a report from the Centers for Disease Control (CDC), the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5% from August 2020 to February 2021.  

There is a dire need for more Psychiatric Mental Health Nurses (PMHNs).

More than 75% of all U.S. counties have a shortage of Mental Health professionals and almost all counties have an unmet need for Psychiatrists.

Mental Health Nurses work in a wide variety of inpatient and outpatient work settings, either as a specialty position or in primary care. Some job opportunities include military care, forensics, private practices, clinics, community health centers, public health facilities, schools, substance abuse centers, senior centers, hospice, rehabilitation services, telehealth and case management.

The day to day duties of PMHNs include:

• Conducting an assessment of a patient’s status
• Conducting intake screenings, initial evaluation, and triage
• Providing nursing care following a treatment plan
• Administering medication and/or other treatment regimens
• Teaching patients self-care activities
• Engaging in crisis intervention and situation stabilization (when necessary)
• Educating patients on how to manage their condition
• Providing education to patients’ families and communities
• Working efficiently alongside other members of an interdisciplinary team

“It’s a very rewarding field. As a Psychiatric health care provider, you may be the first person to talk to someone about why they are in crisis, and that can be a humbling experience," said Emma Mangano, DNP, PMHNP at Johns Hopkins Hospital. 

Some essential traits of a Mental Health Nurse include:

• Critical Thinking
• Good Communication
• Empathy
• Reliability 
• Confidence
• Compassion

The salary of a PMHN depends on their level of experience and the amount of specialized training they have undergone. According to Indeed, the average Mental Health Nurse's salary in the U.S. is $87,156.

A career in Mental Health Nursing can be demanding, but it is extremely rewarding.

Psychiatric/Mental Health Nurse Practitioner (PMHNP) Windi Woods, says that the best part of the job is “knowing that this team is the end of the road for most of these patients and we give them hope." 

Before the COVID-19 pandemic, Nursing was known to be a stressful profession. There was plenty of data showing burnout to be a significant problem among US Nurses.

With increasing stress placed on front line Nurses during this pandemic, hospitals are investing in initiatives and programs to support the mental health of these employees.

Mount Sinai Health System, created recharge rooms for healthcare workers. Dr. Putrino and his team created multi-sensory experiences that can reduce stress in just 15 minutes. These rooms are filled with faux plants and candles, illuminated with calming lights and one wall displays relaxing scenes and sounds. Putrino said, "Listen, what we need is a space or a series of spaces where our healthcare workers can sit down and for just a moment have a lot of their stress just relieved and taken away from them."

Stony Brook Medicine used a similar idea when creating a respite room called "Resilience at the Brook." The large, peaceful area features plants, calming wall art, a pod for private mediation, and relaxing materials, such as coloring books and miniature Zen gardens, to help employees rejuvenate. Employees can also add encouraging messages and quotes to inspire each other on the Motivation Mural Wall.

Ohio State University Medical Center (OSUMC) Stress, Trauma and Resilience (STAR) Program uses the Buckeye Paws program. A group of certified therapy dogs visit to provide comfort and emotional support to healthcare staff.

Emily Fawcett, R.N., a float Nurse on all floors at Lenox Hill hospital, started "hope huddles." Hope huddles are held at the beginning of shift changes and Nurses gather together to share news of patients recovering and other inspiring, and even humorous, stories.

Cody Regional Health created a wellness area for employees. The new space, staffed 24/7, includes a meditation room, eight bedrooms with private bathrooms, laundry and shower facilities, on-site access to licensed therapists for emotional support, puzzles and games, and an exercise area to meet employees’ needs.

Elise Phelan, a surgical unit Charge Nurse at UCHealth created the Resilience Program. Phelan would bring in massage therapists, movement therapists, yoga instructors, nutritionists and sometimes therapy puppies.

Code Lavender began in 2008 with Earl Bakken at North Hawaii Community Hospital. Calling the code signals to the Code Lavender team that an individual or group of individuals are in need of emergency psychological assistance.

Many hospitals like Cleveland Clinic have started implementing this code. The Code Lavender team usually comprises representatives from the spiritual care and healing services departments, and other hospital-based support services (such as employee assistance, music therapy, wellness, the ethics consultation service, and art therapy), and volunteers.

Bayhealth offers staff Code Lavender Kits. Kits include a back massager, aromatherapy inhalers, LED candles, a sound machine, Code Lavender journals, and a tote to store everything in.

It's very clear there is a need for this kind of support and innovation. The well-being and morale of front line workers should remain a top priority even after the pandemic.

Many Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!

Approximately 56 million American adults are struggling with a mental illness or substance use disorder, according to the American Psychiatric Nurses Association (APNA).

An article from mentalhealth.gov, shows the current mental health workforce shortage is projected to grow and would leave the country 250,000 professionals short by 2025.

Only 44% of adults and 20% of children in the U.S. receive the mental health and substance use care they need because there is a growing shortage of qualified professionals trained to provide timely and effective treatment.

This lack of treatment significantly contributes to one of the leading causes of death in the U.S, suicide.

According to the same mentalhealth.gov article, suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 lives each year, more than double the number of lives lost to homicide.

An article in the Journal of the American Medical Association (JAMA) discusses the increase in children under 18 going to emergency departments due to attempts of suicide or suicidal ideation.

One reason demand for mental health professionals has increased is because more Americans are gaining health coverage. It's the law per the Affordable Care Act that insurers can no longer deny coverage to people who have diagnosed mental illnesses.

Also fewer medical students are specializing in psychiatry because psychiatry jobs don't pay as well as other fields. Students facing high medical school debt are more likely to pick the jobs offering better pay.

There has also been a surge in substance use disorders and greater public awareness of mental illness. Increased public awareness means more people living with mental illness will seek treatment.

Healthcare providers and the medical community at large need to implement a more supportive environment for the psychiatry profession. There should also be increased compensation for psychiatry jobs and student loan forgiveness or free/low-cost psychiatry schooling.

Policy makers should support and enact quality mental health services that will improve public health, particularly populations who most often have no access to mental health services.

According to a healthecareers.com article, Mental health Nurses are typically part of a healthcare team that includes Psychologists, Social Workers, Psychiatrists, Occupational Therapists and other healthcare assistants. 

Psychiatric Nursing is a demanding profession but many Nurses find it rewarding and ideal for their qualifications. It can be a financially rewarding specialty as well.

An article by the American Psychiatric Nurses Association says, the Psychiatric Mental Health Registered Nurse develops a Nursing diagnosis and plan of care, implements the Nursing process, and evaluates it for effectiveness. Psychiatric Mental Health Advanced Practice Registered Nurses (PMH-APRNs) offer primary care services to the psychiatric-mental health population. PMH-APRNs assess, diagnose, and treat individuals and families with psychiatric disorders or the potential for such disorders using their full scope of therapeutic skills, including the prescription of medication and administration of psychotherapy.

Colorado Technical University covers some of the skills Psychiatric Nurses should have:

• Interpersonal Communication and Collaboration – Psychiatric Nurses should have good one-on-one people skills since they help administer biopsychosocial assessments and work to educate clients and families on therapies and medications.
• Problem-Solving – Help assess patients by using the psychiatric diagnostic classification systems and observing and examining the patient's behaviors. 
• Attention to Detail – In addition to problem-solving, it is important that Psychiatric Nurses demonstrate care and meticulousness since their duties can include educating patients about psychopharmacologic drugs, administering such drugs, and monitoring patients taking psychopharmacologic drugs as well.

Allnursingschools.com discusses education and certification requirements. Psychiatric Nurses must be Registered Nurses. Although 4-year Bachelor of Science in Nursing degrees are preferred, you may choose to begin your career with a 2-year associate’s degree or a 2- to 3-year diploma through a hospital-based training program. To become a Psychiatric Nurse Practitioner or Clinical Nurse Specialist, you will need additional education at the graduate level, usually two-year Master of Science in Nursing (MSN) degree. Psychiatric Nurse Practitioners are Advanced Practice Registered Nurses (APRNs) who earn master’s degrees in psychiatric-mental health Nursing. 

The occupational outlook for Nurse Practitioners in the field of mental health Nursing is 31%, according to a NurseJournal.org article, which is much faster than other positions within the United States. This job has seen an increase in need for licensed Nurses as mental health awareness has begun to rise throughout the country. The average rate of pay for a mental health Nurse is $96,460 per year or $46.37 per hour.

Are you a Mental Health Nurse? Do you enjoy your career choice? We would love to hear about your experiences. Please comment below. Thank you!