What Psychiatric Nurses Do (Part One – Admissions)

My nursing-related posts have always been popular, including the one I had to delete from my old blog. So as I’ve just left the profession, I thought I’d pay kudos to the hard work of my ex-colleagues and just explain to anyone interested what psychiatric nurses actually do. This will be a little series of posts about the profession, with details of all the aspects of a nurse’s job.

When I registered on the course to train to be a psyche nurse, I honestly had no idea what it actually involved. And if you asked anyone not in the profession, they would probably have some misconceptions about the role, and in truth no real idea of what the job involves. Psyche nursing is completely different to any other type of nursing. And the role is about as diverse a job as you can get. I don’t think even my friends and family genuinely understand what the job involves. There are whole books on the subject, trying to pin down what exactly a psychiatric nurse does. I myself started (and WILL one day finish!) a book based on a psychiatric ward.

So here I’ll try to describe what a psyche nurse actually does…

Well firstly, nurses work on lots of different areas. During my training I was mostly ward-based, because that’s what I preferred, but I also did placements on elderly wards, community teams, rehabilitation and a day-centre. In the UK, people in mental health services (let’s call them patients :P) usually enter mental health services for the first time through a ward. They’ll go to A&E, be picked up by the police or go to their GP (general practice doctor). The ward will assess them and either send them home, refer them to a community team who will support them at home, or perhaps send them onto rehabilitation or to attend day centres. It all depends what level of support is needed.

As I’ve pretty much always worked on a ward, I can only really speak from the perspective of a ward-based psyche nurse. So that’s what I’ll do.

So yeh, most of the patients referred to the type of ward I worked on, come through A&E or the police. We’d occasionally have people referred from a GP, but not very often. Most admissions are people who have either attempted or threatened suicide, and have been picked up by an ambulance and taken to A&E. There they are assessed by the Crisis Team (a specialised team of psyche nurses and Psychiatrists), who are the ‘gate-keepers’ to the wards.

The other way patients are usually admitted is being picked up in the street by the police, usually for acting strangely, or if the police have to go their home after a disturbance. The police bring the patient to a special unit called the 136 Suite, where they can be assessed by a nurse and a doctor, who will decide if they should be sent home, admitted and if necessary sectioned.

So once the patient has either agreed to come into hospital voluntarily (informal) or has been sectioned, the nurse in charge of the ward (i.e. this was me) gets the call from the Crisis Team. I would take a history, find out why the patient is being admitted and what the assessing practitioner wants from the admission. It may be further assessment, treatment, detox (although officially detox isn’t an appropriate reason for admission to an acute ward it does happen, A LOT) or to maintain their safety until further support can be put in place at home. I would then find out when the patient is coming, how they’re arriving, what sort of state they’re in, any risk issues, etc.

Once the call is over I would find the patient on the computer system, do a bit of reading, inform my colleagues and the on-call doctor of the admission, make sure a room is made up, allocate someone to do the admission (which could be me), and start the paperwork. It may be many hours before the patient actually gets to the ward.

Once the patient comes, if I was admitting, I would welcome them to the ward, explain what is going to happen, and then sit down with them and complete their admission paperwork. They may be extremely distressed, in which case I would risk-assess the situation, may ask other members of staff to sit in with them, or simply leave all the admission stuff until a later time. The doctor would attend, and together we would take a history if we could. Then I would show the patient around, explain the ward rules, and generally settle them in. If they were distressed, at that point I would leave them with colleagues and myself and the doctor would discuss medication to help calm them.

Once the doctor has done his stuff, including blood tests, a physical and other little jobs, I would then sit down to complete care plans for the patient, risk assessments, and other bits of paperwork, all of which can take as long as three hours. That’s right… THREE HOURS!!!

Admissions are generally easy but time-consuming, but they can be risky. Most admissions are patients who are known to services and have been in hospital many, many times (which is partly what makes the job so soul-destroying), but occasionally a patient who is completely unknown will be admitted. In truth, when you enter that room with them, you don’t know what you’re walking into. Part of the training to be a nurse is teaching you to recognise dangerous situations and prepare for them. For example, before entering a room with a patient a psyche nurse knows to inform other colleagues where they are, ensure their attack alarm is working and easily grabbed, where the exit to the room is, and where the best place to sit for the quickest exit is. But even with all that, occasionally things can go wrong. It’s never happened to me, but there have been times where the assessing nurse is attacked. A few years ago on the ward next to the one I worked on, when assessing a patient with puerperal psychosis, a member of staff was severely beaten, requiring many weeks in hospital.

So that’s admission. Next time I’ll discuss assessment and care planning.


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