I’m a mental health nurse. There are no good decisions, only least bad ones
Monday
I’m a nurse on an inpatient psychiatric ward in an inner-city hospital. Our patients have a variety of mental health difficulties, and are mostly at the beginning of their recovery journey. I tend to work three days a week because shifts are 14 hours long.
After morning handover, I check medication for a patient being discharged today. I don’t think he’s well enough yet: he’s still disturbed by voices in his head and can become very frightened when out on the street.
After he’s discharged he’ll only see a nurse twice a day to make sure he takes his medication, and those visits will probably stop after a week or so. I think he will be back here, even more unwell, before long. But because of the demand for beds, as soon as a patient gets anywhere near the threshold for discharge, we are under constant pressure to make room for someone more unwell.
My patients need to trust that I’m there for them, but often I just feel I’m letting them down. In a hospital where staff are each doing the work of two or three people, there are no good decisions, only those which are the least bad.
Tuesday
We’re two staff short today. After medication rounds, I spend an hour accompanying patients off the ward for cigarette breaks. People at the beginning stages of their recovery generally only leave the ward with a nurse. Sometimes we chat or get a cup of coffee, and sometimes they just want to sit in silence and enjoy some peace.
A patient with psychosis asks me to take him out, but I decide it isn’t safe for either of us considering how unwell he is. I worry he might run away, or threaten me or someone else while we’re off the ward. My refusal makes him angry, and he follows me around for the rest of the day telling me how he’s going to find and kill my family.
He squares up to me each time I leave the nursing station, trailing me down the corridor. I keep my hand on my panic alarm, just in case. When I was a student I used to find these threats very frightening, but I’ve had to get used to them. Regardless of his behaviour, I’m still his nurse and I’m still there to look after him.
Wednesday
The panic alarm rings mid-morning, and I rush to find a colleague with a patient who has self-harmed and is unconscious. My training kicks in: if I think too hard, I get blinded by panic.
I’m shaky and full of adrenaline afterwards, but relieved we found him in time. I give myself three minutes to call my mum from the staff toilet for a bit of reassurance, then get back to work. I know this man needs specialist talking therapy, but that won’t be available to him during this admission. The chances of him getting it after discharge are also slim, thanks to waiting lists that are sometimes two years long. The best I can offer him is some short-acting medication to calm him down.
There is an unusual lull in the afternoon, and I run a bath for one patient. She is disturbed by terrifying hallucinations and hasn’t bathed in a long time. With much coaxing and reassurance, she gets in and washes her hair while I put her clothes through the wash.
She emerges looking calmer than I’ve seen her since admission three months ago. It is so rare I have the time to do this sort of thing, and I feel a renewed love for this job. I believe in the healing power of small acts of kindness, and making someone feel cared for is a good start to them getting well.
There is an unusual lull in the afternoon, and I run a bath for one patient. She is disturbed by terrifying hallucinations and hasn’t bathed in a long time. With much coaxing and reassurance, she gets in and washes her hair while I put her clothes through the wash.
She emerges looking calmer than I’ve seen her since admission three months ago. It is so rare I have the time to do this sort of thing, and I feel a renewed love for this job. I believe in the healing power of small acts of kindness, and making someone feel cared for is a good start to them getting well.
Thursday
My day off. I go to the pub and see my friends, who make effort to give me space to talk about work. My answers are scant, because it would drain us all to go into detail, and I just want to enjoy my pint. I work in close proximity to so much suffering that I can never quite find the language to explain it all.
The Guardian
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