The psychiatric Nurse 1955

The Psychiatric Nurse

                Something has been said already about the psychiatric ward as an environment in which to pursue a nursing career.  We have no facts to show whether or not the nurses in a special psychiatric hospital lead professional lives that are unlike those of nurse in the psychiatric wards of a general hospital.

                As found in psychiatric wards in North Carolina, psychiatric nurses are younger than the floor nurses, 75 per cent of the sample were under 39(29, p 12). They may turn out to be the Cinderellas among nurses, for only one quarter of them said that they went into their work for its own sake.  Others entered it because it was convenient, or the only job available at the time, or better-paid, as it often is.  However, once in it, 44 per cent said that they planned to spend the remainder of their professional lives in it, while only 8 percent said that they did not; 49 per cent were undecided.

                It was found quite common for the psychiatric nurses in the North Carolina study to be the wives of attendants in the same institution.  Thus, there are families of mental hospital workers.  The presence of kinfolk may give such nurses moral support which maybe very important, for both nurses and attendants are described repeatedly as accepting their first positions apprehensively, with alarmist friends confirming their doubts and misconceptions (29, p103).

                One great source of difference between psychiatric and medical nursing lies inn the difference between the ailments: psychiatric nurses have to learn to operate on a deeper level of experience.  Thus, one of them remarks that the patient’s physical needs are easily met, but that it takes time to recognize his emotional needs-and this is not only in withdrawn cases: “He may act like he needs to depend on you when he actually needs you to depend on him” (29, p.103). 

                Yet, where emotional relationships are primary, there are special hazards, not the least of which is the dangers of playing favorites.  The “right” balance of closeness and distance calls for great sophistication.  This may be too much to expect of attendants, as a class, and not all nurses can cope with it.  Much of the graduate nurse’s day is spent in supervision and record-keeping, while the group that spends the most time with the patients is the attendants, a class of personnel careers.  Perhaps it is inevitable that the nurses who recognize the problem of emotional involvement are the very ones who complain that they do not have enough time.  One gets the impression that, with mental illness on the increase and with the growing disposition to hospitalize patients, the problem of time will be more and more serious for both nurses and doctors and that anxiety over it pervades psychiatric nursing.

In trying to learn what is peculiar to this type of nursing, Martin and Simpson discovered that the doctors in North Carolina are more in agreement than the nurses as to what basic skills it calls for (29, pp92-8).  One quarter of the doctors put skill and understanding in the dealing with patient’s behavior first; the next highest consensus (19 per cent) was that it takes general nursing skills.  But of the nurses themselves, 22 per cent put personality characteristics first, and only 8 per cent thought the most import thing was the skills and the understanding which had loomed so large in the doctors’ view.  The nurses, too, placed less value on psychiatry disagreed both among themselves and with the doctors.  All this points to the likelihood of strain and frustration.  In fact, psychiatric nursing may be reflecting the controversial character of psychotherapy itself.