Psychology Career Workshop V: Mental Health Nursing

Psychology Career Workshop V: Mental Health Nursing

In the fourth session of Whitetulip’s Career Workshop, we had the opportunity to hear from Brittany Lute, who is currently employed as a mental health nurse. She outlined what exactly this profession is. It was incredibly fascinating to learn about this field as most people are generally unaware of this specific nursing specialty. Before we delve into the specifics of her talk we have provided a brief summary of it to aid your understanding of the subject material.

According to the American Psychological Association (APA), mental health nursing otherwise known as psychiatric nursing is “a specialty within the field of nursing that provides holistic care to individuals with mental disorders or behavioral problems so as to promote their physical and psychosocial well-being. It emphasizes the use of interpersonal relationships as a therapeutic agent and considers the environmental factors that influence mental health”. Those who choose to go into this specialty of nursing are known as Mental Health Nurses or Psychiatric Nurses. These nurse’s jobs according to APA is to “not only provide physical care but also socialize and communicate with their patients to create a safe, comfortable environment that promotes positive change. Their specific responsibilities often include assisting patients with activities of daily living, administering psychotropic medication and managing side effects, assisting with crisis management, observing patients evaluate their progress, offering guidance and other forms of interpersonal support”. In other words, they use their skills to help and support those who are struggling with mental disorders.

Hopefully, the following bit was enough to provide you with enough general knowledge of this field. If not please make sure that you take the time to look into it on your own, otherwise, the contents of this speech will make no sense. Also, a quick note that the terms mental health nursing and psychiatric nursing are used interchangeably throughout this transcript.

What is your job?

I am a psychiatric mental health nurse practitioner and I am working in child & adolescent and reproductive psychiatry in a private practice.

How long have you been in this position/industry/field?

I actually just started, I graduated in January 2021 and was boarded in February. I took some time off and now I am getting started. It takes a long time to become credentialed, at the least 3 to 4 months.

What led you to your current career/job?

This was actually not my original plan. I studied psychology in my undergraduate, hoping to eventually get a PhD in clinical psychology. The guidance at my university actually let me know about this profession while I was questioning whether or not to pursue a phD since it is a lot of publishing and I was really more into the clinical side. So

I decided to pursue nursing after getting my bachelors in psychology. I just finished an ADN (associates’ degree in nursing) program. I worked as a nurse for 12 years in different areas, I kind of got side tracked. I really liked nursing too so I did a lot of pediatric nursing, critical care, pediatric ICU, pediatric emergency in some large teaching hospitals. Slowly I got my bachelor’s in nursing which is required, and then two years ago I got my master’s degree in nursing from Case Western. So I did circle back to my original plan even though it was a decade later.

What type of education/training, technical knowledge, or experience is necessary for this kind of work?

So anybody that is interested in nursing and advanced practice nursing can actually start off in a community college. If you are in a large crowded city such as New York, Chicago, some places in New Jersey, sometimes those large teaching hospitals don’t hire associate degree nurses but a vast majority of places in the United States do. Some places will hire associate degree nurses, but require they get their bachelor’s in nursing within a certain time frame. The Cleveland clinic where I work will hire associate degree nurses, but requires them to get a bachelor’s degree within 3 years. That is kind of standard in most places, a lot of times they may even pay for them for you. So if you do not have a lot of money to spend on universities or if you want to get nursing experience under your belt before you pursue advanced practice nursing, community college is a really good way to save time. Community college is very affordable and in some states it’s even free. So you can start working right away and you can get your nursing experience at the same time you are pursuing your bachelor’s. Unlike other master’s, you have to have one specialty in nursing to pursue a master’s in nursing and you need to have a license. So you need to pass the NCLEX, which is the national licensing exam.

When you graduate with a nursing degree you choose your speciality by where you choose to work and you can switch it at any time. I first started working in the medical ICU, but I would cry every day so I switched to pediatrics and worked in the PICU and pediatric emergency medicine. So you can choose your specialty based on where you want to work as an undergrad or bedside nurse. When you choose your master’s degree you also choose your speciality. Several specialties require different types of nursing backgrounds and they require some experience within that field. For psychiatric nursing, it’s very not specific so as long as you have been working with people you should have a good start.Once you choose to pursue advanced nursing practice, you train just in your specialty for 2 to 3 years, then you take another certification exam. You also need to have a certain number of hours in order to be credentialed. This happens when you are pursuing your master’s, your school will usually set this up for you.

What do you like best/least about your job? Why?

The thing I like best about my job is that it is very challenging, every day is honestly different. I love the flexibility I have, I can work whatever hours I want. Also just connect with patients and see how their care progresses. The reason I get flexibility with my job is because psychiatry does not require a lot of overhead. I do not have to have special equipment, a lot of staff with me, or a bedside nurse. I really only have two chairs and maybe a computer if we are doing telemedicine, so that allows for a lot of flexibility. They ask me what days and hours I want to work and I tell them after my kids get on the school bus and I give myself one day a week off. If I wanted to work twice as much I could, same thing with half as much. The way the care is delivered I think it offers a lot of flexibility. Now if you work in inpatient it’s a lot different, it’s shift work, they need night shifts and weekends covered so if you do that psychiatry it is a different flow.

I think all the paperwork is very frustrating, I’m pretty sure anyone in medicine would say that. Psychiatry has a lot of notes and I used to be very good at it when I worked in the ICU but I became terrible at it once I worked in the emergency room since you document very little. Psychiatry notes are long and I spend a lot of time on the phone with the pharmacy, trying to find records, or getting people’s blood work. That is frustrating and takes a lot of time from patients. Since you are busy doing all these other things and putting out those little fires. So you do not get as much time as you would like with them in terms of face to face contact because of this work.

What type of starting position and salary would someone entering this field be most likely to find?

There are definitely regional differences, the two coasts definitely pay the best (top places are NJ, NY, and CA). For bedside nursing whether you have an associates or bachelors in those very high paying areas you are looking at $90,000 a year. In the midwest where I am with 12 years of experience, it was around $60,000 a year. This is not great if you think of how you are working nights, weekends, and holidays. But it’s decent, especially if you only have an associates degree then it’s good. For master’s program nurses, it is absolutely a lot more. Big academic centers are always going to pay less followed by community mental health, but the most is private practices. In Cleveland where I am at is the average for the rest of the country, there are going to be places on the coast that pay a little more and places in the middle of America & the South that pay very poorly. At an academic center here in Cleveland, they offer around $100,000 for a new graduate nurse practitioner regardless of speciality. Anesthesia is the exception, it is very well paying and probably starts around $180,000. Community mental health you are looking at $120,000 to $130,000 in this region, probably more in the high paying area. In private practices, you make as much as the number of patients you see. It can be very lucrative or not as much if you have a lot of no shows or your office is poorly managed. If you like to spend a lot of time with patients, which is the advantage of private practice you can do whatever you want such as spend an hour in a followup you can, but you will make less money.

What is a typical workday like?

Because I am newer I spend an hour the night before skimming charts of patients on the schedule and making a loose plan in my mind so I feel more prepared in the morning. Then I go in, set up my computer, since we are still doing a lot of telehealth visits and then I start seeing patients. My first couple of weeks I actually forgot to put in some

breaks, so it was very busy then. But even with breaks it is very busy and kind of back to back so you have no down time. I usually see around 15 patients a day, when I was at the county hospital I saw 22 patients a day, so this is better. The visits are usually 30 minutes for follow up, 60 minutes for an initial, unless it’s a pediatric patient a lot of times you have to spend a lot of time speaking with their parents, and you may even need to do another visit just to tease out what is happening. I have that flexibility in my practice, in community mental health not so much you will never get more than 60 minutes for an initial. Some places even do 15 or 20 minutes for a follow up which is very difficult.

Do you have to depend on others in order to accomplish your job? Do you work in teams?

It’s a little different than bedside nursing. Bedside nursing is so much teamwork, you work so closely with other people, you know everyone’s skill sets, everybody looks out for each other, and you really wouldn’t survive without teamwork. So going into this field it feels a little more isolated, nurses practitioners that work in the hospital feel that comradery with other people. They are sitting at the nurse’s station or at the physician’s desks and still chatting with each other as well as solving problems. We are kind of siloed into offices same as therapists. So I guess work comes down to when you collaborate on a difficult case, spend a lot of time texting with physician colleagues trying to figure it out. Anybody in medicine would tell you that you often have to consult others as it is the wise thing to do.

What are the opportunities for advancement in this occupation?

There are really two areas, academia which is leading nursing. There is such a huge need for nursing leadership here, as well as for teaching which does pay less. A lot of phD and doctoral prepared nurses are headed towards retirement, so there are always options in academia. The other thing is they turn nurses into administrators of community health agencies. They kind of meet all the skill sets since a lot of our master’s training does focus on these managerial things. So if you start off in a community agency they kind of groom you to work as a director eventually. Personally I am not a fan of administrative things, but a lot of people are. Also they can run non profits and have those types of leadership positions in health departments. That is really it. The nurse practitioner role is the top role in the scope of practice, it is not going to extend beyond that.

Are there other industries or positions where you could work with your skills/expertise?

There are some people that work in media as social media influencers, or as nursing education in private endeavors, but it’s really clinical. You are licensed, have a scope of practice, and have professional organizations that monitor you. Those skills aren’t really needed outside of healthcare that much.

Are certain times of the month or year busier than others times?

In psychiatry as well as the medical field in general, winter tends to be a little bit busier since people are more sick. Hospitals are usually busier around this time. I’ve been working in the ED (emergency department) occasionally which has been crazy and so

overwhelming. Usually in winter when the respiratory viruses are bad, the medical side is bad as well. In psychiatry too, during those long hard winters people tend to be more depressed, the holidays happen, and there is more isolation. People are more likely to skip their appointments during a nice sunny summer day rather than in the winter. But I still feel as though it is busy all the time.

What type of interests, abilities, and skills would help a person to be successful in your occupation?

There are some basic skills for nursing that they assume kind of translate into graduate school skills. My role as a nurse practitioner and a bedside nurse are very different. The expectations and responsibilities you move from being bedside, taking orders, and implementing orders to actually being the person writing the orders so it’s a different role. However, assessing the patients, always putting the patient’s safety and dignity first, always wanting to learn more, being curious, able to problem solve, ethics, and listening, I think those are skills that translate across your career and are very important for nurses. Nursing is hard, it’s stressful, there is a huge learning curve, everyday you learn something new, you don’t have the same day you had yesterday, and each patient is different. There is a lot of responsibility because you are the one that sees the patient, the physician may not even be in the unit, you are the one that noticing if something is getting worse, that is your responsibility. It’s that skill set that makes you able to move to that advanced practice role. If you skip learning the clinical justice role then it’s not really safe for your patients and it’s not going to be a good experience for you as well. You have to kind of know what you do not know. In psychiatry, there are also a lot of medical things that look like psychiatric diseases, so you need to be cognizant of that. There is also the whole supervision thing just like in therapy, sometimes there is transference or countertransference and you need someone to help you move past that.

What advice would you give a student interested in this career?

If you are someone who wants to do hands one, clinical work, face to face with a patient, you can’t get more clinical in nursing. You are in here with the patient the whole time, and you don’t have to worry too much about research. There are a lot of research opportunities in graduate school, since they expect that for you. If you like research you can pursue a terminal degree in research. But if you spend all your time doing clinical work I think nursing is one of the best paths. You can do therapy and prescribing, the demand for it is so high. Right now there are 18 states that are full practice authority, which means that you can finish school and start working without any physician collaboration. There is some political concern around that, but still there are still many many opportunities if this is something that you want to pursue. Even with a nursing degree, if you don’t want to do psychiatry, you can go do something else. I don’t know if people realize how dynamic this field is, in psychiatry they really allow nurses to work at the top of their scope.

Shreya Sekar

Psychology Department

Whitetulip Health Foundation