Cathy's interview
The development of the whole person is what is important; that self knowing and self being. This is the essence of nursing to me.
What do you do?
I work as a crisis nurse at Otago DHB community mental health service. Typically, around 40 per cent of my day is planned in advanced. I really enjoy the intensive and sometimes urgent nature of the work which involves assessment of both clients attached to our team and of new referrals.
Often this can include a comprehensive risk assessment. Assessments may be at the request of a client, a colleague, a general practitioner, a family member or a friend of a client. Other tasks, such as documentation, service planning or department policy work, provide an interesting contrast to crisis work. I am also a member of our small critical incident debriefing team, an important service that supports colleagues when complex situations arise. I work alone and alongside colleagues in our team.
How did you get into this role? Your history?
When I first left school I got a shorthand typist job, but quickly became bored, and found work instead as a psychiatric nurse aide. Seacliff hospital had closed down by then, so I worked at Cherry Farm, the replacement psychiatric hospital. The money was also much better that office work, which was important because I was saving to go overseas.
I was off overseas three times over the next few years. When I finally returned, I worked again at Cherry Farm. I started on the night shift, then moved into a senior assistant nurse role before ‘grandparenting' into psychiatric nurse training.
After I qualified I worked for three or four years in acute in-patient wards, which included a stint as staff nurse in an acute mental health ward for people over 65. I loved the work but almost everyone had co-existing physical health problems and I became very aware that my knowledge of general medicine was lacking. So, when the rare opportunity arose for several of us psychiatric nurses to do a six month swap with nurses from a medical ward, I jumped at the chance. It was a great cross-pollination of mental health and general medicine nursing skills across the hospital and it really extended my practice back in the psychiatric ward.
I then decided to broaden my nursing experience and waited until a vacancy came up in the crisis service. I instantly loved the role and I've stayed in crisis services since.
About 10 years ago I took on an acting team leader role within the service, but soon found my job enjoyment diminishing. So I took a break to give myself time to reflect on what I was doing and what engagement I wanted with actual nursing. I realised I wanted to stay nursing - but working with a clinical rather than a management focus. And I have.
What skills/qualities are required for this job?
A mental health crisis nurse needs excellent communication skills and analytical skills.
You need to be non-judgmental. You need absolute positive regard and attentiveness. You also need experience across a range of mental health services.
Skills in group work, family therapy and psychotherapy are enormously important. Through these interventions I learned about developing a working therapeutic relationship, involving partnership, reflection and empowerment. These form the core practice for any nurse practising in mental health.
More recently cognitive behavioural therapy (CBT) and Mindfulness interventions have become equally important. Research suggests they are as good if not better than pharmacological interventions for depression and anxiety.
What training is required?
A degree in nursing, followed by a mental health nurse graduate qualification. I have access to a range of education programs offered within Healthcare Otago, the University of Otago or the Otago Polytechnic School of Nursing. I also attend mandatory annual courses covering CPR and fire training, and bi-annual training covering risk minimisation.
What study and training most influenced you?
I feel my practice took an enormous turning point when I upskilled through a postgraduate certificate in nursing at Victoria University in 1997. I became more able to step back and analyse where I stood as a nurse. I also started to look outside New Zealand at a time when internationally the energy and focus within nursing was on nurses defining themselves as separate from medicine and becoming quite assertive about the nursing role and the difference between nursing and medicine.
Who do you work with?
I work in a multi disciplinary team, including psychiatrists, clinical psychologists, social workers, occupational therapists, support workers, as well as mental health nurses. We also have a fantastic clerical support team.
What do you enjoy most in your job?
I am a nurse and I want to be at the coal face. I enjoy acute crisis work because it's mostly unscheduled, dynamic, empowering and rewarding. Every day is different. I enjoy the privilege of working alongside the client during a personal crisis in a way that brings about stabilisation, recovery and growth.
What kind of challenges do you face in your role?
The use of the Mental Health (Compulsory Assessment & Treatment) Act to assess and care for a service user, when their degree of impairment is such that they cannot make safe decisions regarding themselves or others, is always challenging.
Another constant challenge is the environment risk assessments that we carry out in the community because nursing care is mostly provided in the service user's home environment. We have to quickly ensure we are secure and safe and have the resources to do the work.
How do you cope with challenges?
You need to have the ability to be present, but silent, so when things get busy you are able to totally attend to the client and genuinely respond to them. As part of this you need to be healthy yourself and have good knowledge of yourself and understand your own processes.
Clinical supervision, ongoing education and networking are incredibly important. In mental health nursing, the self is the tool of the trade.
How do people respond when you say you work in mental health?
I have experienced a broad range of responses about my work. Sadly I have found the health workforce least informed and most negative about mental health nursing, but I do believe the increase in expert mental health nurses working in the community and attached to primary health organisations is having a positive influence on negative attitudes. The Like Minds, Like Mine programme is also having a powerful influence on the general population's understanding of mental illness. Sometimes reflecting a negative response back to the person responding to me with an enquiring naive question can result in powerful reflection and learning.
A mental health nurse needs to be non judgmental. We need absolute positive regard and attentiveness.