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 Nursing the Human SpiritOpportunities abound for minority nurses in the challenging but rewarding field of mental health nursing By Barbara Marquand 
When Faye Gary was working in public health and acute care nursing in the 1960s, she discovered a troubling phenomenon. “I noticed that there were many people [from minority and low-income communities] who were in psychiatric distress but were not being identified and not being treated,” she recalls. “The health care system was not addressing those issues.” Gary, who is African American, wanted to do something about it, so she refocused her career into a nursing specialty where she could help meet the startling needs she saw. Like other minority nurses who have been drawn to the field of psychiatric/mental health nursing, Gary found both tough challenges and profound satisfaction. “Psychiatric nursing is the epitome of nursing,” says Gary, R.N., Ed.D., FAAN, now a distinguished professor at the University of Florida’s College of Nursing in Gainesville. “It’s all about improving the human condition. With our help, people can learn to become self-sufficient and realize their dreams.” As with many other nursing specialties, minority nurses are seriously underrepresented in the mental health field. According to the American Psychiatric Nurses Association (APNA), minorities currently comprise only 15% of its members. Mary Lou de Leon Siantz, R.N., Ph.D., FAAN, associate dean and professor at Georgetown University School of Nursing and current president of the National Association of Hispanic Nurses, says she is the only Hispanic doctorally prepared child psychiatric nurse in the nation. Only 2% of APNA members are Hispanic. 
“The number of ethnic nurses in the specialty is very low, but that is the way it’s always been,” Gary explains. “There are two critical variables that must be addressed in this society: health and education. When opportunities are equal for every American, conversations about the low numbers of ethnic nurses will be classified as historical data.” The shortage is troubling, because minority nurses can play an important role in delivering culturally competent mental health services. “When you walk into a hospital and nobody looks like you, what are you going to think?” says Marvel Davis, R.N., M.S.N. It’s only natural that minority patients feel uncomfortable in such settings, she adds, which may discourage them from seeking treatment. “Minority nurses help bridge the gap for the patient. Just the fact that a minority nurse is on the unit helps make the patient feel more comfortable.” Choosing the Road Less TraveledPsychiatric/mental health nurses work to promote mental health, prevent mental illness and diagnose and treat mental disorders. With opportunities at both basic and advanced levels, this specialty offers a wide variety of career options—from working with hospital patients with chronic conditions and consulting with community groups to running independent practices. Davis, for instance, has cared for psychiatric patients at a day hospital, helped teen moms in a high school program and worked for a large insurance company doing psychiatric reviews. She is now a clinical nurse specialist in psychiatry at Yale-New Haven Psychiatric Hospital. “I absolutely love the field,” she says, “because having an understanding of people gives you skills that you can use in any setting.” Registered nurses at the basic level work with individuals and families in hospitals, community-based programs, home care programs and local, state and federal mental health agencies. Advanced practice nurses with a master’s or doctoral degree in the specialty can work as psychiatric/mental health clinical nurse specialists or as psychiatric Nurse Practitioners. They can also become certified in adult or child/adolescent mental health nursing and can even work as psychotherapists, opening their own practices and, in a growing number of states, prescribing medication. 
“If you’re looking for an area of nursing that’s exciting and challenging and that has a great need for qualified R.N.s, I’d recommend this one,” advises Carla Serlin King, R.N., Ph.D., an independent health care and management consultant in Boulder, Colo., and a member of the Minority Nurse Editorial Advisory Board. Just how great is this need? According to APNA, of the more than 40,000 clinical nurse specialists practicing in the United States, only about 7,000 are certified specialists in adult or child/adolescent mental health nursing. “There’s a huge nursing shortage in the nation, and psychiatric nursing is no exception. It’s always been hard to recruit nurses to the psychiatric specialty,” says APNA President Dorothy Hill. Only about 1% of nursing school graduates enter the specialty, Hill notes, and that percentage has remained stable for years. Why do so few nurses choose mental health nursing as a career? Karen Jenkins, R.N., M.S.N., an African-American nurse who is an instructor at the University of Central Arkansas, explains it’s because psychiatric nursing hasn’t received the recognition it deserves. In some nursing schools, she says, the instructors teaching psychiatric nursing courses aren’t specialists in the field and, therefore, don’t convey the passion that specialists would. Many of today’s nurses want hands-on experience working with high-tech equipment, Hill adds, and are less attracted to a specialty focused on mind and personality. Fear is another barrier. “People tend to shy away from psychiatric nursing,” points out Ruben Celiz, R.N.C., a clinical supervisor for in-patient psychiatry at Kaiser Permanente in Los Angeles. “Some people are afraid of working with psychiatric patients. There are a lot of misconceptions out there.” Yet demand for psychiatric nurses is acute. Advanced practice nurses are particularly needed to work with patients in community mental health facilities in underserved rural areas and inner city neighborhoods. State and private psychiatric hospitals and large general hospitals are actively recruiting nurses as well. 
“I will take anyone interested in learning the job,” says Hill, who is administrator of the 100-bed Acadia Hospital in Bangor, Me. “I am very open to people right out of school as well as those with experience. If you’re interested in providing psychiatric care, I’m interested in helping you get there.” Siantz emphasizes that opportunities are also open for minority psychiatric nurses who want to work with children or elderly patients. Child and adolescent psychiatric nursing is an especially valuable background for school nurses, she says. Maria Rivera-Klein, a Unified School District nurse in West Covina, Calif., agrees. Her specialty is in parent-child nursing, but much of the work she does is psychiatric nursing. “Often-times the school nurse is the person to whom troubled parents and children go. We end up doing a lot of counseling,” she says. Moreover, physical complaints that prompt visits to the school nurse are often rooted in family problems. School nurses can play a valuable role by helping to identify the issues and referring children and parents to the treatment services they need, Rivera-Klein believes. 
Filling Cultural NeedsProviding culturally competent mental health care to minority communities often involves moving beyond common assumptions. Siantz, for instance, in her work with migrant farm families, found a high incidence of depression—shattering the popular belief that new immigrants are happy to be in America and therefore don’t suffer from mental health problems. Because attitudes about mental illness vary dramatically among cultures, minority psychiatric nurses who are familiar with the culture can play a crucial role in bridging communi-cation gaps. For example, some Hispanic cultures believe there is no such thing as mental illness, says Ignacio Aguilar, a licensed psychotherapist in Santa Fe Springs, Calif., who teaches cultural sensitivity. As a result, aberrant behavior is often blamed on external sources, such as the “evil eye.” Nurses must be sensitive to the culture and find ways to make connections between traditional beliefs and modern treatment, Aguilar explains. Rivera-Klein points out that the American mental health system focuses on the individual patient, but in the Latino culture, the family is at the center of everything. “To suggest that a person’s family is toxic and that he or she should separate from them is like telling someone to cut off all their resources,” she says. “You really have to figure out a way to work within the family.” Language can also be a barrier. Limited-English-speaking patients and their families often feel they can’t be as open about their mental health problems when communicating through interpreters, particularly if their children are the translators. “You can’t imagine how difficult it is to be in a locked psychiatric unit where you don’t speak the language of anyone there,” Celiz asserts. Cultural obstacles also exist for African-American patients. A recent study led by C. C. Diala of Johns Hopkins University found that blacks were one-and-a-half times more likely than whites to seek mental health treatment, yet were three times less likely to return after using mental health services. What happened to change their attitude? The study concludes that this finding indicates a bias in how mental health services are delivered. Carla Serlin King points to other studies that have indicated that African Americans are actually less likely to seek mental health services than whites. She feels that part of the problem may be a result of bias among mental health agencies, combined with African Americans having less access to health care and the cultural stigma associated with mental illness. King is currently working with the National Black Nurses Association on a depression screening campaign to increase African Americans’ awareness of the disorder and of treatment options. Making a DifferenceIn addition to helping reduce cultural gaps that can prevent minority patients from seeking the care they need, other rich rewards await minority nurses who choose psychiatric nursing careers. The simple joy of knowing they’ve made meaningful differences in people’s lives brings deep satisfaction, nurses say. “When I see a patient begin to take those small steps [toward mental health] they thought they never could, that makes me feel good,” Davis says. Gary adds, “I get vicarious satisfaction from having assisted people in a tedious journey that many of them are afraid to take alone.” Ruben Celiz finds rewards working with patients’ families. He was inspired to enter the field by the home health care nurses who helped his family when his brother was diagnosed with bi-polar disorder. “It is such a traumatic experience for the families,” he says. “You can see it in their eyes. I know what they’re going through.” But psychiatric nursing isn’t for everybody. “You have to be comfortable with ambiguity and be able to function in the unknown,” Gary cautions. The path to mental health solutions may not always proceed in a perfect line. Gary compares it to piecing together a puzzle: “I find it challenging to look at all the pieces and find out where they go.” Psychiatric/mental health nurses also must be willing to learn about people on a deep level. “You must have an abiding respect for all people and for yourself,” says Gary. “You learn more about a person during a mental status interview than you know about many of your friends. You have to be able to understand the struggles of others.” Because psychiatric patients’ improvement is often gradual, nurses in this specialty must be willing to accept incremental change—and they must be highly sensitive to everything going on with the patient. “The mental health nurse needs to be a particularly astute listener and observer of patient behavior,” King says. Gary believes the future of mental health care in the new century must depend on a stronger focus on the family and the community, not just individuals. Mental illness is like an infectious disease, she notes. It sends ripple effects far beyond the patient. Meeting the ChallengeWhat’s the best way to get started in a mental health nursing career? The American Psychiatric Nurses Association offers a plethora of information about the specialty (see sidebar) and maintains a list on its Web site of all the educational programs in the country for psychiatric mental health nursing. Networking is also important. Jenkins suggests working through minority nursing associations to find psychiatric nurses of color who are willing to share information and advice. She herself gained inspiration and helpful information at the most recent National Black Nurses Association conference, where workshops on mental health were featured and specialists had the opportunity to meet one another and share experiences. Financial assistance is available for minority nurses who want to continue their education and work in advanced practice in psychiatric nursing. The American Nurses Association’s Ethnic Minority Fellowship Program, for example, offers funding to attract more minority nurses to the specialty. Regardless of how they get there, minority nurses who decide to pursue psychiatric nursing will find a dynamic field filled with opportunity. Celiz is excited about the future, predicting that psychiatric nurses will play an increasingly significant role in the nation’s health care process. “There is so much focus on mental health now,” he says. “At every conference I’ve gone to lately, it has been a hot topic. It’s great to see mental illness and mental health nursing finally getting the attention they deserve.” Barbara Marquand is a free-lance writer based in Grass Valley, Calif., who writes frequently on business and career topics. |
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