As the prevalence for individuals requiring inpatient psychiatric treatment and stabilization has increased over the years, more and more nurses are becoming curious as to what a psychiatric-mental health nurse actually does on a given shift.

Before I delve into the specifics as to what my roles and responsibilities are as a psychiatric-mental health nurse, I want to begin by providing you a brief background on my education, training, and reasoning behind choosing psychiatry as my specialization.

Prior to working as a psychiatric-mental health nurse, I received my BSN degree from West Coast University. As a nursing student, I was exposed to a wide gamut of psychiatric illnesses such as depression, anxiety, mood disorders, and schizophrenia, but I never truly understood the subtle complexities that psychiatric-mental health nurses endure behind the scenes.

After graduation, I worked briefly in the ER and ICU settings, which taught me invaluable lessons such as time management and prioritization, but it never fully gave me the satisfaction I was yearning for. It was at this moment that I decided to pursue a career in psychiatry in hopes of better understanding not only mental illness but also the psychological, emotional, and spiritual ailments that patients experience on a daily basis.

Because of the stigma associated with working in psychiatry, I am frequently asked what my typical day looks like working with this vulnerable population. And to put it plainly, working as a psychiatric-mental health nurse can be both extremely challenging yet rewarding.

Typically in psychiatry, most mental health hospitals utilize an 8-hour shift system, which is evenly divided to AM, PM, and NOC shifts. Since I currently attend graduate school full time, I work per diem NOC shift, which is from 11:30 PM – 08:00 AM.

11:00 PM – 11:30 PM: During this time, I look at the schedule to see where I am assigned and what my role will be for that day. Depending on the staffing situation, my role may vary as the charge nurse, staff nurse, preceptor, or a breaker.

Once I know where I am appointed to and what my role will be, I normally like to go to my assigned unit, perform medication count with the previous shift, and speak with the nurses as to how their shift went. I do this because it gives me an opportunity to “feel out” the unit and get a sense of what might be required depending on the type of patients we have and the acuity level of the hospital.

11:30 PM – 12:00 AM: Once I’ve performed my aforementioned tasks, my team and I receive report on each patient on the unit. In psychiatry, our reports are more heavily focused on “patient presentation,” which details the patient’s mood, affect, their medication compliance, comorbidities, and their behavior. Since most patients admitted to our hospital are either held involuntarily on a 5150 hold for Danger to Self, Danger to Others, or Gravely Disabled, it is essential for us to know how each patient is responding to treatment as well as their behavioral presentation.

In addition to this, the previous shift notifies us if there are any patients that require 1:1 observation (reserved for patients who are highly suicidal, combative, or medically compromised) as well as any potential “watchers” who can be unpredictable, violent, or dangerous. Providing this information is crucial because it not only makes us more mindful of any potential issues we may encounter during our shift but also hypervigilant in ensuring our unit remains safe and secure.

Lastly, the previous shift also provides us with a report on any incoming or pending admissions as well as any discharges that are expected to occur the following morning.

12:00 AM – 12:15 AM: Once report is completed, the charge nurse then assigns the nurses with their patient load as well as their assignments for that day. Once I receive my assignment, I normally like to check on my patients who are asleep and introduce myself to those who are awake. By doing this, it gives me an opportunity to not only meet my patients, but also form a rapport with them while discussing any concerns they may have.

12:15 AM – 04:00 AM: After checking up and introducing myself to my patients, the rest of my day ultimately depends on what needs immediate attention (pending admissions, patients requesting for PRN medications, medical or psychiatric emergencies, etc.).

If for example there is an incoming admission to be expected, I usually take this time to read more about the patient, why they are coming to the hospital, and organize their chart and paperwork for them to sign.

Although performing an admission can be a tedious process, inpatient psychiatric admissions are unique in that it depends on the patient, when they arrive, and how cooperative they are. If patients are uncooperative, admissions can be difficult and timely so efficiency is truly predicated on how organized the nurse is.

If there are no pending admissions, however, I usually take this time to chart on my patients, which involves filling out nursing flowsheets, writing or updating care plans, auditing charts, and reassessing behavioral statuses. In addition to this, the nurses and floor staff is required to round on their patients every 15 minutes to ensure that patients remain safe, secure, and free from any harm.

04:00 AM – 05:00 AM: During this time, I am on my break. Regardless of the demands of the day, I normally try to eat some food and utilize my break time as a way for me to recharge and revitalize before coming back on the unit.

05:00 AM – 07:00 AM: Once I arrive back on my assigned unit, I take this time to carefully go over and make any necessary revisions to my charting to ensure that it’s valid and free from error. I also check up with my patients to ask how they slept and to reassess their psychosomatic symptoms and behavior to determine if their individualized treatment is either effective or ineffective.

After speaking with my patients, I then take this time to administer any scheduled or PRN medications they may require. Depending on the type of medication the patient is taking, I typically like to ask my patient how they feel about the medication and if they notice any improvement in regards to their psychosis or behavior.

As a psychiatric nurse with five years of experience, I have learned that active listening is critical in psychiatry because it not only validates what the patient is saying, but also reaffirms their trust in you as their health care provider.

07:00 AM – 07:30 AM: At this time, we typically serve breakfast to our patients while providing grooming necessities for individuals who want to shower.

While breakfast is being served, I make an effort to make my rounds around the unit to ensure that the 15-minute rounds are being completed while checking on the patients who refuse to eat or are actively psychotic, hearing voices, or feeling anxious and choose to stay in their rooms. Depending on the patient’s presentation, I do my best to lend an empathetic ear while offering support and guidance in addition to offering PRN medications to help them in their current psychotic and behavioral state.

07:30 AM – 08:00 AM: Once breakfast is over and the patients’ needs are attended to, we give report to the incoming AM shift and discuss any significant behavioral changes or issues that we encountered during our shift. In addition to this, I make it a point to relay how my patients are feeling regarding their treatment and any concerns they may have on their medications.

Once I completed my report, I say my farewells and introduce my patients to the incoming AM nurse who will receive my caseload. This is to ensure that my patient is aware of the shift change and that continuity of care is promoted.

Jonathan V. Llamas, DNP (c), BSN, RN-BC, PHN

Jonathan V. Llamas, DNP (c), BSN, RN-BC, PHN, is an ANCC board certified registered nurse and freelance writer from Los Angeles, CA. He received his BSN degree from West Coast University - North Hollywood in 2013 and is currently pursuing his DNP degree at Loma Linda University to become a Psychiatric-Mental Health Nurse Practitioner. In addition to this, he currently functions as an acute psychiatric registered nurse at Kaiser Permanenete - Los Angeles with previous inpatient experience in both the ER and ICU settings.
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