Howdy. I’m Zarathustra, the latest contributor to this blog. I’m a final year mental health nursing student, currently about 6 months away from finishing my studies, paying an extortionate sum for my NMC registration and thus joining the ranks of the Brain Police.
Some of you know me under a different username. Others may guess who I am. I’ve chosen a new, more anonymous username to avoid possible breaches of confidentiality that might land me in hot water. If you happen to guess the true nature of my spirit, please avoid making mention of this in the comments threads.
So, for my first post, the subject shall be…looking for your first nursing job.
All through my degree, RMNs have told me, “Oh, you must do your first job in acute! You’ll get such a good grounding! Spend a year in acute! You’ll learn so much!” I’ve been told this again and again and again….
This has had the sum effect of making me determined to go and work anywhere except acute. Maybe it’s the part of me that never grew out of the childhood habit of doing things precisely because somebody told me not to do it. Ask a kid not to wee on the electric fence, and he’ll be unzipping his fly before you’ve finished the sentence.
Or maybe it’s just the overwhelmingly negative experiences I’ve had of working on acute psychiatric wards. A mental health nursing degree is a cruel animal. They fill your head with wonderful-sounding concepts like “building therapeutic relationships” and teach you lovely skills in counselling and cognitive-behaviour therapy. Then they send you out on placement to the local acute psych ward. These have a tendency to be places where the RMNs have an unfortunate tendency to spend lots of time filling out paperwork, and very little time building therapeutic relationships; places where the limit of peoples’ counselling skills appear to be the ability to say “I’ll be with you in a minute” without crossing your fingers.
I’m not saying there aren’t hardworking, decent RMNs on acute wards. Of course there are. You can see them doing all they can to snatch a bit of quality time between the paperwork and the phone calls to spend a while with patients, getting to know them, working out their hopes and fears. Sadly, you can also meet a lot of nurses who have stopped caring. Burnt-out, cynical, institutionalised Nurse Ratchet types, only interacting with patients to let them on and off the ward, or to prise them apart when an argument brews.
My first placement on an acute ward was especially negative. The nursing staff seemed to spend all their time lurking in the office, drinking endless cups of tea, pausing between sips only to shout “Can you stop hanging around the office door, please” at any patient with the temerity to want to speak to a member of staff.
The cups of tea thing used to bug me in particular. Not only because the nurses were constantly sitting around, mug in hand, but because the patients had to wait for a tea trolley to come around. One patient was impudent enough to ask outside of tea-break time if he could have a pot of tea to share with a visitor. An NA looked at him as though he’d just taken a dump on the ward office floor, and then told him, “No, because the NHS trust has to pay for the tea bags.”
Wow, two tea bags, eh? Clearly that’s what’s causing the NHS deficits crisis. Every time we give someone an injection of Risperdal Consta, then £150 goes straight into their arse. Who’s worried about two tea bags?
A patient asked me, while we having a game of pool, “So how come you lot can go into the office and make yourselves a cup of tea whenever you want, but we have to wait for the tea trolley to come round?” I had to concede to him that I really didn’t have an answer to that. Just to emphasise the point, as we were talking an NA strolled out of the office and said to me, “Would you like a cup of tea Zarathustra?”
Okay, so we’re only talking about cups of tea, but it’s the little things that sum up the pettiness and the lack of caring. While I was there, a final year student nurse on his management placement (for the info of non-nurses, at the end of a nursing degree you complete a three-month “management placement” where you behave more like a qualified nurse, and on certain days act as the nurse-in-charge of the ward) tried to make some changes. He tried to make the nursing staff spend less time lurking in the office and more time out on the ward floor talking to patients. Within a very short space of time, he found that a clique of several NAs, one RMN and the ward domestic had united against him. He was bullied off the ward, and had to finish his management placement elsewhere.
So, to all those who tell me I’d learn loads if I spend my first year on acute, I have to ask what I’ll actually be learning. How to be an admin clerk first and foremost, and a therapist only if there’s any brief snippets of time left over? How to burn out, become cynical and institutionalised? How to rapidly deskill in all the counselling and CBT skills I’ve learned on my degree? How to turn into Nurse Ratchet?
I still haven’t decided where I’ll go for my first job. Possibly I may go to elderly services. Most RMNs seem to loathe elderly care. I loved it. Caring for people with dementia is probably the least glamourous job in mental health nursing, but despite this, some of the best, most inspirational RMNs seem to wind up there. I also have the advantage of being in a major city where there are a number of specialised units that may take a newly-qualified nurse. All I know is, I’m not going to acute.
Well done you, start a trend of not spending a year in acute coz you might still find yourself there in many years!
Oh wow, sounds like you’ve been to the hospital Mr Man was in. No, just kidding, they at least could have a cuppa when they wanted one… so that means there is more than one acute ward with nasty nurses? Hmmm… I’d definitely stay out of acute while you’re still new. At least wait until you’re in the position to fire people
Welcome on board, Zarathustra.
I have to say you`re not too far off the mark with this post but I`ve a few words of caution.
Never say never. We`ve all got to pay the bills. As it happens I`ll be re-locating shortly. There are areas that I`d really not like to revisit ( any type of secure environment tops my list ) but until I find my bearings beggars won`t be choosy.
You are quite correct, the best RMN`s do work with the elderly but a lot of no-hopers do too. I have a funny feeling I may be there myself before long. I`ve no doubt my acute experience will help hugely if that is my destiny.
I`m afraid you can`t get away from it, life as an RMN is a freeclimb on a remorseless learning curve and acute wards are the ultimate learning environment. I`m not happy with the MHA nor am I an admirer of psychopharmacology but I can`t circumnavigate them. Diagnoses can be a curse, they can also be an important way of conveying information. Symptomatology is highly subjective but it`s important nonetheless. Potential therapeutic interventions are, quite simply, boundless. If you want to learn these things quickly and, what`s more, learn them in a pressure setting then there is no real competition to an acute ward.
I take on board what you`re saying. I have known of a member of staff to be disfigured by scalding water but there is no excuse for denying patients access to limitless beverages. There are, undoubtedly, staff who just need sacking but there a hell of a lot more who just need some inspiration and support to divert them away from the path of least resistance. You`re very industrious Zarathustra, perhaps that could be your calling.
Well it’s good to know (or maybe that should say “disheartening”) that it is not just in my area that this happens.
I want to ask though, the wards I have been on, the staff all buy their own tea, coffee, sugar and milk. (Students aren’t asked to contribute thankfully!) Is it different where you are?
I spent ten years of my clinical life working on acute wards, four of which were spent as a practice development nurse. Fortunately, I had an inspirational ward manager who showed me what decent acute care could be.
However, when I found myself – after promotion to practice development nurse for the entire unit – writing out guidelines for how to answer the telephone, I started to think that perhaps I was wasting my time, that a certain culture was too deeply ingrained for anyone to make much of a difference. The will was there from the unit manager and the ward managers and their deputies, but everything stands or falls on the staff nurses and some of them were clearly only interested in their pay packet at the end of the month.
In their defence, staff nurse on an acute psychiatric ward is a pretty shitty job. You can’t plan your work, you’re almost constantly distracted by phone calls, and you don’t know what you’re walking into from one day to the next, with violence a regular occurrence, inappropriate admissions a daily problem and (particularly in the last five years or so) substance misuse a major exacerbating factor for any disturbance on the ward. I wouldn’t go back if you paid me – and they would!
Hi… err… Z.
As usual this will probably be a lengthy reply, sorry.
When I was a student I shared your enthusiasm for the acute wards. While they were undoubtedly the most stimulating and interesting units to work in, there seemed to be an inverse proportional law set in place whereby the staff in these units were the least stimulating and interesting.
They were very much a clique of like minds who seemed to view themselves as some sort of master race. When assessing students their primary concern was what type of clothes you wore and what music you listened to. This was back in the 80s and one of the main things that helped me survive the experience was secretly sniggering at the main man who led the trendies. He had a rats tail hairdo a la Rik from the Young Ones and held soirees where he was indeed the “people’s poet”. Whenever I heard their howls of laughter roaring from the office I would imagine Rik standing on a chair and reading from a school jotter “Cliff! Cliff! You really are a Cliff When fascists keep trying to push you over it Are they the lemmings? Or are you Cliff? Or are you, Cliff?”.
I really didn’t fit in with this crowd and they knew it… only too well apparently.
Soon Mo registers and works as an RMN… the picture shimmers… time passes… Mo has just completed 6 months acting up as a CPN but fails to get the job. After the interview, “Sorry, it was extremely close. Our best advice is that you get some more acute experience”. Fair dos, I’ll suffer a year of it and move on.
A few weeks later an advert appeared in the Bedlam Gazette… “Trendy RMN required for Acute Ward. Please submit a list of your record collection to…”. Great! I applied. One of the advantages of the old asylum was complete (albeit sometimes underhand and ill gotten) access to all information. A new group of students were just nearing the end of their traiing. Sources informed me that the only applicants for the job were me and 5 of these students. Hooray!!! A few days later my letter came…
“Dear Bucks Fizz listener,
We are sorry to inform you that on this occassion…”
What? When I found out that 5 candidates had been selected for interview, 5 students and not me, I was devastated. I tried to stay positive and arranged a meeting with the charge nurse. She explained that the reason I had not been shortlisted was down to my time in her ward when I was a student. “You spent too much time with the patients.” I stayed calm and professional but tried to explain my views on nursing. “I can understand you wanting to make the most of your time here but it’s very important to build strong relationships with your colleagues. Even at times when the ward was quiet, instead of coming into the office for a coffee with us you sat with the patients.” In light of her views I accepted that I would not fit in with the staff ideology here.
About six weeks later I walked out of psychiatric nursing, embittered, dejected and vowed never to return (although I did 8 years later when I had calmed down).
Well, if anyone from St Dante’s Royal Inferno is reading this they will know exactly who I am. Relax, it’s OK, I won’t be coming back.
Mo
PS1: I think I have just realised why my replies are so long. It’s because they’re not really replies at all but just me taking over the thread to rant. Sorry.
PS2: Where has Margaret gone? I’m still chuckling at the thought of her engraving maltesers. If you’re reading Margaret… “Hi. Hope you’re well. I miss your wit”
Wow, this has attracted some interesing replies. I’ll try to respond to some of you in turn.
Oldschoolbaby
If I’m honest with myself (do I have to be? Self-deception is such a panacea) I’d be forced to admit you’ve got a good point about “never say never” and the fact that there are few places where you can learn as much about mental illness as quickly as on an acute ward. The only problem is, how to get that learning experience without succumbing to the ingrained staff cultures that one finds on far too many acute wards.
The idea of going in there and trying to make changes is a tempting one. Even so,it’s hard to do so when you’ve seen a student try, and saw him quickly get ostracised to the point where he had to be moved to another ward. He was lucky in that he tried it when he was a student. He had the support of the university, who got him out of there and then told the ward manager in detail what they thought of the way the nursing team had treated their student. If he’d tried it after qualifying, I suspect he’d have been bullied out of a job.
Beakie
I think you’re right that the sheer environment of an acute ward makes it very difficult to do a good job. I think it’s this environment that causes so many RMNs to give up and slip into Nurse Ratchet mode.
It’s getting worse too, I think. Although I think the use of Crisis Teams to reduce hospital admissions is an excellent thing in itself, it does seem to mean that those people who *do* get admitted to an acute ward are the illest of the ill. I spoke to a consultant recently who said that it seemed to him that it was getting to the stage where if you weren’t on Clozaril, you wouldn’t get admitted.
I’m not sure what the answer to this is, except for putting the argument that the ratio of staff to patients on acute wards needs to increase. In particular, the numbers of qualified staff needs to increase, so that each RMN can spend less time sitting in the office writing care plans and risk assessents, and more time out on the ward floor actually doing care and eliminating risk.
bipolarmo
This comment of yours sounded disturbingly familiar.
While they were undoubtedly the most stimulating and interesting units to work in, there seemed to be an inverse proportional law set in place whereby the staff in these units were the least stimulating and interesting.
Funnily enough, last time I was on an acute ward I used to spend all my time with the patients too, for pretty much the exact same reasons. Some of the patients on there had led the most fascinating, extraordinary lives. By contrast, sitting in the office with a bunch of dullards planning their lottery syndicates just wasn’t an appealling prospect.
All I can say is, thank Cthulhu the 80s are over, and none of them were wearing rat tails. Or worse, mullets. *shudders and reaches for the brain bleach*
Shocking really, that you were turned down for a job for “spending too much time with patients”. I’d like to say that wouldn’t happen these days, but I wouldn’t be all that surprised if it did.
Still, in honour of your 80s peoples poet, let’s all have a rousing recital from Rick from the Young Ones himself. Put on your donkey jackets and raise your copies of the Socialist Worker in the air:
Pollution
all around
sometimes up
sometimes down
But always around
Pollution
are you coming to my town
or am I coming to yours?
We’re on different buses, pollution
but we’re both using petrol
BOMBS
“Shocking really, that you were turned down for a job for “spending too much time with patients”. I’d like to say that wouldn’t happen these days, but I wouldn’t be all that surprised if it did.”
I would be sure it does, but I would doubt very much that the Charge Nurse would ever give the real reason.
That was interesting, thank you.
I’ve never been on an acute ward, but I i/p a few times (in Brussels and Bristol) and was always able to make my own tea and coffee for free whenever I liked. I had a friend in a unit who chose to pour boiling water from the kettle over his hand and I suppose that might account for why more acute wards can’t risk it.
On the ward in Brussels, we couldn’t make tea after midnight…
There`s more than one way to skin a cat Zarathustra. I`m big enough and ugly enough to dragoon the amotivated into doing my bidding. I would organise an egg and spoon race or some corridor football just to remind everyone that there is life, and more importantly fun, beyond the office door. The newly qualified have to think a little smarter. It`s largely a case of reigniting something which has been snuffed out. You only have to organise something simple such as a quiz or crossword. It will be enjoyable and the patients will respond well. The office will no longer seem like the centre of the universe. You can change the dynamic without actually affronting anyone. Coaxing can achieve a lot that a big stick won`t.
Elliecat – you were lucky. My local hospital closes its kitchens in between tea rounds and you have to beg if you want a cup for the water cooler, which doesn’t always have water in it. I grabbed a cup and kept it hidden whilst I was there and filled it from the tap in the toilets when I couldn’t get water from elsewhere.