Psychiatric Unit Nurse Specialty Ultimate Guide
According to the National Alliance on Mental Illness (NAMI), one in five adults in the United States experiences mental illness each year; one in twenty adults experiences serious mental illness each year, and one in six youth ages six to seventeen experiences a mental health disorder each year. Furthermore, according to Kessler and others (2007), more than 50 percent of people will be diagnosed with a mental illness or disorder at some point in their lives.
Although most people with mental illness won’t require hospitalization, some will need to be hospitalized at some point so that they can be diagnosed, have their medications adjusted, or be monitored during an acute episode. At these times, psych nurses are at the forefront of patient care. Read on to learn all there is to know about working as a psych nurse: job description, salary, certifications, and more!
What Does Psych Stand For?
In the field of nursing, psych stands for psychiatric-mental health nursing. According to the American Psychiatric Nurses Association (APNA), psychiatric-mental health is represented with the abbreviation PMH. Other commonly used abbreviations are MH, which stands for mental health, and PNP, which stands for psychiatric nurse practitioner.
What Does Psych Mean in Medical Terms?
Since psych refers to psychiatric mental health, it encompasses emotional, psychological, and social well-being. It also encompasses how people think, feel, and act, including how they react to stress, interact with others, and make choices. Mental health is part of the broader field of behavioral health. In fact, these terms are often used interchangeably.
Psychiatric-mental health nurses assess, diagnose, care for, and treat patients with mental illnesses and substance use disorders. They also promote well-being through education and prevention. These healthcare professionals care for individuals, families, groups, and communities in a variety of settings, including the following:
- Hospitals
- Primary care
- Community health centers
- Substance use treatment programs
- Public health facilities
- Forensic health settings
- Nursing homes
- Clinics
- Private practices
- Telemedicine
- Schools
- Academia
Psychiatric-mental health nursing may have distinct areas of focus, such as child and adolescent mental health, gerontological-psychiatric care, acute care, substance use disorders, forensics, disaster care, and military mental health, among others.
Many different professionals work with these populations, and the role of a psych nurse may overlap at times with that of a psychologist, social worker, or psychiatrist. For example, both advanced practice registered nurses and psychiatrists can prescribe medication. Furthermore, all these professionals may offer psychotherapy. However, since psychiatric-mental health nurses have degrees in nursing, the nursing process guides their practice.
What Is a Psych Unit in a Hospital?
Psych units may be found in general hospitals or private psychiatric hospitals. These units offer around-the-clock in-patient care; this care is provided by psychiatric nurses and group therapists and is supervised by psychiatrists.
Aside from these psych units, each state has public psychiatric hospitals that provide short-term and long-term care to people with low income, people requiring long-term care, and forensic patients. In addition, partial hospitalization provides therapeutic services during the day, functioning as an intermediate step between in-patient care and discharge. Finally, residential care offers twenty-four-hour psychiatric care for children or adolescents or residential programs for the treatment of addictions.
Individuals may choose hospitalization, or it may occur at the insistence of a family member or professional. It also may be the result of an encounter with a first responder, such as a paramedic or a police officer.
What Is the Role of a Psychiatric Nurse?
An important part of the psych nurse’s role is eliminating the stigma surrounding mental health care and treatment by educating patients, families, communities, and fellow healthcare professionals.
Psych nurses promote mental health in a number of ways, including the following:
- Working with children who have experienced traumatic events
- Working with soldiers returning from combat
- Assisting older adults with Alzheimer’s Disease or dementia
- Helping teenagers and adults living with serious mental illnesses
- Counseling and treating people working to recover from opioid, alcohol, or other substance use disorders
- Researching and creating interventions for people with suicidal thoughts
What Does a Psych Nurse Do?
Within this role, psychiatric-mental health nurses have many responsibilities, which vary depending on their qualifications. According to the APNA, here are some of the duties of a psychiatric registered nurse:
- Helping individuals achieve their recovery goals
- Promoting and maintaining health
- Conducting intake screening, evaluation, and triage
- Providing case management
- Teaching patients self-care
- Administering and monitoring psychobiological treatment
- Practicing crisis intervention and stabilization
- Conducting psychiatric rehabilitation and intervention
- Educating patients, families, and communities
- Coordinating care
- Collaborating with interdisciplinary teams
“I try to sit or pace with my patients as much as possible to build rapport and to make sure they feel heard. Psych is a lot of emotional labor, so I'm constantly making myself available for patients to talk through issues and to empower them to use whatever strategies work best for them to reach their wellness goals…” Reddit – u/msblankenship
In addition, PMH advanced practice registered nurses (APRNs) fulfill the following duties:
- Providing individual, group, couples, and family psychotherapy
- Prescribing medication for acute and chronic illnesses
- Conducting comprehensive assessments
- Providing clinical supervision
- Diagnosing, treating, and managing chronic or acute illness
- Providing integrative therapy interventions
- Ordering, performing, and interpreting lab tests and other diagnostic studies
- Providing preventative care, such as screenings and immunizations
- Developing policies for programs and systems
- Making referrals for health problems outside their scope of practice
- Performing procedures
How to Become a Psychiatric Nurse?
Individuals interested in psychiatric nursing have several options, including pursuing science, liberal arts, and nursing undergraduate or master’s degrees. Licensed practical nurses may also pursue further education, training, and licensure in psychiatric-mental health nursing.
To become a psychiatric-mental health RN, individuals must pursue one of the following paths:
- A two-year associate’s degree in nursing program
- A three-year diploma in nursing program (usually hospital-based)
- A four-year bachelor’s degree in nursing (BSN) program at a college or university
- An accelerated BSN program (for those who already have a bachelor’s degree in another area)
Regardless of the chosen path, all graduates must pass the National Council Licensure Examination (NCLEX-RN) to obtain their RN licenses.
In addition, individuals who wish to become psychiatric APRNs must complete a master’s or doctoral degree from an accredited PMH nurse practitioner program.
Psych Nurse Certification?
The APNA offers the Transitions in Practice Certificate Program to help nurses transition into practice in a mental health setting. It is meant for the following professionals:
- RNs wanting to transition to psychiatric-mental health nursing
- PMH RNs wishing to refresh and update their nursing practice
- RNs working with people with mental health needs in their current work setting
- Nurse educators who provide orientation to PMH nurses
- Nurse administrators who hire PMH nurses
The American Nurses Credentialing Center (ANCC) also offers certification options for both RNs and APRNs. RNs can obtain the Psychiatric Mental Health Nurse – Board Certified (PMH-BC™) credential, and APRNs can obtain the Psychiatric-Mental Health Nurse Practitioner Certification (PMHNP-BC), previously called the Family Psychiatric–Mental Health Nurse Practitioner certification.
The following are the eligibility requirements for the Psychiatric Mental Health Nurse – Board Certified credential:
- Holding a current, active RN license
- Having worked full-time as an RN for at least two years
- Completing at least 2,000 clinical hours in psychiatric–mental health nursing within the previous three years
- Completing thirty hours of continuing education in psychiatric–mental health nursing in the past three years
Here are the eligibility requirements for the Psychiatric-Mental Health Nurse Practitioner Certification:
- Holding a current, active RN license
- Holding a master's, post-graduate certificate, or doctor of nursing practice (DNP) degree from a psychiatric-mental health nurse practitioner (PMHNP) accredited program
- Completing three graduate-level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology
- Completing training in health promotion or maintenance, differential diagnosis, disease management, and at least two psychotherapeutic treatment modalities
How Long Does It Take to Become a Psych Nurse?
The time required to become a psychiatric nurse depends on the level of education acquired. Becoming an RN takes a minimum of two years for an associate’s degree, and becoming an APRN usually takes six years or more. Furthermore, some certifications, such as the PMH-BC™, require RNs to have at least two years of full-time work experience before applying.
Psych Nurse Salary?
Another aspect of working as a psychiatric nurse that depends on a nurse’s level of education is salary. Whereas RNs earn an average annual salary of $82,750 annually, APRNs earn an average of $118,040 annually.
PMH nurse salary also depends on the settings where nurses work. According to the US Bureau of Labor Statistics, these are average RN salaries in different settings:
- Psychiatric and substance abuse hospitals: $80,260
- General medical and surgical hospitals: $85,020
- Outpatient care centers: $93,070
- Home health care services: $78,190
- Offices of physicians: $73,860
- Nursing care facilities (skilled nursing facilities): $72,260
The following are average APRN salaries in different settings:
- Home health care services: $133,170
- Psychiatric and substance abuse hospitals: $131,830
- Outpatient care centers: $129,190
- General medical and surgical hospitals: $122,960
- Offices of physicians: $114,870
- Offices of other health practitioners: $108,890
What Is Psych Nursing Like?
As with many other nursing specialties, psychiatric nursing has advantages and challenges. Likewise, this specialty isn’t for everyone. Here are some ways psych nurses describe the work they do:
“Get ready to expect anything! You'll find patients who are trying to find whatever they can around the unit to hurt themselves. Psychotic patients who'll be calm one minute and then the next you'll become a target. Patients fascinated with water and are constantly trying to flood their rooms. Med seekers, lots of manipulation, intrusive behaviors.” Reddit – u/CeleryBallerina
“Community psych is really interesting! You do a lot of med management (refills, prior auth’s, monitoring labs, administering long-acting antipsychotics, etc.), but you get to know your patients over time, you get to see their periods of stability and their struggles. You do some education on preventative care, administer vaccines, smoking cessation counseling, nutrition education.” Reddit – u/youbetyourasparagus
Is Working on a Psych Ward Hard?
Here are some of the aspects of PMH nursing that psychiatric nurses find most challenging:
“In psych nursing you are dealing with a lot of behaviours, helping people navigate through complex emotions and trauma…A lot of time it’d policing, which can sometimes fee draining and ethically challenging. It isn’t easy taking peoples choices awAy or telling them they can’t wear their favourite hoodie because the string in the hood is a danger. But you have to keep the rules for the safety of all. You have to give forced medications. You have to be able to balance these acts with caring and compassion. You have a to build trust and support people through some of their darkest times. It’s an honour and a challenge...” Reddit – u/Bright-Garden-4347
“The ugly? I guess it would be the violence, maybe. Yes, we do get violent patients. Have a guy right now that threatened his family with a knife. We get plenty of training to deescalate the situations and it just takes some common sense on how to calm and redirect people…Accidents, of course, do happen, and though I've never been seriously injured by a patient, I have been slapped, spat on, kicked and hit quite a bit. Odd to say, but you get used to it.” Reddit – u/thackworth
Why Choose Psychiatric Nursing?
Despite challenges, many psych nurses love their jobs. Here are some reasons why:
“I love working with this population. Helping someone recover brings great satisfaction. Our acute population requires more intervention and occasionally seclusion, but when someone who is going through a bout of psychosis recovers, it's simply stunning to see their change.” Reddit – u/hazelquarrier_couch
“You meet amazing people, with amazing stories, and you truly get to treat the person and not the ailment. There are also so many different settings, all with their own positives and negatives. I can say, my experiences have been one of a kind and I wouldn't change them for the world.” Reddit – u/CrystalPeppers
What Makes a Good Psych Nurse: Tips for New Nurses?
According to the APNA, a good psychiatric nurse understands that people are not defined by their illnesses. Psych nurses must be compassionate, sensitive, excellent communicators, and exceptional relationship builders. In addition, here is some advice from psych nurses themselves:
“In psych nursing you have to be passionate about this field and population, work well as a team, be attuned to small changes in mood or behavior, have the ability to not take patient behaviors personally, and have a pretty offensive sense of humor. For better or worse, you will NEVER have a boring day in psych.” Reddit – u/msblankenship
“If you work in psych you need to be really mindful of setting boundaries with patients. When you are new some of these patients will take advantage of your kindness and caring, and you can find yourself spending most of your time appeasing just a couple patients and giving into their demands. I saw this happen with a lot of the newer nurses on my units.” Reddit – u/moonstarfc
Final Thoughts on Working as a Psych Nurse
Do you think you have the personality profile to work as a psychiatric nurse? If you are still unsure about the type of nursing work you would like, the next best step is picking up per diem nursing shifts to get some first-hand experience in different settings and roles.
Through Nursa’s healthcare staffing app, you can browse available per diem jobs near you and request as many as you like. You can work per diem on your days off, or you can work per diem full time: it’s entirely up to you.
