The Top Six Things Psychiatric Nursing Has Taught Me
“I'm not interested in whether you've stood with the great; I'm interested in whether you've sat with the broken.”
― Sue Fitzmaurice
Hi! I’m Jen Beitko. I was an inpatient psychiatric nurse for ten years, and now I'm a psychiatric nurse practitioner--the best job in the world! It is an absolute honor to do what I do, helping people who are struggling at some of the lowest moments of their lives. When Catilin reached out to me about writing for ReelChat, I had no idea what in the world people would want to hear from a Psych NP. Luckily, I also have a Writing Degree, so I sat down and began to write--it doesn’t usually take too long for my muse to pop up and be heard and this time was no different: I started thinking about why I do what I do and how what I do has changed me--and it’s definitely changed me (for the better, I believe).
The top six things psychiatric nursing has taught me:
(1) Everyone--and I mean EVERYONE--has a story. We hear it all the time: you don’t know what goes on behind closed doors. I not only have heard that, I have seen that play out time and time again. I have taken care of murderers, drug addicts, and rapists. I’ve also taken care of attorneys, doctors, and accountants--and sometimes they’re the same people. I’ve heard heart-breaking stories of abuse, trauma, and neglect from people from whom you would never expect to hear such stories. I have also come to realize that I am incredibly lucky to have come from a not-perfect-but-very-loving family. I cannot begin to imagine the person I would be had I been raised with some of the abuse I’ve seen in my profession. I think the quote is “There but for the grace of God go I.” I’m not so sure if I believe God plays a role, but I completely understand the sentiment, now. Certainly the person I am is based on some of my own choices, but those choices are developed from the situations from whence I came. I’m just lucky mine were mostly good. Not everyone is so lucky, but everyone has a past with events out of their control that have shaped them, and everyone struggles with something whether they show that or not.
(2) We are all a few events/decisions away from a stay on one of my inpatient units. I think people tend to believe that they could/would NEVER have to be on an inpatient psych unit. You know what? I’ve seen scores of people who never thought they’d spend time in the hospital with me. Of course we have our “regulars,” but most of our patients pass through our doors but once--and certainly never expected to be there. Life throws curveballs. Sometimes when you get enough curveballs in a row, one hits you square between the eyes and you’re knocked outta the game for awhile. Not everyone has a savings account or a support system that can help when the bottom drops out. Sometimes my unit is the “safety net.” There is no shame in that. Reaching out for and accepting help is a great act of humility and courage.
(3) Judgment is useless. It can make us feel powerful (see above, the “this could never happen to me” sentiment), but all it really does is separate us from our fellow humans. The trick is understanding WHY people make the choices they do. Yes, there are some people who are personality disordered and genuinely do not care about others; that is not most people. Most people make the best choices they can with the tools that they have. Very few of us say to ourselves, “Hey, this is an atrocious decision: let’s do it!” Much of the drug abuse I see comes from people who are unable to deal with the difficult/uncomfortable emotions of life and who have never learned the skills to cope with those emotions. We have ALL felt overwhelmed at one time or another. Imagine feeling that way with no faith, no love, no skills, no support. It’s easy in our minds to tell ourselves we’d never find ourselves in these terrible positions; the reality is that I see people in those positions regularly. These aren’t “bad” or “stupid” people. They’re struggling people. Judging them is not helpful--reflecting on the “why” can be.
(4) People want to be heard. All people want to be heard. I’ve never yet met a person on my unit or off my unit who doesn’t want to be heard. I jokingly say that my job is being “a cheerleader who prescribes medication.” And I definitely do try to empower my patients, for sure--but the vast majority of my job is LISTENING. I keep my mouth shut, and I listen. Many times, that is enough. Lately a lot of my patients have been older folks who are at the point in their lives where they’re considering hospice care (i.e., their medical situation has advanced to the point where death is nearing and treatments are only prolonging life and not healing). I have no magic words for them. I can’t fix a darn thing--but I do allow them to express their fears and their frustrations. People don’t need to be in dire straits like that, however, to need to be heard. I know that hearing about difficult emotions can feel overwhelming, but it is such a gift that we can give to one another. (There’s a whole separate blog in there about self-care but you really don’t want to read that much from me right now!)
(5) Learning to reframe, especially with humor, is one of the great keys to life. As you can imagine, being an inpatient psych nurse has afforded me many opportunities to be called all sorts of fun and profane things. Two examples spring to mind immediately: one time we had a patient who was very ill and very angry. When a patient is beginning to escalate, several staff will approach the patient but only one person takes “point” so-to-speak. On this particular day, that person was me. Now, I’ve always looked very young for my age, but I was probably about 38 or so when this happened. I’m trying to talk calmly with the patient and ask her what’s going on, what’s bothering her. She looks me dead in the eye and says, “What are you, 16? Did you suck dick to get this job?!” While I don’t remember my response to her in that moment, we were able to deescalate her successfully. As we walked back into the nurses’ station, I looked at my coworkers and said, “Did you all hear that?! She thinks I look 16!!!” (really the most important take-away from the interaction!) Another time a patient who was none too pleased with some boundaries that I set followed me down the hall singing, “You’re stupid and ugly and unintelligent … you hoe-bag!” at which point I reached the nurses’ station, walked in, and said, “You guys! I just got serenaded!” Psychiatric nursing isn’t for the faint of heart--and neither is life. If you can learn to reframe things and to laugh, that covers a multitude of difficult situations.
(6) “The greatest of these is love.” Again, I’m not much of a religious person these days, but man, oh, man, what couldn’t be solved if we broke things down to loving one another. I don’t mean giving everyone a pass for all behaviors, but if our motivations in life are based off of love, how can we go wrong? To be clear, being loving means establishing boundaries and not allowing people to treat us poorly--but there is a big difference between boundaries drawn to punish and boundaries drawn to protect. A lot of my work as an inpatient psych nurse was boundary-setting. This didn’t mean that I was a mean nurse (though certainly some of my patients felt that way from time to time!), but it did mean that I realize that when people’s emotions are very out of control, it is important for them to have guidelines/boundaries/rules to keep them safe. The same is true outside of the hospital, as well. Took me a long time to realize that setting boundaries is loving--and also a long time to understand the nuances between the different reasons we establish boundaries. When we do so cemented in love, we are making good choices for ourselves and others.
I am so grateful that I found psychiatric nursing--it has changed me in ways I never imagined and has allowed me to connect with and sit with hundreds of amazing, strong, brave, determined patients. I hope I give something to them in our exchanges because I know what they have given to me is priceless.