Everything You Should Know About Psychiatric Nursing

Psychiatric nursing is unlike any other kind of nursing. You cannot fix depression like you fix a broken leg, and the rest, ice, elevation and compression method isn’t going to do much for recurring panic attacks. But as a psychiatric nurse, you can offer the understanding and empathy a patient needs to begin healing.

Mental illness is arguably one of the most challenging illnesses to treat. It’s tough to detect for many and while attitudes are shifting, some still attach a stigma to seeking treatment. Add in the fact that there is not always a clear, uniform path to recovery, and it’s easy to see how psychiatric nursing can bring some unique challenges—and rewarding moments.

In this article, we’ll dive into the details of psychiatric nursing. This includes a look at the different roles within psychiatric nursing, what their duties are, where they work, the types of illnesses they commonly treat and which skills are essential in order to thrive in this nursing specialization.

Types of psychiatric nursing roles

If you’re interested in working in a psychiatric nursing unit, you should know that there are two primary paths:

1. Working as a psychiatric registered nurse (RN)
2. Working in advanced roles like psychiatric nurse practitioner or psychiatric / mental health advanced practice registered nurses (APRN)

Becoming a psychiatric registered nurse

In order to become a psychiatric registered nurse, you will first need to earn either an Associate’s degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). From there you’ll need to pass the NCLEX-RN licensure examination to become a registered nurse (RN). It should be noted that while both degrees are viable options for becoming an RN, some employers may strongly prefer candidates with a bachelor’s degree or have the expectation that you complete a bachelor’s degree within a certain number of years after being hired. If you’re set on becoming a psychiatric nurse, you may want to ask employers in your area about their preferences.

Looking for more information? Check out “ADN vs. BSN: Your Guide to Help You Decide on a Nursing Degree.”

Once you’ve passed your licensure examination, you’ll likely want to spend some time building nursing experience before applying to psychiatric nursing roles. That said, it’s not unheard of to find one of these positions available to new graduates.

Though it is possible to work in psychiatry without certification, you may want to pursue certification in psychiatric-mental health nursing. The American Nurses Credentialing Center (ANCC) offers a certification exam to those who have:

• An active RN license
• Practiced two years full time as a registered nurse
• A minimum of 2,000 hours of clinical practice in psychiatric nursing
• Completed 30 hours of education in psychiatric-mental health nursing

Advanced practice and postgraduate psychiatric nursing

Advanced practice registered nurses (APRNs) and nurse practitioners (NPs) both have expanded scopes of practice when compared to psychiatric RNs. While some psychiatric RNs may want to go more general in their practice and become a Family NP, others may want to dive even deeper into the world of mental health as a psychiatric-mental health NP (PMHNP). That said, things get a little more complicated at this level and the best route for you will depend heavily on the state in which you wish to practice—currently state laws are not uniform regarding scope of practice, education and licensure requirements.

That being said, as with psychiatric registered nursing, you will first need to obtain your RN license. Because the next step is graduate school, a Bachelor’s degree program is the ideal first step—though there are options like accelerated BSN programs if you have an unrelated Bachelor’s degree or RN-to-BSN programs for ADN-RNs looking to make the jump.

Once you complete your bachelor’s-level registered nursing education, you will most likely want to spend time working in a psychiatric registered nursing (or closely related) role as many graduate nursing programs will require this for admission. Once you’ve gained acceptance to a PMHNP program and completed your program, you’ll need to complete a certification exam and pursue licensure as your state requires it. It should be noted that some employers may require nurse practitioners to complete a doctorate of nursing practice (DNP) as well.

What are some common psychiatric nursing duties?

Depending on which path you choose, your duties will vary. As a psychiatric nurse, you can expect to meet with patients to discuss and note symptoms, implement care plans, administer medications, update patient charts, assist in basic needs, facilitate group therapy projects and more.

As a psychiatric nurse practitioner or APRN psychiatric nurse, you will be more involved in the process of diagnosing, creating treatment plans and offering psychotherapy. In some states, APRN and NP psychiatric nurses may be allowed to prescribe medication.

Where do psychiatric nurses work?

As with other medical professions, your options include inpatient and outpatient care. Inpatient care refers to places where a patient is admitted such as a hospital or psychiatric facility. Outpatient care typically refers to patients seen in their own homes or local clinics. While psychiatric registered nurses and advanced practice psychiatric nurses can work in both settings, advanced practice psychiatric nurses are typically more independent and are able to work with a wider variety of patients on their own, making outpatient care a more common option.

What conditions do psychiatric nurses treat?

Psychiatric nurses will work with patients with a wide variety of disorders and mental illnesses with symptoms that may manifest in surprising ways. Here are a few common areas psychiatric nurses encounter regularly in their work.

• Mood disorders: Depression and bipolar disorder are two of the most common mood disorders. People with this type of illness may experience extreme feelings of apathy, worthlessness, emptiness, fatigue and sadness. In the case of bipolar disorder, they may also experience cases of extreme mania, not sleeping for days and losing the ability to think clearly.

• Psychotic disorders: People experiencing psychosis may have auditory and visual hallucinations that can range from strange to serious. This includes patients with schizophrenia and substance-induced psychotic disorders.

• Dementia disorders: Dementia refers to the general loss of mental abilities such as memory, processing and language. Alzheimer’s is a common form of this disease and occurs most often in geriatric populations. As a result, many patients with this disease will have other physical needs and disabilities to care for.

• Eating disorders: Though these disorders cause significant physical issues, they are primarily a mental illness. People with these diagnoses often have an unrealistic view of their self-image, resulting in dangerously unhealthy behavior. Common eating disorders include anorexia, bulimia and binge eating disorder. Often these disorders go hand in hand with other mental health issues.

• Addiction disorders: Addiction to drugs, alcohol or certain behaviors can cause several other mental health issues, including psychosis and depression. There are many layers to treating this type of disorder, including symptoms (both physical and psychological), withdrawal and the initial causes of the addiction.

What skills make for a good psychiatric nurse?

• Communication: As a psychiatric nurse, you will have to practice active listening a lot. In order to feel validated and safe, most patients just need to feel heard. This can be a difficult skill to master when what a patient is saying does not line up with reality. If they are hallucinating or spiraling, you must be able to find out exactly what they are thinking in order to help them cope. This requires keen attention, interpretation and overall good communication skills.

• Observation: Psychiatric nursing can sometimes feel like an unpredictable storm. One moment, a patient seems OK—maybe even like they’re improving. The next moment, they need to be restrained from hurting themselves or others. While not all patients will be at risk for violence, it is important to stay observant. If you can learn to read people for subtle signs of distress, you may be able to help them before the situation escalates.

• Self-care: In order to care for others, you must be able to care for yourself. Nursing can be physically and emotionally taxing—and that’s especially true for psychiatric nurses. When it comes to doing this job effectively long-term, it is important to stay both mentally and physically healthy.

Be a light in the dark

Psychiatric nursing can be a difficult career. Not every patient will get better, and some days will be chaotic. But pursuing psychiatric nursing could also be one of the most rewarding decisions you’ll ever make.

If you’d like to take the first step toward a psychiatric nursing career, visit the Rasmussen University School of Nursing page. Interested in exploring other nursing options? Start with our article “Top 25 Types of Nurses Employers Are Looking to Hire.”