Psychiatric Nurses Navigating the Pandemic
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By Jennifer Larson, contributor
Across the United States, psychiatric nurses and nurse practitioners are working harder than ever to meet the needs of a stressed, anxious population that is going through an unprecedented pandemic. Many people fear getting sick from COVID-19, or losing their income in the financial fallout. Others are struggling with isolation. And practitioners are dealing with new challenges in patient care.
In fact, psychiatric nurses in a variety of settings are grappling with the best way to navigate the current situation, according to Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, president of the American Psychiatric Nurses Association (APNA). That includes nurses in hospitals, outpatient programs, community health centers and other settings.
"Our focus continues to be maintaining safety for our patients and our colleagues," Dilks said.
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Fielding Requests for Psych Nurses’ Expertise
Briana Snyder, PhD, RN-BC, CNE, keeps getting text messages from friends and family, asking for recommendations for psychiatrists who see patients via telehealth and ideas for anxiety management strategies. As a nurse who works in a private psychiatric hospital and an assistant professor of nursing at Towson University in Maryland, her loved ones know that they can count on her to point them in the right direction.
Timothy Legg, PhD, PsyD, gets multiple requests from strangers every day, asking if he’ll take them on as new patients. As a psychiatric-mental health nurse practitioner and psychologist, his services are in greater demand than ever.
“Many psychiatric-mental health nurses are also providing mental health interventions to frontline staff who are overwhelmed and struggling with the impact of what they encounter daily,” said Dilks.
Indeed, it’s a hectic time for psychiatric nurses, who are facing several short-term changes—some of which have the potential to affect their practice in the future.
Discovering the Benefits (and limits) of Telehealth
Face-to-face encounters are the cornerstone of psychiatric-mental health nursing care, according to Dilks. But the coronavirus crisis has thrown a wrench into that.
“We have all had to become more creative in how we create that therapeutic relationship with our clients as a part of their treatment without our ability to ‘be present’ physically with that person,” she said.
Some have been able to turn to telehealth. For example, Legg’s ability to use telehealth technology enables him to continue seeing patients. In fact, some patients have already asked him if they can continue the telehealth visits after the shelter-in-place policies come to an end.
“Telehealth gives nurse practitioners some flexibility in the way they visit with patients in need of psychiatric care and services,” said Legg, a member of the core faculty in Walden University’s MSN psychiatric-mental health nurse practitioner program. “But the work of nurse practitioners will continue to evolve as more patients seek mental health care and services at the same time they’re facing significant economic loss and loss of insurance coverage.”
Telehealth can have its own challenges, though, noted Nick Angelis, CRNA, owner of Alleviant of Akron in Ohio, a treatment center that focuses on a holistic approach to mental health. Sometimes patients will get frustrated and give up if there are any technical issues with using the telehealth software, he has found.
Dealing with Restrictions to In-person Encounters
Even in-person encounters have been altered because of new safety protocols and social distancing guidelines brought on by the pandemic. For example, patients at Snyder’s psychiatric hospital can no longer attend educational group sessions or receive visitors—or even eat together with other patients. The staff wear masks, as do many patients, which can provide protection but can hamper their ability to communicate sometimes.
“We rely a lot in psych on nonverbal cues to tell us someone is anxious or agitated,” said Snyder. “If we can’t read each other’s facial expressions, it makes it hard sometimes. It’s definitely a barrier to our therapeutic communication.”
Many of the changes enacted in the name of protecting patients can also lead to more isolation. Snyder and her fellow psych nurses worry about their patients, as many safety guidelines seem to run counter to the way you'd normally do things to promote mental health. Isolation is really not good for mental health, she noted.
Adapting to New Units or Protocols
Changes in the workplace can also be a source of anxiety for practitioners. Many psychiatric nurses have had to adapt to a constantly evolving series of protocols in their workplaces. Some have even had to work in different units or settings.
Snyder’s hospital has closed its outpatient and day programs during the current crisis, so the nurses who usually work in those settings have been floated to various in-patient units. Being shuffled around can inherently be stressful, she said, “So there’s some anxiety associated with that.”
Nurses Caring for Their Own Mental Health
In addition to worrying about their patients due to COVID-19, psychiatric nurses have their own fears, anxieties and stressors. Some fear for their own health and safety, or they worry about exposing their family members to the coronavirus.
Whether or not a nurse’s job has changed in the wake of the pandemic, the crisis can still affect his or her mental health. Experts urge nurses not to neglect their own mental and emotional needs, especially during a time of crisis.
“A good way to discover how to heal during time off is to ask, ‘Is this activity distracting me or recharging me?’” says Angelis. “Distraction just delays dealing with mental health issues, while finding healthy ways to unwind creates space for learning and caring, so we’re not at work operating with a fight-or-flight response like many of our patients are.”
Legg suggested that nurses and nurse practitioners might also benefit from forming mutual support groups with their colleagues to share ideas and talk about their concerns.
Looking Toward the Future
The coronavirus crisis has highlighted a problem that already existed.
“Even before this pandemic, the statistics show a great need for more mental health services,” noted Dilks. “One in five American adults have a mental illness, and suicide rates have risen dramatically in recent years, and we continue to have a shortage of psychiatric-mental health providers in the U.S.”
The crisis has also highlighted the vital role that psychiatric nurses and nurse practitioners play.
“We have the opportunity to really be leaders in the recovery after this and promote resiliency,” said Snyder. “I think people are really going to see our value and the skill sets that we have to mitigate the effects of this.”
Snyder often tells her nursing students that that there will always be jobs for nurses with psych experience. Moving forward, she expects that need will be greater than ever before.
Dilks also hopes for an increased investment in building up the mental health workforce, including nurses, to meet the anticipated growth in need.
Related: The Mental Toll of COVID-19 on Healthcare Workers