An Unconventional Path to Psychiatric Nursing

I didn’t always plan to be a nurse. Originally, I wanted to be an English teacher. About a quarter of the way into that path, right around the same time that a test-run as a substitute teacher left me questioning my career choice, I enrolled in a Psychology 101 course to fulfill a general education requirement. I had never been so fascinated by a subject matter. That summer, I sought out a field internship at a local state-run psychiatric hospital. I didn’t prepare myself in any particular way, and my first day was admittedly jarring. Still, I knew immediately it was what I wanted to with my life. Luckily for me, the supervising psychologist with whom I’d been placed was willing to go to great lengths to tell me all about the field and list the different options for making a living within it.

After I graduated with a bachelor’s degree in psychology, I knew I wanted to work with patients with mental illness, and I knew I needed a graduate degree to do so, but I was struggling to decide on a direction. I was hired initially as a therapy aide on an inpatient mental health unit and eventually floated through many roles, settings and phases of psychiatric treatment, from crisis intervention to intake to treatment planning to discharge. As one might expect, I worked directly with several nurses throughout those three years! That’s when I began seriously considering nursing as a possibility, an idea supported not only by the nurses around me, but also most of my physician and social work colleagues as well. Even the psychologist with whom I had completed that first internship told me that given the chance for an educational and career “do-over,” she would likely choose nursing. 

When I wasn’t working, I was frequently researching graduate programs and thinking about my next steps. I discovered the nurse practitioner option and read multiple message boards online where people were raving about the profession for its versatility, high degree of autonomy and the return on the investment put toward the degree. The nurses whom I was working with at the time echoed that sentiment and provided me with reassurance and encouragement, but I still had some grappling to do with the idea of me as a nurse. I knew there would be clinical placements to get through, intense science courses and a huge quantity of information to take in. I wasn’t sure I could do it. The nurses who worked with me seemed destined for that profession; they were nurses through and through. They wore it like their identity. I didn’t see that in myself. Now, I feel myself slowly becoming that way, too. The career jump was challenging and the learning curve was steep, but I found in myself a nurse after all. 

Many people are surprised to hear that we take most of the same courses as nursing students in general specialties. We took both foundational and advanced courses in physical assessment, general pharmacology and pathophysiology. We also complete clinical rotations in all the major specialty areas of nursing. In our specialty curriculum, we focused our studies on psychopharmacology and psychiatric assessment skills, as well as the neurobiological foundations of psychopathology. We took several psychotherapy courses where we were presented with an overview of the major schools of therapy as applied to individual, group and family settings, sometimes with experiential components applied in laboratory settings. A major component of this type of nursing education is processing and discussing personal factors related to transitioning into this particular professional role, including having a forum for exploring and acknowledging the triggering of one’s own issues and countertransference, the impacts of bearing witness to trauma and the challenges of maintaining professional boundaries. The processing piece is very important.

A PMHNP comes with knowledge of and takes responsibility for both the physical and mental health needs of our clients, different from many providers in the psychiatric setting who focus solely on psychotherapy. While much of what we do overlaps with the scope of other providers in our field, whenever there is a question about physical implications, medications, or a health complaint, our colleagues look to us and/or the psychiatrists first. In some settings, we might also take patient vitals, give injections or complete urine toxicology screenings in addition to performing some aspects of a physical exam. More generally, I would say PMHNPs make it their mission to provide the most accessible, holistic, pragmatic and patient-centered care possible while attempting to really hear our patients and meet them where they are.

It alters things quite a bit—it’s widely discussed as both a blessing and a curse. I think the main thing is that it makes me very aware of both sides of an issue and able to understand the behaviors and perspectives of all involved, because I’ve made it my job to empathize with people and get inside of their perspective all day long. There is also a large aspect of psychiatry that involves following your gut instincts because it has much less to offer in terms of objective data, definitive testing or treatment algorithms compared to other specialties. It’s good practice for learning to trust your instincts in other areas of life as well.

I think being driven by a strong desire to do this work has to come first. Then asking “what do I need?” I try to train myself with good habits because I’m aware of how difficult this can be. I practice yoga and meditation, almost always sleep eight hours a night and have great friends and family. All of those things help. Debriefing with colleagues, finding a sense of camaraderie and maintaining a sense of humor…those are hugely important as well.  Many of my peers in this program have become close friends, which makes that part easy.