Frontline: mental health nurse

“Nursing was something I really wanted to do, but within seven months of qualifying and getting a job – on an acute mental health ward in a small, English city – I had made the difficult decision to leave, because I felt completely unsupported in what is a very stressful job.

A lot of the staff members on acute wards are newly qualified; these wards are often used as gateways to other mental health work, because the hectic environment means there is a high turnover of staff. It’s really busy and you’re dealing with patients who are so seriously ill that they’ve been admitted to hospital despite the government’s drive to treat people in the community.

I expected it to be stressful, but during my seven months there was also a complete lack of support: I never got a ‘preceptor’, the senior team member who is supposed to mentor newly-qualified nurses for their first nine months.

In theory, they should meet you regularly, discuss your work and the decisions you’ve made, and make sure you have met the set of competencies needed for the next nursing grade.

Without a preceptor, I was lost in the amount of work I had to do and felt very alone. Even unsupported, I was made a ‘named nurse’ for patients – coordinating their care with all the different doctors, psychiatrists, occupational therapists, social workers and others involved in their treatment, and liaising with their families. I had to prepare for weekly meetings with those professionals, meet patients and hear their concerns, and write and update care plans so that everyone knew what interventions were required.

As a newly-qualified nurse, fresh from university and without a preceptor to advise and support me, I found it very difficult to have confidence in the decisions I was making about the care of very, very unwell people – a lot of whom were high risk patients.

My situation was not unique, either. On my ward, I was one of three newly-qualified nurses and we were all in the same boat; my flatmate had the same problem on another ward in the same hospital. One nurse on my ward complained so much they were moved to a ward with a preceptor, but I just didn’t have the energy to fight. After I left, my other colleague did finally get a preceptor. And while this is only one mental health trust, I honestly think most other trusts experience the same kind of staff shortages.

It wasn’t just the lack of a preceptor that meant I felt unsupported; there was also a general problem with management. The head of my ward was a fantastic nurse and a lovely person, but she didn’t have any people management skills. Although there is management training available, she is not the only one to lack the skills. Nurses often become managers whether or not they’re good at managing people.

It was not all bad: the clinical review system is great. Instead of working by email or phone, you meet weekly and can brainstorm and bounce ideas off each other. All of the staff I worked with made a real effort to keep lines of communication open with anyone involved with the patient, from drug and alcohol workers to the local night shelter.

Unfortunately, as a named nurse I often wasn’t able to produce clinical review paperwork to the standard I would have liked, because of a lack of time. Only an hour a week was set aside in rotas for me to meet my five patients and keep their notes up to date, and that was often lost if there was an incident or a new patient arrived.

Even when I did get it, an hour was not enough time to do all that prep. I can’t remember a single shift when I left on time. Staying late, for which you’re not paid, just becomes the norm.

Lack of time was a real frustration because it meant not spending much time with patients. My ward operated with two qualified members of staff and three healthcare assistants and, if you’ve got a couple of staff accompanying patients to outside appointments and some meetings to deal with, that can be insufficient.

Sundays were great because all the staff were there and some patients would be on weekend leave, and that meant you had time to do some activities with patients.

But that’s not normal, which is horrible. The reason I became a nurse was because I wanted to spend time getting to know the patients – who have complex problems – and learning how to help them. It takes a long time to build a therapeutic relationship with someone who is psychotic, delusional or paranoid, and 10 or 15 minutes during a shift is simply not enough.

I had so wanted to be a mental health nurse, and it was really difficult and sad when I decided I had to leave – especially after working so hard at university for three years.

However, working for many months in such a stressful and unsupportive environment was really taking its toll. By the time I left I was not sleeping well, and had lost a lot of weight. In the end, ironically, I had to think about my own mental health.”