Registered psychiatric nurse
A registered psychiatric nurse is a nurse who specialises in holistic physical and mental health promotion. RPNs are often licensed as registered nurses that work in psychiatric-mental health settings. RPNs are often licensed as registered nurses who work in psychiatric-mental health settings. Although RNs may receive additional training, certification, or experience in psychiatric-mental health nursing, certain countries have multiple pathways for psychiatric nursing education and registration. Notably, Western Canada regulates RPNs separately from RNs; graduates of an undergraduate program in psychiatric nursing are licensed as RPNs.
Mental health care provided by RPNs utilizes the bio-psycho-social model of health and well-being for the promotion of health, as well as prevention and treatment of illness. Just as important, RPNs take a person-centered approach to patient assessment, treatment, and advocacy. In essence, physical and mental health care is individualized to the patient to ensure each patient is connected with the most appropriate resources. In addition to competency in foundational medical-surgical nursing skills, psychiatric nurses possess advanced therapeutic communication, teamwork, and interpersonal techniques to provide safe and effective patient care. In short, RPNs contribute their specialized knowledge, skills, and experience across various psychiatric-mental health services.
Often, RPNs work in collaboration with a team of health professionals, including physicians, psychiatrists, social workers, among others. They may practice in general hospitals, psychiatric hospitals, long-term care centres, primary community clinics, or mental health community team settings.The scope of practice for RN, RPNs and advanced practice nurses in diagnostic and prescriptive abilities varies by country and state/province.
History
Australia
Psychiatry in Australia has been historically influenced by the colonial origins of the states since the first penal colony settlements. The first psychiatric institution in Australia was established in 1838 and many more appeared of the 100 years following. However, care for psychiatric patients was not generally haphazard and not recognized seriously as nursing care, it was not until the 1930s that psychiatric nursing was registered. At that time, psychiatric nursing regulation was up to the states, with formal psychiatric nursing training at Royal Dewent Hospital in Tasmania starting in 1935 and opening nursing registration in 1936. For Western Australia, however, they did not have registered mental health nurses regulated by the nursing board until 1944. Victoria also struggled to professionalize psychiatric nurses during this time, which operated up to this point mental institutions in deplorable conditions for both the patient and attendants. With the Mental Hygiene Act of 1933 Victoria hospitals of psychiatric patients became mental hospitals with the trained attendant renamed as a Mental Nurse. This signalled a changing tone in how patients were treated and seen as a step towards professionalizing mental health nursing in Victoria.Australia developed a private health care system, which during the 1970s underwent a move towards deinstitutionalization of psychiatric health care. Under the 3-step National Mental Health Strategy plan, between 1993 and 2008, psychiatric nursing care moved more into the community. Mental health nurses became involved in specialized community services such as assertive community treatment, crisis intervention teams and social recovery services.
New Zealand
Before the 20th century, New Zealand kept its mentally ill in asylums managed by female and male attendants. In 1876, asylums were put under the administration of the central government with the aim of systematically improving asylum conditions. At first, non-qualified supervisors had the authority to assess and treat any patients. The New Zealand approach for psychiatric care of patients in mental asylums then adopted the structure of the British mental health system. In 1905, under the Mental Hygiene Division of the Department of Health, psychiatric nursing training commenced. This allowed trainees who completed 3 years of work experience, training attendance, and final exams to qualify for registration as a mental health nurse; the first of whom became registered in 1908. It was not until 1945, however, that mental health nurses were registered by the Nurses and Midwives Board. An ongoing challenge for registered psychiatric nurse recognition was in part due to generalist nursing leadership hesitancy to be associated with psychiatric nursing, which made it difficult for psychatric nurses to obtain general nursing training at the time. In the 1960s New Zealand saw a trend away from "accidental nurses” and emergence of psychiatric nurses from diverse backgrounds who became collectively unified by their shared identity and values as a psychiatric nurse. The deinstitutionalization movement of the 1960s and 1970s in New Zealand shifted patient care from containment to rehabilitation. As a result, psychiatric nursing responsibilities and duties became differentiated from nursing assistants and attendants as specialization of services increased. Influenced by the American model of mental healthcare, New Zealand nursing regulators and administrators in 1972 opted to integrate mental health care into generalist nursing education and practice.America
The inpatient model in the United States before the 1950s was considered the most effective way of treating mental illnesses. However, there was a push for de-institutionalisation as there was a belief that patients would receive better care outside of these psychiatric hospitals. By the 1960s many patients were moved from the hospitals to local facilities or mental health homes where they received personalised care by qualified psychiatric nurses. The number of institutionalised mentally ill patients fell from 560,000 in the 1950s to 130,000 by 1980.Finland
Finland built its biggest hospitals during the 1920s and 30s. From the start, psychiatric nurses were the primary staff responsible for the care of the mentally ill. The treatment in Finland was mostly institutionalised and during the 1970s, more psychiatric hospitals were being built and psychiatric nurses remained the biggest group within these facilities.Ireland
In 1833, one of the first mental hospitals, which were called lunatic asylums at the time was established in Ballinasloe. There were no significant differences between a general nurse and a psychiatric one, they both provided care to their patients. However, psychiatric nursing roles were typically untrained and were former patients themselves in these asylums. Once their treatment was fulfilled, they were allowed to stay and continue to deliver care to other patients in these institutions. These origins made psychiatric nursing less respected and had a substandard reputation, this was until Florence Nightingale's professional treatment of patients became the gold standard for nursing. As nursing in general became more professionalised by the skills and training they were now required to have, psychiatric nursing, however, still had a stigma of being seen as an inferior field of nursing. As time went on, training became an important part of psychiatric nursing and it allowed these nurses to specialise in the treatment of mental illnesses. In Ireland today, psychiatric nursing is seen as a more respected career choice and are essentially intermediaries between patient and doctor with both sides depending on a trusting relationship to accurately treat a patient's mental illness.Canada
There is an east-west split in Canada of how nurses in psychiatric and mental health work are educated and regulated. At the beginning of the 20th century, care for psychiatric patients in Canada was performed in asylums, which rebranded themselves into mental institutions. It was typical across the country that care was provided by the untrained attendants under the strict control of psychiatrists and other institution leadership.Ontario hospitals in 1909 began offering 3-year mental health nursing curriculum training, shifting the workers in institutions from untrained to trained mental health nurses. In doing so, workers in mental institutions became replaced in turn with trained mental health nurses. However, in response to the mental hygiene and deinstitutionalization movements, Eastern Canada pursued changes to incorporate mental health nursing training in generalist nursing programs. Gradually, mental health and generalist nurses were cross-trained through affiliate programs beginning in the 1930's. Consequently, mental health nursing training in Eastern Canada has become a part of generalist nursing education instead of a separate, specialized nursing profession.
Unlike the eastern provinces, provinces west of Ontario have retained the specialized psychiatric nurse role, licensed and regulated by the applicable provincial or territorial regulatory body as a registered psychiatric nurse. The provinces of British Columbia, Alberta, Saskatchewan, and Manitoba, and the territories of the Yukon, Northwest Territories, and Nunavut have developed such legislation and regulatory frameworks for this nursing profession. The roots of Western Canadian psychiatric nursing as a distinct profession have been traced back to the early 20th century Riverview psychiatric institution in BC. The mental hospital aimed to professionalize and specialize psychiatric nursing care in the region, providing formal, on-the-job training to untrained institution attendants and aides. From 1930 to 1973 Riverview was the home of the BC School of Psychiatric Nursing. Despite pressure to integrate with RNs Western Canada has maintained RPN education and their unique role in the healthcare system.
Nursing Interventions
Psycho-social Interventions
RPNs and mental health nurses work with patients to improve their overall physical and mental health. These patient populations often struggle with mental illnesses and/or substance use issues to varying degrees. Psychiatric nursing care is specialized in developing therapeutic relationships with patients that may otherwise be misunderstood and/or mistreated. It is through understanding the patient's goals, strengths and challenges/barriers that RPNs form assessment and treatment plans. In comparison, registered nurses working in other medical fields do not specialize in therapeutic communication and interpersonal techniques in this way.RPNs are also skilled in motivating interviewing, risk assessments and resource planning. These nurses use the combination of patient assessment and specialized nursing theory to inform appropriate nursing interventions. In this field of nursing patient interactions and conversations are important in continually assessing for changes to illness, as well as treatment efficacy and tolerability. Sometimes keeping an open line of communication with close family members is a helpful strategy for RPNs looking to strengthen the patients support system.
Biological Interventions
RPNs utilize their therapeutic relationship with the patient to reduce any barriers they may face accessing treatment to improve health outcomes. This is an important part of safe, effective psychiatric nursing care, as a large proportion of patients may have persistent and/or disabling mental health issues. They also help educate the patient about medications they may be taking, including its effects and side effects profile, as well as any potential interactions with other medications or foods. RPNs may be tasked with dispensing, administering and prescribing medications within their scope of practice. Changes to medication tolerability, illness symptoms and concordance are also monitored by psychiatric nurses.Brain stimulation through ECT and TMS are common biological therapies for mental health issues such as major depression. As with other biological therapies, RPNs provide counselling prior to and monitoring during the course of treatment for patients undergoing these procedures. Nurses specialized in psychiatric nursing care work with the patient to express their treatment preferences when exploring treatment options, especially for procedures. This involves exploring the patient's beliefs, values and culture whenever possible. Psychiatric nursing interventions like engaging with the patient in their own treatment promotes health and reduces harm to the patient.
Physical Health Promotion
Patients with mental health issues may have or develop co-morbid physical health conditions. This can make treatment more complicated, so psychiatric nurses assess, plan and provide nursing care inclusive of both the patients mental and physical health needs. RPNs communicate with the patient's health care team to ensure the patient receives the most appropriate treatment. Psychiatric nursing care prevents harm caused by medication interactions through the effective coordination of patient health care. Common co-morbidities RPNs may see in clinical practice are diabetes, coronary heart disease, respiratory conditions, as well as liver and kidney diseases.Diabetes
There are two different types of diabetes. Type 1 diabetes is where the pancreas does not have the ability to produce any insulin. Whereas type 2 diabetes is a condition where there is a reduced sensitivity to insulin. An example of how it affects the patient is that psychotropic medications will generally have a side effect of weight gain. It is important for people, especially people with type 2 diabetes to have control over their weight. It is also shown that psychotropic medication is known to have links to impaired glucose metabolism thus prescribing the right medication and dose is essential to have all medications working how they are prescribed. Psychiatric nurses need to be aware that chronic conditions such as diabetes can only be managed with a mental illness if there is a combination of self-management with the patient and monitoring by the psychiatric nurse.Coronary heart disease
Psychiatric medications can affect the rhythm of the heart, so people who have a pre-existing heart condition need to have the psychiatric nurse aware of this issue before administering of any psychiatric medications. An electrocardiogram can help detect a heart condition prior to dispensing of psychiatric drug. So, patients need to have the psychiatric nurse aware of any heart problems, so precautions can be taken.Respiratory conditions
Asthma is a respiratory condition that people who struggle with mental health may neglect and if they do not attend to this, the condition will worsen and sometimes may be fatal. Psychiatric nurses are important to frequently monitor symptoms and encourage the use of asthma related medications such as inhalers.Smoking is a habit that will exacerbate chronic respiratory conditions, and this will increase the patient's susceptibility in developing infections. Psychiatric nurses will need to observe patients whenever there are signs of respiratory illnesses because psychiatric medications can decrease the respiratory rate of patients and in some cases reduces the effectiveness of the doses.
Liver and kidney disorders
Liver and kidney problems tend to occur either with alcohol and drugs being abused, or when an individual has a genetic liver problem. People that have a mental health issue tend to misuse alcohol and drugs as a coping mechanism. A study found that ten per cent of psychiatric patients that are prescribed antipsychotic medication have livers that are impaired and not functioning at full capacity. For psychiatric nurses, they need to be aware that some diseases that are liver related might not show in initial liver scans, so they need to be knowledgeable of certain medications that have the potential to further damage the kidney or the liver. An example of this is lithium, this medication can significantly damage an organ, even if it is a minor impairment.Education
Australia
In order to become a mental health nurse in Australia you must first graduate with an undergraduate degree in nursing. After graduation they must apply to Australian Health Practitioner Regulation Agency to practice as a registered nurse. To begin working as a mental health nurse, registered nurses must be in progress or completed a post-graduate mental health nursing certificate. Working then as a provisionally credentialed mental health nurse is recommended to demonstrate committment to the specialized field of mental health work. Additional education in mental health nursing is required, either completion of a diploma or masters program approved by the Australian College of Mental Health Nurses. Further specialization into specific mental health and substance use populations and therapeutic modalities are available, but optional. Once these steps are completed, registered nurses can become a credentialed mental health nurse.New Zealand
The New Zealand requirements to work as a qualified psychiatric nurse is a postgraduate certificate in Health Sciences specialising in Mental Health Nursing. This certificate can be attained if the entry requirements have been satisfied, which is an undergraduate degree at either a recognised university or an institution that offers a degree within a health sciences discipline such as nursing, social work, pharmacy and so forth. A current registration with the is also a requirementUnited States
To become a psychiatric-mental health nurse in the United States you must complete a nursing program eligible to take the NCLEX-RN exam, such as an associate, diploma bachelor of nursing or accelerated bachelor of nursing degree. Once passing the NCLEX-RN, new graduates can obtain licensure as a registered nurse. In the United States RNs can start working in entry-level mental health care roles, such as in hospitals or agencies without additional education. However, cerifications in psychiatric-mental health nursing are available to RNs with additional experience and training, demonstrating their commitment to the field of mental health nursing.Some RNs working as psychiatric-mental health nurses opt to take a master's program in psychiatric-mental health nursing. Nurses can then practice as a psychiatric-mental health nurse practitioner, which further specialize in diagnosing and treating both acute and chronic mental illnesses using the medical model. This means they have greater scope in prescribing, ordering diagnostics and performing advanced procedures in the mental health context.