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Day in the life

What it’s like working in a psychiatric hospital Q&A

Auxiliary nurse, therapy care assistant or healthcare assistant which ever name you use the job role and responsibilities are relatively unknown. As a result I often get asked…

“What do you actually do at work?”

“Who and what do you assist with”?

“Who do you work with”?

So I’m going to explain my role and answer a few questions I receive frequently on Instagram.

*Disclaimer – Confidentiality is very important when you work in healthcare therefore, I will be meticulous when answering all questions plus sharing any work related information. For my own safety and the safety of the patients I work with I won’t be discussing where I work in detail.

Where do I work?

I work in a psychiatric hospital on a in-patient, locked female personality disorders rehabilitation unit. In-patient basically means an individual is mentally unwell to the extent a hospital stay is required.

What training did I do beforehand?

Guys, I had such intense training before I was allowed into the wards! Every day for two weeks, six hours a day I was trained in mental health law and legalities, basic life support, PMVA techniques, recognising vulnerable individuals,

What is your job role?

I support the patients in their everyday lives, to assist them through their stay at hospital. My role depends on the day and varies from making breakfast, organising group activities like arts & crafts, accompanying day trips, to a more medical side like taking patients general observations, and assisting the nurses in clinic.

What’s a typical day like?

7:30am with a handover from the night staff. During which we are told about each individual patient health, any concerns etc.

8-8:30am Prompt patients to wake up for breakfast, morning meeting and mindfulness.

9am Morning meeting and mindfulness. Here patients can express any concerns, requests for the day e.g. go for a walk outside or to the local shops. Mindfulness activity starts the day which can be any short activity done mindfully e.g word association.

Other than lunch and dinner the morning is the only time that there’s any specific structure. Activities are scheduled into the timetable but I am allocated something different every hour. I can be on intermittent observations, 2:1 observations, relieving staff in restraint, accompanying walking group or be involved in activities.

What do you mean by observations?

The main thing that structures our day are observations. Each patient is observed and monitored individually and to their specific care plan. Patients are checked either 4 hourly ( every 15 minutes), twice hourly ( every 30 mins) and hourly. Depending on their risk level patients can also be on 1:1 staff, 2:1 and, 3:1 with further precautions put into place such as within eyesight, within arms reach or hands on.

Regardless of where the patient is during this time you have to physically have eyes on and document what they’re doing, their behaviour and mood.

What do you mean by restraint?

If a patient becomes so distressed and becomes a risk for themselves and for others they *might* be restrained. I have been trained in specific ways you can’t just jump in and touch a patient in any which way the same as you wouldn’t in general day to day life. Verbal de-escalation is the most important thing! You really don’t want to be putting hands on and restraining patients.

What qualifications did you need for the job?

For my specific company other than basic math and English no official qualifications were required. All training is provided with further training as you progress. However, it’s worth knowing that before I found this job quite a few wanted 12 months previous clinical experience.

What’s career progression like?

You begin as healthcare assistant progressing to senior healthcare assistant and then lead healthcare assistant. From there it depends on where you want to take it. A common stepping stone is nursing both mental health and general. You also have the opportunity to go into psychology, occupational health and management.

What is the most challenging part of your job?

A lot of people assume the long shifts are challenging when in reality I’ve adjusted to them fairly quickly. Night shifts are a little more difficult especially by the time the third night. For me it’s the unpredictability of the shift. Am I going to be at the hospital today, will I be involved in restraints or seclusion, am I going to get attacked today? (I haven’t been subject of an attack but I’ve witnessed fairly minor & major incidents involving staff) Is somebody going to self harm today?, is somebody going to try and abscond today. It’s unpredictable and not knowing what you’re walking into that shift is hardest part.

How do you keep yourself mentally well?

This job is emotionally challenging. You’re exposed to a lot situations some people just wouldn’t believe. Some days I come home from work and I just want to be left alone and unload. I usually write about everything that’s affected or bothered me in a journal and I highly recommend headspace guided meditation.

Is there anything rewarding about your job?

Working 1:1 and building a therapeutic relationship with patients who at first wouldn’t even acknowledge me. It’s amazing to see progress even small progress. Seeing them progress from 4 hourly observations to being granted home leave, and, then discharged home.

*This blog post is my experience as permanent staff on a PD ward. The hospital I work at has numerous wards – male acute, female acute, 1 mixed acute, 2 male picu, female picu, eating disorder, personality disorder, emerging personality disorder (under 18yrs old), young people, a stand alone ward for 1 individual & Male rehabilitation house.

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