Dispatches from the end of first year in mental health nursing

Well, this is the end…almost, anyway.  In around two months (I am still on placement, and this entry is an eyebrow raising procrastinating from essays distracting itch) I will no longer be a first year mental health nursing student.  So, what have I learned?  Here it is in handy bullet point form.

1) I no longer believe in the medical model. 

Some of you have been reading this blog since the very beginning.  That was, holy shit, 2007!  In 2007, I was a faintly dogmatic twenty one year old who had been newly diagnosed as a mental.  Before I started writing this blog, I had been flip-flopping wildly in terms of where I stood on mental illness.  Eventually, I swallowed the medical model whole.  I believed I had an illness, I needed medication, and anyone who argued with me on that point got their head snapped off.  Now, it’s by the by that I rarely ever took that medication.  But my beliefs were firmly in the camp that bipolar disorder was a chemical imbalance that had nothing to do with me, and woe betide anyone who disagreed with me on that.

As time has progressed, my views have changed considerably.  The point where I started to recover from mental illness was the same point in which I accepted that maybe I was not a passive victim of my illness and that just maybe there were a couple of things I could do meself to help. I stopped seeing medication as the cure and started seeing it has a helpful aside. (Albeit a very helpful one indeed- I do still take medication, almost seven years later).

This back and forth is natural.  You get sick, have to enter the sick role, but as a mentally ill person you can’t keep up your side of the bargain.  You don’t want to recover as soon as possible because sometimes you don’t understand or accept you have anything to recover from.  You can’t just swallow the pills and- gulp, what an awful word it is- comply because the pills in themselves throw up a whole shebang of shit that is almost worse than the illness itself.  And taking pills at all is a tacit agreement that you have a problem, one which I was so very resistant to.

Being so entrenched in the medical model of illness means that I ignored a lot of the things that were not helping me.  I buried my grievances and grief, I repackaged them under, “mental illness” and not human experience, I replaced my language with their language, I buried all suggestion that I had some sort of control over my illness.  I didn’t believe in sleep hygiene or the fact that stress sends me doolally and perhaps I needed to have a handle on that.  I didn’t believe or accept those things to begin with because my illness had led to be places so exquisitely painful and destructive that I simply could not face those things at the time.  Had I, from the onset, accepted those things, I would have collapsed under the weight of the terrible guilt and shame that still assails me as I fall asleep even to this day.  But knowing these things helps me to minimise the damage this illness does in my life now.  In that, these days, it does very little because I am aware that taking medication is not the end of the story.  Not by half.

So as a student nurse, this is the attitude I have towards my patients.  Not in the slightest against medication, but aware that there are a host of factors that are not medical that can make someone’s experience of their illness worse (or better).  That a failure is not a failure of medication, nor the patient, but a failure of us in not understanding, not seeing someone as a person but as a disease to be medicated and cured.  I no longer believe that.  So on that note…

2) I don’t want to be a nurse.

Sadly, this is what this year has taught me above all else.  I do not want to be a nurse.  I want to work with people who have mental health problems but I am not comfortable giving people medication in acute settings and I am not comfortable in general with the paternalistic nature of psychiatry.  But never fear- I am using my degree as a means to an end. I want to go down the graduate psychotherapy training route.  Hopefully. One day. And maybe have enough time to write, which I don’t now.

3) Shifts kill me. 

I am, at this point in time, dissolving into dust particles from exhaustion.  My shifts are: 7.15-3.15 and 1.30-9.30.  Now, one of these shifts all week would be good.  But nope, I do them both, and it’s going to get worse because next year, I’m doing nights.

It is absolutely messing with my head.  On late-earlies, I cannot take medication because I WILL sleep in. It takes me a long time to wind down after a shift so right now I am mostly operating on about 4 hours sleep a day, if I sleep at all, and it’s showing.  I am not entirely sure that I will be able to manage another two years of this. It’s partly the reason why I want to go into therapy- more regular hours.  Shifts are categorically bad for my mental health and it’s a big pile of bollocks.  (This is also partly why I don’t want to be a nurse.  I genuinely can’t do the shifts, I am breaking).

4) The shitty attitudes towards personality disorders in the system?  It’s true.

Sorry. But it’s not true of everyone, if that helps.  Or of me, either.

5) I love the patients and I love mental health.

I thought I’d be bored by now of talking about or thinking about mental health, but I’m not.  It is still the most fascinating thing in the entire world and I could talk about it all day.  It is definitely my area of interest in life- not just from a personal perspective but from an academic one.  Hooray for mental health!

I also love working with patients. My biggest issue in this regard is that I still identify more with patients than with the profession, but I’m a first year, and I expect this to change.  But I do find it incredibly rewarding speaking to patients, helping out, even if it’s just doing something small and silly.

6) Anyone who thinks nursing is a, “soft” degree needs to go fuck themselves right in the face.

I worked full-time this week in a place so busy that I genuinely have blisters on my feet.  I do insane shifts on no sleep and spend my days being constantly scrutinised by patients and professionals alike.  One thoughtless word can land me in the shit or upset a patient.  When I’m finished work on no sleep I come home to do one of my two 3000 word essays due in 3 weeks. The essays are not titled, “Cuddly Wuddly Nursing Woo Woo” and, “How to Wipe Arses”- they are, “Social sciences”, so I am writing a patient narrative and linking it to sociological theory like that of Goffman, Parsons, Marx, etc, and, “Professional Values, Ethics and Law” in which I discuss a case study from ethical, professional and law perspectives.  Also, we get four weeks off.  Two, if you’ve failed your essays.

7) Some people are really fecking stupid about self harm.

On this placement, I have had to confront my biggest horror- wearing my sleeves up in public.  I’ve written about this many times before, but for infection control reasons, I have no choice.  So far, two people (not patients), have grabbed my arms and shouted, “OH MY GOD, WHAT’S THAT?!” I don’t think there was any ill-meaning in that, but I am flabbergasted anyone thinks it’s okay to grab a body part and exclaim in such a way.  I find it intensely stressful wearing short sleeves but on the plus side, walking down the street with my arms out is no longer frightening to me because it can’t get much worse than the context I’m in.

Seriously though.  Silly buggers.

I am moaning a lot about my course at the moment because I am very acutely feeling the pressure I am under.  Shifts are really fucking with my head, and I am struggling. I am getting married and I am going to have a family to support- I have to qualify in order to earn some money to do that.  Due to being in the wilderness for so many years, I have no qualifications and no other options.  I could write, if anyone actually wanted me to write for them, but right now that isn’t paying and I am mercenary.  If (well, when) I lose my DLA when I am transferred to PIP, it is most likely game over for me- it is literally the only way I am financially surviving this course. Ah well.

Some of the moaning here may also be first year blues! HURRY UP AND BE OVER SO I CAN ACTUALLY PLAN MY FECKING WEDDING!

Now back to essays.  I’m, “working” tomorrow, i.e going to placement for the princely sum of £477 a month to live on! Yay!

5 Responses

  1. I’ve been trying to think of a coherent comment to put here, because this post really deserves one. But all I can come up with is Good because this really is, all of this. It’s so powerful to watch people make massive changes, and that’s one of the many reasons that I think you’ll make a wonderful therapist – you know how hard it is, but also have first hand experience of it, you’ll have a quality that is lacking in many of the NHS treatment providers that I have come in contact with – empathy.

  2. Hello Seaneen,
    This is a well written dispatch. I can only add that treating Bi-Polar from my experience of 63 years is that a combination of medication and self therapy is the solution.
    Bye for now and Keep Calm and Carry on, you will succeed in the end and I hope sooner than later.
    David.

  3. Really great post, thanks. I am surprised that you say you no longer want to be a nurse. You seem to have gone through an awful lot to get to where you are now but i can understand your reasons. I suppose the thing that struck me most was that you are willing to go through another two years (i think?) of training and all of the personal consequences of that. What is it that is motivating you enough to do that rather than starting training now as a therapist (or lecturer)?

  4. Sorry to hear that you no longer want to be a nurse, but I’m wondering whether it’s simply that you don’t want to be an acute ward nurse?

    If you’re more interested in psychological therapies than simply dishing out meds, then there are opportunities to do this as a nurse. CAMHS is a particularly strong area for this – I work in CAMHS and the bulk of what I do is talking therapies: a mix of CBT and systemic/family work. As well as CAMHS there are nurses on the CMHTs who might be, say, running a DBT group, or if you were working in rehab you could be doing social skills work.

    My advice would be spend the next couple of years shopping around and exploring the very varied things you can do and still call yourself a nurse.

  5. I’m a newly qualified OT and had a pretty similar experience, I almost dropped out after my first placement in an acute setting because it was just a million miles away from what I had gone into the profession to do. But I think Zarathustra has it spot on, you may find other settings are suit you better, both in terms of the approach and the practical things like the shift patterns. Training is really, really tough, I constantly wondered how I was going to manage being a professional if it was this hard even before qualifying. But once you’re working you’re better supported and you don’t have to deal with the constant changing involved in placements (I felt like I’d had five new jobs in two years on top of all the academic work, absolutely draining). Which adds up to a lot less stress. I’m in a community mental health job now where I work with a fantastic team who genuinely ‘get it’; that we’re there to help and work in a holistic way, not just to shovel meds down people and then ignore their complaints. I wish you good luck in whatever decision you make about your career, but please believe me that it does get better.

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