Being a mental health nurse was not my original career choice. I wanted to be a ballerina. As a nurse herself, my mother convinced me that at a minimum I would always have a job, and I could work while “figuring out what you really want to do.” 23 years later I still have a job as a nurse. And I’ve realized that being a mental health nurse is exactly like what I “really wanted” to do:
Dance.
Like a dancer floating across a stage on their toes, being a mental health nurse requires fine-tuned instinct cultivated over years of training. Unless I am measuring a blood pressure I really don’t rely on machines to tell me what important things are happening inside of Spurwink’s Youth Residential and Day Treatment clients.
One of the most important skills as a mental health nurse is to be a non-judgmental witness and observer. Like an intricate interplay of dance steps between two partners, I must recognize when a request for a Band-Aid is really just for a Band-Aid, or a need for something else entirely. Sometimes what on the surface appears to be a simple request for medical help can actually be an event that ends in a broader, greater, treatment victory.
One such victory was a teenager – I will call Ann – who came to me and asked to start taking one of her medications “on her own.” On the surface it didn’t seem to be anything to think twice about. But in reality, she was inviting me to learn the intricate steps, unique timings, and complex movements of her life.
Ann has been in and out of mental health treatment programs – including residential and day treatment – since she was small enough to run under a table without crouching. Ann, like many youth at Spurwink, has a history of trauma which affects her perception and ability to cope with minor stressors. She also has learning difficulties which further make daily life more challenging. A colleague recently compared this difficulty to the way we feel when we are lost while driving a car with music turned up too loud. Unlike the dial on the car that can be turned down, a teenager with a history of trauma, developmental disabilities and hormonal changes cannot turn down the volume to focus and find her way.
Before Ann developed the skills she learned at Spurwink it would have been typical for her to lash out violently or make unreasonable demands if she wanted something. Ann would have difficulty even defining what it was she needed. On the surface it appeared she would cry or scream for no reason. She hadn’t learned to use skills or ‘turn down the volume’ to navigate.
In residential treatment, Ann would make an abrupt dance move – coming to me with her fists clenched, face red, and scream, “Dara, fire my staff immediately, they #$%@ stink at giving me meds!!” Adjusting my step I would reply, “Ann, I am your nurse I can’t fire your staff at the house. What is happening with staff and your meds?” This is where I listen. Read between the words in the question. Try to understand what the request is really for:
Dance with a client in an effort to keep in step with her.
Before even finishing my sentence, when Ann heard that “firing” couldn’t happen, it would be typical for her to scream, kick, swear and run away. We may have assumed she was unhappy with limits staff had placed on her at the residence and guessed she reacted to hearing ‘no’ about firing staff.
Now, though, over a period of time with therapeutic intervention and care, a new scenario with small victories happened:
- Ann recognized that she was frustrated with her new staff members frequently questioning her medication schedule
- Ann came to understand that if she could administer the medication herself, it would prevent a conflict with her staff
- Ann asked if I could allow her to take her own medicine.
I said yes and explained that this would take some steps and a bit of time. But Ann didn’t react harshly, get frustrated and swear at me or give up. She was able to adjust her steps in rhythm with mine, ask what to do next, and tolerate not getting what she wanted immediately. She wasn’t joyous that her request couldn’t happen immediately, but she was able to wait with some support.
The reality of my job is not as glamorous or as beautiful as a ballerina spinning across a stage. The victories I witness are small and not always obvious or dramatic and are rarely met with applause and calls for an encore.
But they are rewarding.
Helping Ann and witnessing her progress from a girl in pain, running around screaming and lashing out violently, to a young woman advocating for herself, is evidence to me that my job is awesome. This transformation took many months and many dedicated teams but most importantly Ann’s own work and growth. My job as a Mental Health Nurse was to recognize the significance and importance of her simple request to take her own medication. In this instance Ann takes center stage with a bow, while I applaud.
Like criticizing a dancer before learning the complexities of his/her steps, my experience as a mental health nurse has taught me to never assume a reason for behavior. What looks like anger, defiance or negative behavior on the surface can be emotional or physical pain, or a child lost in emotions they cannot identify or navigate through.
I must learn each person’s unique dance.
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Dara Oja, RN, BSN | Director of Nursing