People often say they couldn’t do my job. I frequently wonder how I do. There are times I dread going in, times I can’t sleep at night because I’m worrying about a patient and days where I can laugh and cry intermittently. Every day feels like a gamble working as a community mental health nurse, not knowing what to expect.
Take Friday as an example. My diary was packed. Any sensible community nurse knows to keep this day as free as possible. With paperwork on the rise, I try to reserve a few hours on Fridays to make referrals to hostels, find people homes, update risk assessments, call carers and check patients have their crisis plans for the weekend.
9.30am
On my way to a visit, my work phone is already ringing non-stop. The day has begun. “Call us. It’s urgent,”the text messages read.I return the call and the duty worker tells me: “It’s Adam; he is threatening to seriously harm a member of the public, then to kill himself. His girlfriend’s not sure whether it’s driven by command hallucinations and is at the hostel now, waiting for the police.”
I rush to the hostel, my heart racing. I had a female patient due in the clinic at 12pm. She has had her children removed and was discharged from a psychiatric ward yesterday. I also had a to-do list the length of my arm of notes and referrals to make before Monday morning.
I arrive at the hostel. Adam has gone. Two police officers arrive as I explain to them the seriousness of the threats Adam has made while describing a worrying relapse in his mental state. With anxious, hastened energy and no idea where Adam is, I inform them of the serious assault on his mother two weeks prior. With some reluctance, they finally agree to go to the addresses we provide, but as they have no powers of arrest, we need to arrange an emergency assessment.
12pm
My phone is going wild, my anxiety through the roof. Worried family members are calling requesting updates on how relatives are doing – I’ve got 46 unread emails since yesterday. What to do about Adam? I text my patient that I was meant to see to tell her I can’t see her today, and reschedule or cancel my other appointments. The all too familiar ‘letting people down’ feeling churns in my stomach and weighs on my shoulders.
1.45pm
I need a doctor, a social worker, a bed in an acute psychiatric unit and a medical manager to authorise all of this.
I can’t find a doctor, the one we deal with is working nights so I call the social workers, who suggest calling the GP.
Feeling alone, stuck and panic stricken, I picture the patient at home with his mother, dreading the worst. Amid an NHS mental-health bed shortage crisis, if finding a doctor was hard, finding a bed felt impossible – they are like gold dust. The bed manager told me they were waiting for 13 male acute beds in my trust alone.
As if by sheer magic, I find one.
I have no idea what is going on with my other patients; a young woman with post-natal psychosis in a domestically violent relationship; another currently on 1:1 observation in hospital following a suicide attempt; another man just discharged from a long psychiatric hospital admission and who has recently stopped taking his medication; and a patient whose antipsychotic injection is due today.
2.45pm
The doctor in the team next door offers to help.
3.30pm
Together we stop off at the police station, briefing the fresh batch of officers.
4.30pm
We go on our way in the back of a police van. The social workers call asking us to hurry as they finish at 5pm. We arrive, the police enter, make the property safe and we manage to get Adam on his way to a hospital bed. The mum screams at me. As a community nurse, everything gets directed at you: blame, violence, tears and pressure.
7.30pm
Tears are in my eyes on the way to the hospital. Sat in front of Adam, still cuffed and surrounded by police, I can’t turn to look at him. I don’t want him to see me crying. I can’t mutter a word. The echoing words of his mother haunt me: “Look what you’ve done to my son, my family. Look.”My stomach was rumbling so hard – I haven’t eaten all day. It is now 8pm, and I only get paid until 5pm. The doctor senses my uneasiness and relieves me of the task of taking Adam on to the ward; instead he puts his hand on my shoulder: “I’ve got this. You get yourself home.”
As I exit the hospital gates, the nurse mask slips from my face. Tears stream down my cheeks and for the first time in my 10 years of nursing I think: “I don’t think I can do this any more”.
Monday morning came. I knew I could do this. I made my way to work not knowing what to expect next …
Names have been changed to protect patient confidentiality
- In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
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For the first time in my nursing career, I think: I can"t do this any more
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