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Many people, including nurses, still see psychiatric nursing as something straight out of "One Flew Over the Cuckoo's Nest," with white-uniformed Nurs Ratched-types keeping patients drugged and strapping them down for electroshock therapy or a lobotomy.

Mozettia Henley, DNS, MSN, RN, started her psychiatric nursing career in the 1960s at a 9,000-bed state hospital in New York, a typical facility for the chronically mentally ill in those days.

Henley remembers a group of female patients that woke up, got dressed, then walked to the institution's front porch. Each patient sat in the same chair every day. They left the chairs only for meals. They did not get up to go to the bathroom. No one worked with them or organized therapy groups. "They were institutionalized," said Henley, president of the California chapter of the American Psychiatric Nurses Association. "It was their life."

After she left the facility, she heard that one day the women sat down in their chairs and the porch fell in. "I'm glad those days are gone," said Henley, now associate administrator at the mental health rehabilitation facility at San Francisco General Hospital Medical Center, a skilled nursing home for people with chronic mental illness. Her patients receive care from an interdisciplinary team of health professionals that helps them learn to care for themselves and manage their illness.

Her facility is one of a few these days that admit psychiatric patients involuntarily for long-term stays. Most of the mentally ill now are treated as outpatients or for a short time in a hospital psychiatric unit. Restraints are seldom used and only under strict legal guidelines. Patients receive one-on-one assessments, group therapy and vocational rehabilitation.

New medications control symptoms of anxiety or depression with few or no side effects. Mental illness is seen as a brain disorder rather than as a character flaw, and psychiatric nurses work hard to treat their patients with dignity and respect, even if a patient hurls insults at them or becomes violent.

Still misunderstood

But many people, including nurses, still see psychiatric nursing as something straight out of "One Flew Over the Cuckoo's Nest," with white-uniformed Nurse Ratched-types keeping patients drugged and strapping them down for electroshock therapy or a lobotomy.

"They think we have two heads and come from the planet Zork," said Kathleen Smerko, MS, CS, a psychiatric nurse practitioner in private practice in Phoenix. Some of her medical colleagues used to ask her in amazement, "You do psych?" She always responded, "And you think you don't?"

"Mental health is still misunderstood or seen as separate," Smerko said. "It's not really viewed as an integral part of care. Yet every good med/surg nurse will tell you the benefits of sitting at the bedside and talking to someone."

Psychiatric nursing may not involve elaborate IV pumps or complicated medical procedures, but in many ways it represents the essence of nursing, say those who practice it. Psychiatric nurses must understand the mental, physical, sexual and spiritual aspects of their patients. They work with individuals, families and communities. They must offer both medications and a willing ear to someone who desperately needs to talk.

"It's a different kind of care," said Amanda Saxe, RN, a psychiatric nurse in the behavioral health inpatient unit at Scripps Mercy Hospital in San Diego. "It's not physical, it's mental. The symptoms may be different and the medications are different. But you do the same steps as in medical nursing. You're still doing nursing care, those basic things you learn in nursing school."

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