If you had told me even a year ago that I would be working in a mental hospital, I probably would not have believed you. Even in the modern age, mental health remains a very stigmatized issue, and it’s true that mental hospitals can sometimes be very scary places. However, psychiatric care facilities (the proper term) are also a therapeutic space where care, compassion, and even fun can occur. It is rewarding, engaging, fast-paced, emotional, and above all, extremely impactful work.
I want to make it abundantly clear that I understand psychiatric care facilities are often clouded with a lot of serious systematic issues, such as greed, neglect, evil secrets, death, etc. The fortune 500 company that parents my hospital, UHS, is pretty awful and corrupt. However, I am not the CEO of United Health Services. I am just a 22 year old woman who gets paid $17.50 an hour to keep people alive. I am not in this industry to be a millionaire, I am in this industry because I enjoy working with acutely psychotic adults.
Every day is different for me, depending on the patients and the staffing, but generally, the day (or evening) follows a very regular routine. I work both 7-3:30 and 3-11:30 shifts, so there are obviously slight differences in between those shifts as well. Day shifts are typically much busier, as that’s when doctors, social workers, and psychiatrists come onto the unit to meet with the patients. 3-11:30 is much slower, and by 8:45PM, most people are even in bed.
With that being said, this is an example of what a day in my life would typically be on a 7-3:30PM shift.
5:30AM: My morning starts bright and early when I have to work a day shift, which is typically 2-3 times a week. I don’t need much time to get ready in the morning; I just wash my face, brush my teeth, and put on my scrubs. I don’t typically wear a lot of makeup, partially because I can’t be bothered too, but also in part because I don’t really need to with my lash extensions!
6:00AM: By this time, I am out the door. I have about a 40 minute commute without traffic, which gives me time to grab a coffee and relax for a bit in the breakroom before my shift. I will usually take my first bus, pick up my coffee, get to the second bus, and boom, my work is right there. The ride goes by pretty fast, especially when I have a coffee to help me wake up.
7:00AM: Report starts around 7, which is the time when the overnight RN goes over any new updates and medical information with the day RN and MHA’s. This is also a time for me to learn about any new admissions I haven’t met yet, any discharges scheduled for later, any important updates about the patients that we should know ahead of time, etc. This is also when the lead MHA (mental health associate) prints out the assignment sheet and we choose what roles we want to fulfill that day. For example, if I choose to be MHA #4, that could mean I am responsible for safety checks from 8:30-9:30 and 12:30-1:30, 1:1 from 7:30-8:30 and 2:30-3:30, and my break is at 12. When I am not on safety checks or 1:1, I am expected to just be chaperoning the unit, helping patients with things they need, taking them down to the cafeteria for meals, coordinating admissions/discharges, etc. Let’s go off of the example above and say that I am MHA #4 for today.
7:30-8:30: 1:1. A 1:1 basically just means a patient has indicated they have serious intent to harm themselves or others, and they need to be supervised by a staff member at arm’s length’s at all times. Obviously, I am not expected to watch one person for eight hours straight, so we all take turns doing an hour or so at a time, and then we swap out. I usually like to start the day on a 1:1 because the patient is usually still sleeping, and that gives me a chance to sit back, have quiet time, and relax for a bit. However, it’s definitely not a time to let my guard down. If the patient gets up to go to the bathroom, get water, shower, etc., I am expected to follow that patient everywhere within arm’s length. Usually, there are not too many 1:1’s going on at once. For example, my unit usually only has one 1:1 on a census of 23 patients. Sometimes, if that patient likes your company and you get along, you can be on that 1:1 for hours upon hours!
8:30-9:30: First round of safety checks. Safety checks are a standard routine in which we go around the unit every fifteen minutes and document what the patient is doing. We obviously monitor the patients to make sure they aren’t harming themselves or others, but the other purpose of safety checks is to document patterns of behaviors in patients. For example, I can pull up someone’s chart from the previous day and see that they only slept for a couple of hours on the overnight shift, so they might be extra cranky today. Or, I can see if a patient has a trend in developing aggravated behaviors at particular times of day. Most people are awake by 8:30, as breakfast has definitely arrived by then and another MHA has already started vital signs. Vital signs (blood pressure, 02, pulse, and temperature,) are required to be taken twice a day so that the patients can be authorized to take their medications safely. If a patient is eating their breakfast in the day room, I would write D (day room) 11 (eating.) Like I said, we go around and document this every fifteen minutes, so it gets pretty repetitive and tends to go by fast.
The important thing to note about safety checks (and 1:1) is that you CANNOT DO ANYTHING ELSE. If I have the safety check binder in my hand, I cannot go behind the desk to answer the phone, respond to a code (I will explain later,) or take a bathroom break. If I am not paying attention to routine safety checks and someone (god forbid) commits suicide under my surveillance, I am in big trouble. It doesn’t matter if there’s a fire in the building- that check book can never leave my hands.
I actually really like safety checks, because they are so routine, organized, and they go by quickly, since you have to do four rounds in an hour.
9:30-12:30: After my first round of checks, I don’t have to be posted anywhere else for a couple of hours, so this is the time when I can take a quick bathroom break, eat a snack, and take post somewhere else; like a blind spot in the back day room that is out of the nursing station’s view. It can be really boring to just sit in one place for a while (sometimes hours at a time,) but these sorts of positions are extremely important. For example, if a fight breaks out in the back day room, I can be the first one there to redirect the patients and call a code on my walkie-talkie. I can also use this “free time” to help the patients with things they can’t get for themselves, like taking them on trips to the vending machine, taking them outside for fresh air, or chaperoning them while they shave. Sometimes, patients just want to talk about what’s going on in their lives, which can also be nice.
Remember those codes I mentioned earlier? Let’s talk about codes.
If I am not on a 1:1 or safety checks and I hear “code green” over the loudspeaker, I am expected to go to the code. A code green is a psychiatric emergency in the hospital, usually a fight or an assault. Just the other day, I was called to a code green for a patient who was trying to escape the hospital. She had pushed past a social worker on their way off the unit and was running down the hallways, banging on the windows, and punching/kicking anyone who got into her way. In a situation like that, you will definitely need a ton of backup to restrain the patient having a crisis, prepare the mechanical restraints in the quiet room if needed, get the IM ready to tranquilize the patient, and redirect bystanding patients from getting involved. One time, we had to call a code because a patient had punched a hole in the wall and was using a piece of concrete to assault a staff member. Staff members have been put into chokeholds, had TV’s thrown at them, etc. A good code response should usually have at least ten people show up to help, because in a crisis situation like that, we need to make sure that everyone is safe as quickly as possible. Codes can last anywhere from a few minutes to more than an hour, depending on what the situation is. We also have code blues, which indicates a medical emergency in which the patient is not breathing. I have only ever heard one code blue over the loudspeaker, and in that situation, only designated code blue RN’s responded to the code. There are a bunch of other codes too, such as “bomb threat” and “hostage situation,” but THANKFULLY I have never encountered one of those. Code red is also fire, as you could have guessed. Again, I’ve never seen a code red.
12:00: So let’s say the code on another unit starts at 11:15 and I get back to my home unit around 12. Perfect, just in time for lunch! I almost always bring my own lunch from home, but I can also buy food from the cafeteria for $2 if I want. The meals at our hospital are actually pretty fire, I have to say. We have a really bomb cheese and veggie quesadilla. This is especially helpful if I am working at both my hospital job and my desk job later in the evening, because I can buy hot lunch at job 1 and eat my bagged lunch for dinner at job 2.
12:30-1:30: It’s time for my second round of safety checks. Around this time, most patients are taking a nap, eating their lunch, attending a group with the group therapist, meeting with their doctor, etc. What you may not know about a psychiatric hospital is this: pretty much none of the furniture or decor is what you would expect. The chairs and tables are filled with heavy bags of sand, so that patients cannot easily throw them. The TV’s and computers at the nursing station are covered with a special unbreakable plastic. There are no door handles- everything has a push lever. The bathroom doors are cut diagonally at the top so patients cannot hang themselves in the crack of the door. The shower curtains are designed to fall apart easily so they cannot handle any weight. ALL of the bedroom furniture (bookcases, desks, bed frames,) are nailed down to the floor and walls. When conducting safety checks, we check all the rooms and bathrooms for contraband- which basically means anything a patient is not allowed to have. If a patient has somehow managed to sneak, like, drugs into the hospital, obviously that is also contraband, and we will confiscate it and report it. Even something like a hairbrush could be considered contraband, if the patient’s doctor has not already approved it.
1:30-2:30: More down time. Let’s say there is a female admission at this time; I am obviously not really doing anything, so I would go down to the ambulance room, meet the new admission, conduct a johnny search, search all of their property, document their property, fill out the paperwork, interview the patient, etc. I actually don’t have to do admissions very often; I am almost always busy or on checks when they come in. However, I have done quite a few discharges because they are super simple. We just gather the patients’ property from the property room, they sign a few things, and poof, they are off.
2:30-3:30: Last 1:1. Depending on the patient, this is either very quiet, or very fun and talkative. There is one patient at my hospital who has been on a 1:1 for several months, and I am usually paired up with her for 20+ hours a week, so we tend to talk a lot and the environment is very comfortable. If it’s a patient I don’t know very well, it’s usually really quiet and a bit awkward. Like, hi! You haven’t met me, but I’m here to stare at you while you poop. Sorry about that one.
The evening crew comes in at 3:00, and they are in report from around 3:00-3:30. When they finish up, someone in the evening crew will come to swap out with me. And then I go home.
Haha, just kidding. I have a second job I go to after my morning shifts. These lash extensions don’t pay for themselves, you know?
I hope you found this piece interesting and informative. It is definitely very intense to work in a mental hospital, especially when its understaffed and the patients are cruel/demanding, but it’s not always like that. Sometimes, the bonds and therapeutic relationships you form with the patients can be beautiful. When someone says to me, “I look up to you and you helped save my life,” that is why I continue to do what I do. I am looking forward to working my way up the ladder and eventually going to nursing school someday, and I am so grateful to have had this experience.
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