Mandi Higenbottam started working as a psychiatric nurse in 2009, pursuing a particularly challenging path in an already demanding profession. She works at Forensic Psychiatric Hospital in Coquitlam, where she’s part of a team that treats and rehabilitates people who have come in conflict with the law and are deemed unfit to stand trial or not criminally responsible due to mental illness.
“They [the patients] are the most acute and often the most dangerous patients in the province,” Higenbottam says by phone.
She wouldn’t want to work anywhere else.
“I really can’t imagine working with a nonforensic population,” says Higenbottam, who trained at Douglas College. “I love my job. It’s challenging, but that’s part of what drew me to the profession. It’s dynamic and complex. Everybody’s wellness or illness presents differently. It’s exciting, the people I work with are amazing, and the psychiatry is fascinating.”
With Canada said to be experiencing a nursing shortage, psychiatric-nursing grads in particular are well positioned for the future. According to Stenberg College, the average age of a registered psychiatric nurse in B.C. is 47, with the number of retirees exceeding the number of graduates. The pay is attractive, too, with starting salaries ranging from $51,000 to $62,000, according to Kwantlen Polytechnic University. There may be bonuses for people working in rural and remote locations and higher salaries for those who work in forensic settings.
“The job prospects are good,” says Dan Murphy, president of the Union of Psychiatric Nurses of B.C. (UPN). “There’s always work out there for psych nurses, especially in the Interior and northern Interior.”
Three schools in B.C. offer programs: Douglas College (a four-year bachelor of science in psychiatric nursing degree or a three-year diploma), Kwantlen (an eight-semester bachelor of psychiatric nursing degree), and Stenberg (an online diploma). Stenberg’s 101-week program allows people living outside Metro Vancouver to do clinical training in their local area. Stenberg is also affiliated with Kwantlen, giving Stenberg graduates the option of switching to a bachelor’s degree.
“We look for people who are engaged with the community, who want to work with people, and who want to move into a career that will offer a lot of opportunities,” says Jean Nicolson-Church, Kwantlen’s associate dean of health, of potential students.
Besides forensic settings, psychiatric nurses work in hospitals, residential facilities, corrections facilities, drug and alcohol treatment centres, community mental-health clinics, and long-term-care facilities, and with the homeless.
“Candidates need the requisite skills set out by the College of [Registered] Psychiatric Nurses of B.C.,” says Jacqollyne Keath, Stenberg’s dean of nursing. “One of the qualities an individual needs is a genuine interest in helping others. Sometimes…your own personal experience, life experience, makes you more empathic.”
Despite their focus on mental health, psychiatric nurses also need to possess medical knowledge relevant to all areas of nursing, including pathophysiology and disease prevention.
“A lot of times, people don’t really understand so much what psychiatric nurses do,” Higenbottam says. “We provide holistic nursing care. We don’t just deal in the realm of mental health; we also deal with the body and do regular nursing stuff like every other nurse does. There’s a lot of assessment—comprehensive, lengthy mental-status assessment; a ton of observation and documentation of people’s behaviour. We also give medication.”
However, prospective students need to consider the work’s potential danger. Psychiatric nurses are sometimes assaulted by patients. At the Crossroads unit at Burnaby’s Maples Adolescent Treatment Centre, a forensic unit for youth, 25 workers were seriously injured on the job last year alone, some so badly that they needed time off work and went on to experience posttraumatic stress disorder.
“One of the big areas people who go into psychiatric nursing have to be prepared for is the potential for violence,” says UPN’s Murphy, who works in forensic psychiatric services. “We probably have the most violent profession to be in, including being a police officer.…Our challenge is educating the employer on how to keep us safe. In this day and age in health care, where the budget seems to get placed ahead of the safety of workers, it makes it very challenging for psych nurses to maintain a therapeutic relationship with patients when they’re also expected to do the security on the ward.”
While certain risks are associated with the job, there are rewards.
Sanjin Ramovic graduated from Douglas College last year and now works for Fraser Health at Surrey Mental Health and Substance Use Services’ adult short-term assessment and treatment unit. He says there’s no typical day: he’s helped people who have depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder, anxiety, a personality disorder, and other conditions.
“It’s a challenge, because each day you have to go into the job understanding that you could be met with a number of difficult circumstances and people who have some challenging experiences who, for the most part, haven’t had anyone to talk to about them,” Ramovic says in a phone interview.
“But seeing some of the changes that occur, seeing somebody light up after being able to tell their story, is something you can’t really describe,” he adds. “There’s something about that—when somebody feels understood and they feel good about being able to express themselves—that’s so rewarding. That’s my favourite part of the job.”