Lives Through a Nurse’s Eyes

The Demanding Role of Psychiatric Nurses

The world of a psychiatric nurse is often an emotional rollercoaster. These professionals play a crucial role in the mental health care system, balancing medical expertise with deep emotional labor. Their work involves high-stakes clinical responsibilities and managing complex human emotions in often volatile environments. Psychiatric nurses are specially trained to care for the psychological and physical well-being of individuals with mental health conditions or behavioral problems.

They face significant challenges, primarily driven by high levels of patient aggression, violence, and unpredictable behavior, coupled with severe staff shortages and inadequate facilities. High stress rates, frustration, and compassion fatigue are common due to the intense nature of psychiatric care. Additionally, they navigate societal stigma surrounding mental illness and deal with prejudice from other health professionals. Despite these challenges, psychiatric nurses remain at the forefront of care for patients battling depression, schizophrenia, bipolar disorder, substance dependence, and other mental health conditions.

Daily Realities and Emotional Toll

In Nigeria, every shift for psychiatric nurses is a delicate dance between compassion and caution, empathy and endurance. They serve as caregivers, counselors, mediators, and often the last line of defense between patients and self-harm. There are about 10 major federal neuro-psychiatric hospitals in Nigeria, supplemented by psychiatric units in around 12 teaching hospitals, alongside a few state-run and private centers.

Haruna Hauwa, who works in a psychiatric unit in Abuja, shared that the hardest part of her job is not the aggression or long hours but the stigma. “People think we only restrain violent patients. They don’t see the counseling, the listening, the patience. We treat wounds you cannot see,” she said. She recounted holding the hands of patients battling severe depression through the night, emphasizing that sometimes all they need is someone who will not judge them.

For Olusegun Badmus, the emotional burden often follows him home. “You hear stories of abuse, abandonment, addiction. Sometimes I sit in my car after work and cry. But you learn coping mechanisms: prayer, talking to colleagues, supervision sessions,” he said. He stressed the importance of mental health support for professionals, noting that absorbing so much pain without decompressing can affect them.

Challenges Faced by Nurses

In Benue State, psychiatric nurses battle stigma and poor remuneration amid daily risks of aggression from caring for patients. At the psychiatric unit of the Federal Medical Centre in Makurdi, Nurse Maannem Zaki described how she begins her shift knowing anything could happen. Managing patients who are suicidal, aggressive, confused, or withdrawn requires winning their trust before administering treatment. She also highlighted the difficulty when patients refuse to eat or communicate.

Zaki expressed concern about people stigmatizing her for being a psychiatric nurse, recalling how her brother reacted years ago when she chose this specialty. “My brother had said that of all the specialized roles in nursing, why would I want to become a psychiatric nurse? I was then a general nurse, but I enjoy working here. If we don’t care for them, they can easily kill themselves,” she said.

Nurse Rebecca Yahaya noted that the major risk attending to patients is usually noticed during their initial admission because they are often brought to the facility when their cases become life-threatening. “We face the worst hazards in the hospital system because our patients, when brought in, don’t even know that they are sick. We risk being raped by violent patients. They are in high libidos. So some of us – male or female – are sometimes harassed,” she narrated.

Yahaya added that despite the hazards, psychiatric nurses face greater challenges from society’s perception of their profession. “People don’t see psychiatric nursing as prestigious. Some even ask why you would choose to work with ‘mad people.’ We face stigma from family members, the society and even within the profession. But mental illness is like any other illness. It deserves care and compassion.”

Systemic Issues and Call for Support

A psychiatric nurse in a private facility in Makurdi lamented poor remuneration, stating that despite specialized training and managing unpredictable behaviors, the incentives are not commensurate with the risk. “It is discouraging,” she said. However, she emphasized that what keeps her going are the smiles on the faces of recovering and healed patients.

At the Aminu Kano Teaching Hospital, nurses raised alarms over acute manpower shortages, poor welfare packages, and lack of appreciation for their work. Muhammad Namadina, who heads the male psychiatric ward, stated that nurses are overwhelmed by the number of patients they attend to daily. “Almost all mental health conditions are treated here, but the number of psychiatric nurses in Nigeria is not enough to care for the people with mental challenges,” he said.

Namadina explained that psychiatric nursing requires balancing medical attention with emotional support, depending on the patient’s diagnosis. “The approach for someone with depression is different from that of a patient with mania. Each case demands individualized care,” he noted. He lamented that nurses face serious risks without commensurate hazard allowances.

Salis Ali Kabo, the coordinator of clinical nursing activities at the hospital, painted an even dimmer picture. “Kano has a population of more than 20 million people, but the number of trained and registered psychiatric nurses in the state is not up to 60. The workload is too much,” he said. He stressed that individualized care is critical, especially for substance-induced psychosis. “The backbone of treatment is to take patients away from the substances they abuse. But the most difficult aspect is preventing relapse due to cravings. Nurses must treat both the addiction and the psychiatric symptoms,” he said.

Advocacy for Better Conditions

Both nurses acknowledged stigma as another challenge. Namadina said psychiatric nurses are often dismissed jokingly as “mental health workers” whose behavior is excused as abnormal. Kabo added that even among health workers, misconceptions persist. “Some say if you train as a psychiatric nurse, you may end up behaving like the patients. This is totally false, but it shows the stigma we face,” he said.

The nurses urged the government to incentivize psychiatric nursing through better pay, allowances, and immediate employment of graduates. Kabo noted that psychiatric nurses are in high demand globally. “If a psychiatric nurse applies abroad, within two or three weeks he will get a job. To reduce brain drain, government must train more nurses, employ them immediately and provide incentives,” he said.

He warned that the current ratio of nurses to patients is dangerous, saying, “In some hospitals, one nurse attends to 50 or even 100 patients. The World Health Organisation recommends one nurse per patient. The gap is too wide.”

Conclusion

Psychiatric nurses operate in one of the most demanding areas of healthcare, facing workplace violence as a significant precursor to mental health problems. Dr Fagbo Oluwabusayo, a Consultant Psychiatrist, highlighted underfunding, implementation gaps in policy, lack of training, and stigma as factors bedevilling psychiatrist hospitals in the country. She emphasized that mental health has received a disproportionately small share of the national budget, with most facilities operating with outdated infrastructure, limited medicine, inadequate security, and minimal rehabilitation resources.

The emotional care takes its toll on psychiatric nurses. Haruna Hauwa, a psychiatric nurse in Abuja, noted that some of her worst days were the ones that followed suicide attempts or violent psychotic breaks by patients. “One of my toughest shifts was when a teenage boy was brought in after attempting to jump from a bridge. He asked why we saved him and was angry that he was still alive. I stood there as a nurse, but I’m also human. His words stayed with me long after I left the ward,” she recalled.

Hauwa admitted the emotional toll sometimes follows her home. “There are days I just sit quietly in my car before entering the house. I replay conversations in my head, wondering if I missed a sign. It can be mentally exhausting because psychiatric care is not just physical work, it’s emotional labor.”