A Day in the Life of a Community Psychiatric Nurse
CPN Jocelyn Cusack on why she'd never go back to permanent work and how the NHS would collapse without agency staff
Published on 1st December 2015
Jocelyn Cusack is a Community Psychiatric Nurse who is working through the agency Tripod with an Assertive Outreach team in Leighton Buzzard.
Mental health has always been the Cinderella Service
I was 50 when I took early retirement. I’d been working for the NHS since I was 21 initially as a general nurse and district nursing in the community with terminal ill patients. I then trained to do my mental health nursing eight years later and have worked predominantly in crisis teams for mental health.
It wasn’t one thing that made me decide to retire early at 50, it was a drip, drip scenario, it was classic burnout. I’d been working 50 hours a week and I enjoyed it, and I love nursing and I’m very passionate about it, but I was just exhausted, mentally and physically.
I did some research on the RCN website about entrepreneur nurses and, inspired, I decided to set up a limited company in 2011 and do agency work. I’m so pleased I did, the money is twice as good. I got less of my pension because I retired early, but what I got in my final pay out, I could earn in a year as a locum nurse! At this age, you have so much experience and you can work anywhere. That in itself gives you confidence and you get the joy back in your working life, confident to work into any department – and I have worked in departments I’d never worked in during my career in the agency within the NHS, for example, as a dementia specialist nurse and with a community mental health team.
I wanted to use my experience and still nurse. I wanted to earn more money. In the NHS I’d been at the top of my clinical band (7), and working evenings and weekends, yet I still only took home half the salary I take home now as an agency nurse. Plus I get paid weekly! Brilliant.
In my early career in general nursing, and especially as a district nurse for terminally ill people, I was always talking to relatives but didn’t get much time to support them. I liked psychology and that side of the job, so I got my training to work in mental health. Back then it was a diploma and you worked and studied at the same time. Now it’s a degree and there’s much more time spent in the classroom and less time on the wards. For me, it really helps being doubly trained in mind and body, as there is so much overlap between physical and mental health.
Human beings are fragile
For the last 25 years I’ve been working in mental health. It’s always been the Cinderella service but still in this day and age there is a taboo around mental health. People are stressed, and their mental health is going downhill. We need to demystify the stigma around mental health.
Most of the people I see are just normal people, barristers, teachers and they have a blip and need specialist help. A lot of people don’t want to take anti-depressants and I find myself saying, if you were a diabetic, would you take insulin? It’s the same thing, your serotonin levels are just below what they need to be and life events and stress contributions cause our minds to be unwell. People see it as an element of failure. It’s not, it’s an emotional illness. Human beings are fragile. There’s a big need for mental health services and it’s only going to get bigger, with people's stressful lives and the recession.
The biggest thing in my job is to facilitate change, assess mental state, ensure compliance of medication and manage risk. The people I work with are aged between 18 and 65 and in 70 per cent of cases the problem is depression. Other people are experiencing psychosis, schizophrenia and bipolar, anxiety disorders and then phobias and OCD.
My core duties are monitoring compliance with medication, carrying out CBT techniques with patients, monitoring their mental state, assessing risk, are they suicidal or delusional and hearing voices? Are they a risk to themselves or others? Can they stay in the community? Is there any insight? The main part of it is having a therapeutic relationship with that person.
We are aligned to the community mental health team and have multi-disciplinary meetings once a week with the doctors where we can discuss clients and cases. We have a handover each morning so we all know who is seeing who and update each other on progress but aside from that we don’t tend to have meetings. We have our own caseload and get on with it primarily on our own, ensuring people are functioning by assessing how their houses are, how they are presenting themselves, are they eating? Unless they talk to you, you can only go on presentation. You do get to know people quickly and you’re also talking to families.
"If someone now offered me a job forever I’d actually feel quite depressed at the prospect of staying in one place."Tweet
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I had to cancel my appointments as a client had taken an overdose
Often people will have had a crisis where they are dealt with relatively quickly by the crisis team and then they are transferred to the community mental health team and we work with them. Some people can be non-compliant and hard to engage with, particularly people with drug problems or experiencing schizophrenia. The crisis teams tend to work with people who are on the brink of suicide, high risk due to psychosis or depression. They have to be active at nights and weekends to deal with crisis whereas our job in the community is more Monday to Friday 9-5. Some placements have laptops that enable you to write up case notes on the go but others you go back to the CMHT office after visits and do your paper-work there.
I spend 80% of my time with patients, caring in the community. There is a lot of paper-work but the most important thing in my role is risk. If someone does commit suicide, however, all my paper-work risk assessments, and care plans have to be in place legally.
I do 4-5 visits a day and most visits are at least an hour, sometimes 2-3 hours. The other day I had to cancel some appointments as one of my clients had taken an overdose so I had to go with her to hospital. It’s like anything, you are trained to respond, like a soldier so you cope well. Often you are working with many of the clients for years because the problems are complex. One of my clients has just experienced their first psychotic episode at 44 so they will be in hospital for a time and then will come out to the community and to the responsibility of the CPN and CMHT. People are only in hospital if they are really, really unwell. Every day is different. You may see a client one day and they appear fine, the next day they might be swearing at you and refusing to see you. Most mentally ill people find it hard to trust, and the biggest skill in this role is to form a rapport and form a therapeutic relationship, allowing change to occur.
The NHS would collapse without agency staff
You have to do mandatory training for your registration with the Nursing and Midwifery Council and of course that was all free in the NHS. I paid to do my training in one go but I hadn’t realised some of the agencies help you out, like Tripod who I am with , they give you money towards training so it’s definitely worth seeing what’s on offer. I’m also a member of the RCN and with that I get £5 million professional indemnity.
I love locuming, I love going into new teams and learning new things. If someone now offered me a job forever I’d actually feel quite depressed at the prospect of staying in one place. If I don’t like a placement – and I always have – but if I don’t, I’m passing through, I don’t have to worry about it. I don’t get involved with the office politics.
As it’s usually 9-5, I’m home by 5.30. I couldn’t go back to permanent work, the money in locum work is too good. The NHS is sinking and it’s getting more and more stressful. The NHS would collapse without agency staff – I talk people into it and encourage them to go locum. People are desperate and need the money. You do have to have a certain personality though and be willing to take a risk and be flexible.
Best thing about being a CPN: You are out in the community, driving around, working autonomously. You have to be good at working on your own, good at assessments and adapt to the environment you are in – you’re seeing people in their own homes and you work autonomously.
Best thing about being a locum CPN: The money. Plus the agencies I work with like Tripod are very good, they are respectful, always available and treat you as an individual. If you have any problems, they try and sort it out for you.
Worse thing about being a locum CPN: You can get a bit anxious towards the end of your contract about where you will be working next and whether you will need to travel. I am willing to travel but prefer to keep my journeys under 25 miles if possible.
The greatest challenge: Wanting to do a good job and feeling satisfied that people are happy. Ensuring all patients are better off when you left than when you arrived and you have made a difference to the patient’s lives.
Advice to someone considering going locum: Go for it – I wish I’d done it sooner. I hadn’t realised but you can take a career break of one year and return to the NHS on the same band or you can take four-five years off and be guaranteed a job when you return, it might not be on the same band. If you want to clear debt or get savings behind you, you can do that and then return if you want to.
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