Nursing 1984 - Year 1 of my Training

ID CardI started my psychiatric nursing training in April 1984, in a class of about thirty students. There were seven males at first, but that soon shortened to six (three Davids, two Marcs and one Mike). On my first day, I wore my best approximation of a nurse's uniform, which must have amused my new colleagues no end. However, they were far too polite to comment to my face.

I was 17 years old, totally naive. I really had no idea what I had let myself in for. For one thing, I didn't realise that being a psychiatric nurse would actually require me to have medical skills. I was mortified when I found out that in our first three months we would be learning such things as how to give injections and enemas. Had I known any of this I probably wouldn't have applied for this training in the first place. But now that I was there, I was determined to see it through.

Our first year was to consist largely of "general nursing" training, that is: anatomy & physiology, basic medical and nursing procedures, etc. We would also be loading up on psychology and psychiatric theory, but have only limited practical experience in these areas.

I was immediately fascinated with psychiatry. I quickly realised that, like most people, I was totally ignorant about mental disorders. The first thing I learnt was to unlearn everything I thought I knew about madness.

My first placement was Ward 9, male psychogeriatric. Senility in all it's miserable stages. Old people, largely forgotten or hidden away to hide the painful fact that they were still alive.

There were two main living areas. The first was a carpeted lounge, visible from the road and the ward reception area. This was for patients who were still fairly presentable and able to interact with others. Working here was pleasant enough -- the old guys co-operated when being shaved, went to the toilet when reminded and participated in simple activities. I must admit that I wasn't completely supportive of the staff's obsession with these activities. Every single patient who was sufficiently able, was hounded into joining the daily quiz sessions and bingo rounds. There was a constant drive to keep their minds active. Fair enough, but I thought that maybe sometimes they might just prefer to have a day off.

The second lounge was more discreetly located near the rear of the building and required a nurse escort to enter, not that it often received visitors. This room housed residents who were in the advanced stages of dementia, seated in rows of vinyl chairs amid the competing odours of urine and air freshener. This was a tragic place.

I remember Graham. Like most other patients, I found it hard to think of him any other way than a collapsing body whose soul had long since departed. For me he was a nondescript chore in a list of chores. That is, until I read his history notes one day during my lunch break and discovered that he had been a very successful academic author with an impressive career and fascinating life. Being able to attach this persona to the body gave me a completely new perspective. Now here he was, alone, staring 12 hours a day at a wall, helpless even to tend to his own ablutions. From that day on, wherever practical, I made a point of reading the history of every patient I cared for.

Then came Ward 16, home to the charmingly-named "multi-handicapped patients" (people with both intellectual and physical disabilities). This ward was mostly children and young adults, because patients who fit this category don't usually survive long into adulthood.

I'll write more about ward 16 later.

Ward 2 was something else altogether. If there was a place in the hospital which bore any resemblance to the environment of "One Flew Over The Cuckoo's Nest", then this would have been it. It was classified as a "forensic psychiatric" ward, which basically meant a secure facility for patients who had been confined for legal reasons. The atmosphere was more one of a prison than a hospital - in fact many staff, as well as patients, had migrated here from nearby Waikeria Prison. Apparently Waikeria inmates referred to Tokanui as "Club Med", and it was a popular scam to fake madness in order to be transferred. As a rule, though, Ward Two patients were genuinely very mad indeed.

Females weren't allowed to work in Ward Two, and technically neither were first year students. It was only staff shortages which resulted in me being assigned there so early in my training. When I first arrived for duty, the charge nurse rang the area supervisor and complained about me - but it wasn't about my lack of experience, it was about my lack of bulk. As he was talking on the phone, he looked at me and said "I don't know if this guy will be able to look after himself." Obviously I was too weedy to be able to survive here. However, there was no choice in the matter and I began my time.

I certainly was out of place in this ward team - the rest of the staff were gorillas. Apparently gigantism was a prerequisite for working in forensics, and at just over 60kg I was sadly under-qualified.

More important than physical stature, though, was my difficulty with the ward philosophy. This was "Old School" territory, where a firm hand was seen as only way to control patients - and control was the name of the game. It was us versus them. When accepting a new admission to this ward, the procedure was straightforward: Lay down the law in no uncertain terms, and make them understand that we don't take shit from anyone here. Virtually all new admissions were confined to a "side-room" (a small, bare isolation cell) for the first 24 hours. If anyone showed any violent tendencies, they risked being shown the error of their ways with a quick, discreet beating.

To be fair, there are two ways of looking at this situation. It was an outrageously difficult environment to work in. There really is no way to describe the feeling of being in a side-room with a violent six-foot lunatic. Psychotic people often show super-human strength. It's no exaggeration to say that four or five big men would often struggle to pin down one person. In these situations, four of us would take a limb each and lie on the patient, leaving one person to administer the sedative by intra-muscular injection. As the smallest person, it would usually be my job to give the injection. This was a frightening task, as the patient would be would be lurching about like a man-sized fish out of water.

Madness can induce people into extreme acts of violence with no warning whatsoever. It was a constant concern and a great source of stress for both patients and nurses. One of the problems was the volatile mix of people living together in close quarters, from those with intellectual handicaps to those with paranoid delusions. Imagine being paranoid, terrified that your life is in danger, then finding yourself in a place like Ward 2. It just wouldn't be helpful.

The daily routine would include sitting in the day-room with perhaps thirty or forty patients, with three or four staff, for hours on end. Some would be watching TV, some would be playing table tennis, some would be quietly simmering in their psychosis. Most people sat in arm chairs with backs placed firmly against the wall, in a huge square around the edge of the room (it was unwise to leave your back exposed in Ward Two). Every now and then, out of the blue, someone would stand up and attack their neighbour. Sometimes a melee would ensue and anarchy would reign until backup arrived, sometimes nobody except the staff would bat an eyelid.


I recall being horrified when a patient declared on his admission form that he smoked a joint every day. My reaction demonstrated to the rest of the ward staff just how naive I was.

I was also stunned to learn of the level of drug use and abuse amongst my co-workers. Sometimes it seemed that every second nurse smoked pot, including many in senior positions. I came across some student nurses who were regularly shooting up, and one told me how she could not face daily life in the wards without a joint to relax her. I had worked in this environment for some time without being aware of any of this.