Study participants were 27 nurses from three referral hospitals in Iran. Their age mean was 8.1 years. Most participants were female (fourteen participants), had bachelor’s degree (21 participants), and worked in acute care wards (twenty participants).
Participants’ experiences of the causes of their LOI in working in psychiatric wards were grouped into eight subcategories and three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitudes towards psychiatric nurses, and concerns over patients (Table 2).
Table 2
The subcategories and categories of the study
Subcategories | Categories |
Forced choice of working in psychiatric wards | Inadequate professional skills for psychiatric care practice |
Inappropriate work conditions |
Lack of the required professional knowledge for working in psychiatric wards |
Colleagues’ negative attitudes towards psychiatric nurses | Negative public attitude towards psychiatric nurses |
Families’ negative attitudes towards psychiatric nurses |
Negative experiences of psychiatric nursing from their studentship period |
Fear over patient assault | Concerns over patients |
Fear due to unfamiliarity with patients and their conditions |
1. Inadequate professional skills for psychiatric care practice
Inadequate professional skills for psychiatric care practice was one of the main causes of LOI among participants. Participants noted that they were not ready enough for psychiatric care practice when starting their work in psychiatric wards and had chosen this work because they had no more option. They considered work in psychiatric wards to be harder than work in other hospital wards due to factors such as insignificant patient recovery, limited readiness for work, and finding no pleasure at work. The subcategories of this category were forced choice of working in psychiatric wards, inappropriate work conditions, and lack of the necessary professional knowledge for working in psychiatric wards.
1.1. Forced choice of working in psychiatric wards
Most participants reported that they were compelled to work in psychiatric wards due to their own physical problems, heavy workload in other wards, or nursing staff shortage in psychiatric wards. Some of them also noted that they chose to work in psychiatric wards due to its advantages such as lower working hours, earlier retirement, no night shift, and more leaves.
I had undergone a surgery and my doctor had emphasized that I shouldn’t work in infectious diseases wards. Therefore, I chose psychiatric care practice, stayed in it, and couldn’t change it. I chose it without any interest (P. 19; a male nurse with a ten-year work experience).
1.2. Inappropriate work conditions
Participants reported that they had limited interest in working in psychiatric wards due to repetitious nature of work in these wards, limited patient recovery, patients’ frequent re-hospitalizations, their own limited readiness for psychiatric care practice, and subsequent considerable occupational strain. They also noted that their unfamiliarity with working in psychiatric wards, management of patients with psychiatric disorders, and medication administration contributed to their LOI for working in these wards.
I cried a lot the first day I came here. I didn’t like to be here. Patients with psychiatric disorders never achieve complete recovery. We don’t have a pleasant feeling of nursing practice here; I mean a feeling that results from patient recovery (P. 16; a female nurse with a seven-year work experience).
1.3. Lack of the necessary professional knowledge for working in psychiatric wards
Participants reported that nurses in psychiatric wards have lower levels of professional knowledge compared with nurses in other hospital wards. They also referred to wide theory-practice gap in psychiatric wards and described these wards as wards with repetitious patients and limited range of diagnoses. Accordingly, they noted that they had limited interest in work, had fallen behind their colleagues in other wards respecting professional competence, and had been fossilized.
I didn’t have any interest in working in this ward because working in this ward lowers your professional level and knowledge. Repetitive tasks in these wards have resulted in rote learning and routine practice. When you stop doing these routine tasks for a while, you easily forget them. I know that I have fallen behind my peers in other wards (P. 14; a female nurse with a seventeen-year work experience).
2. Negative public attitudes towards psychiatric nurses
Negative public attitudes towards psychiatric nurses was another main cause of LOI in working in psychiatric wards. Participants noted that people, including their family members and relatives, have misconceptions and negative images about working in psychiatric hospitals and hence, psychiatric nurses feel compelled to hide the name of their workplace from others despite several years of work experience in psychiatric wards. They reported family members’ and colleagues’ negative attitudes towards psychiatric nursing and their own past experiences during their university education as causes of their LOI in working in psychiatric wards. The subcategories of this category were colleagues’ negative attitudes towards psychiatric nurses, families’ negative attitudes towards psychiatric nurses, and negative experiences of psychiatric nursing from their studentship period.
2.1. Colleagues’ negative attitudes towards psychiatric nurses
Participants reported that their colleagues in other hospital wards had negative attitudes towards psychiatric nurses, asked them to change their workplace, and had asked them not to choose working in psychiatric settings at the time of employment. These factors had negatively affected their interest in working in psychiatric wards.
Previously, I was in another hospital. When I successfully passed the employment exam, a nurse asked me whether I could change my workplace. It greatly disappointed me (P. 24; a female nurse with a fourteen-year work experience).
2.2. Families’ negative attitudes towards psychiatric nurses
Participants noted that their family members and significant others had negative attitudes towards psychiatric nurses and did not have accurate understanding about psychiatric hospitals and patients. Therefore, our participants attempted to hide the name of their workplace from others. Family members’ negative attitudes had negatively affected their mood, caused them preoccupation with their work, and reduced their interest for work. They reported that their significant others considered psychiatric hospitals as a place for keeping patients rather than as medical centers and believed that patients in these centers were in chain.
I had no interest for working in psychiatric ward. I feel whatever I explain to my significant others, they don’t understand and just say that I work in madhouse (P. 17; a female nurse with a two-year work experience).
2.3. Negative experiences of psychiatric nursing from their studentship period
Participants noted that they had negative experiences and image of psychiatric nursing from their studentship period and hence, were not interested in working in psychiatric wards. Some of them reported that they had experienced patient assault during their studentship in psychiatric wards.
I didn’t like psychiatric wards from my studentship period because studentship in these wards had greatly affected me. Those days, I thought to myself that I would never choose working in psychiatric wards (P. 21; a female nurse with a six-year work experience).
3. Concerns over patients
Fear over patient assault and unfamiliarity with patients were also among the causes of participants’ LOI in working in psychiatric wards. They noted that due to the negative attitudes of their friends, colleagues, and significant others towards patients with psychiatric disorders, they felt fear when they heard the expression “patients with psychiatric disorders” at the time of starting their work in psychiatric wards, attempted not to get close to them, and had anxiety over working in psychiatric wards. The two subcategories of this category were fear over patient assault and fear due to unfamiliarity with patients and their conditions.
3.1. Fear over patient assault
Participants had fear over patient assault because they believed that patients with psychiatric disorders might become irritable and aggressive. They were mostly concerned with assault by patients with schizophrenia due to their delusions and hallucinations, patients with paranoia, and physically strong patients. Such fear was a major cause for their LOI in working in psychiatric wards.
I didn’t like to work here due to my fear over patient irritability. Patients with psychiatric disorders may suddenly become irritable and aggressive and attack you. I had fear over injury to myself (P. 24; a female nurse with a fourteen-year work experience who worked in men’s psychiatric ward).
3.2. Fear due to unfamiliarity with patients and their conditions
Participants expressed that they were not interested in working in psychiatric wards due to their unfamiliarity with patients with psychiatric disorders and their unique characteristics. They were not familiar with these patients and their symptoms and hence, felt fear when witnessed conditions such as panic attacks. They noted that they did not know how to manage unfamiliar conditions and hence, experienced high levels of stress.
In the first days, I had no knowledge about these patients and their problems and hence, I feared them and didn’t want to work in this ward (P. 21; a female nurse with a six-year work experience).