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| Group | Theme | Subtheme | Illustrative quotations |
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| Administrators | (1) Recruitment challenges led to a focus on retention | (a) Recruitment was challenging but slightly improving | (i) “We’ve had three offers out waiting on two, one has accepted so we are now seeing folks coming and wanting to come into behavioral health.” |
| (ii) “I’d say about 2 months ago…we started to see a lot of applications had quite a few new hires, 6–8 months prior to that, it was like, okay, is everything in there [application site] right?” |
| (b) Focus on retention | (i) “We have another process that if a staff is injured, we follow up with them and several people involved in that and really doing a dive into supporting them through that process, and I think all of that has been helpful for retention.” |
| (ii) “Everybody else is doing increasing wages and doing retention bonuses and all those types of things.” |
| (2) Ongoing processes and support for nurses | (a) Varied and individualized onboarding process | (i) “…so we make sure that we’re talking about more experiences that the orientee needs to have. Are there areas that we need to reinforce, areas that are going well, those type of things so we can keep tailoring it to the needs of the person…” |
| (b) Ongoing formal/informal support provided | (i) “So we have a policy on workplace violence, and we put a lot of effort around staff doing incident reports, if they’re witnessing it or if it’s happening and to come forward, there’s an anonymous way to report it.” |
| (ii) “We have that stress first aid program, and then we utilize EAP quite a bit…” |
| (3) Needed support for nurses and the profession | | (i) “…we brought in individuals who were trained in crisis intervention, how to deal with a violent episode to kind of work through those feeling…I think the ability to have a 911 [emergency] support person to come in and triage, that would be great.” |
| (ii) “…keep working on getting started in high schools and getting kids interested in mental health.” |
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| Nurses | (1) Experience and challenges of their profession | (a) Benefits of the profession | (i) “It’s just very rewarding watching people recover from a very, very dark place and just seeing that personal growth and self-discovery.” |
| (ii) “…one person can have an impact on one other person, and if you can be that person and have an impact and totally change their life.” |
| (b) Challenges of the field | (i) “I’ve worked in some places that have been really unsafe where staff are getting seriously injured or patients are getting injured…and I'm not willing to work in a unit or a facility that has those core safety concerns.” |
| (ii) “I’ve definitely seen a lot of conflict between disciplines and roles when it comes to this career field and my first job there was a lot of conflict because our techs were high school diploma or GED techs, and there was challenges with that. And then my second job, all of our techs had to have at least a bachelor’s degree in a related field so that improved a lot of the morale and decreased a lot of the conflict.” |
| (2) Sources of current support (formal, informal, and self-care activities) | | (i) “That's where I learned most of my stuff is from veteran nurses who have been through it, and so venting to them after a situation like this really is helpful to me and to get their support and feedback about what happens.” |
| (ii) “I would say I’m having more phone conversations with people to let some of that out, whereas, you know it used to be face to face, but now it’s more on the phone.” |
| (3) Need for additional support | | (i) “We need to find courage from each other. So, if we just had a little more support, I believe the emotional stuff we go through would be beneficial.” |
| (ii) “…but also maybe Q&A would be the right word, for people to just talk with other psych nurses, ask the questions they have or definitely like I’ve already said, I would love to be a preceptor.” |
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| Students | (1) Mental health experience | (a) Previous/current work and personal experience | (i) “I feel like we’ve gotten to see a good variety of psychiatric diseases and mental health disorders and all of that just on like Med Surg floors and everything.” |
| (ii) “I specifically work at [a rehabilitation facility] and so by working there I feel like I get to work a lot not just in behavioral health but also like helping patients with their physical health…” |
| (b) Clinical experience | (i) “So we got to observe quite a few mental status exams, a lot of therapeutic communication and trying to de-escalate situation as well as…their daily routine…the nurses were kind of spread thin so were in the way a lot trying to help them…” |
| (2) Concerns about the PMH specialty | | (i) “I’ve been hearing it…just [students] thinking it’s all violent patients but it’s not. I think that’s a big thing that worries some people.” |
| (ii) “I also said that my biggest concern is safety.” |
| (3) Desire to know more about and interest in psychiatric nursing | | (i) “They (nurses) sit in with the doctor, with the patients, and kind of talk about what’s going on. We haven’t had the opportunity to attend those meetings yet and I kind of would like to. I think it would be interesting to hear about and observe how those meetings [go]…” |
| (ii) “I really wish we would be able to follow those nurses on the psych unit…on a nursing standpoint, we’re not getting anything really, truly productive out of it.” |
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