Acute crises are commonplace in psychiatric wards. Someone suffering from an acute psychiatric episode can put themselves, other patients, and healthcare providers at risk. However, psychiatric nurses with specialized skills are well-equipped to deal with such crises.

When a person’s mental health is fragile, every word, action, or nonverbal cue means a lot, and nurses must be equipped to defuse tension and provide adequate care. The role of the psychiatric nurse in crisis management is dynamic and is different from the role of a psychiatrist.

If you’re deciding between a career as a psychiatric nurse practitioner vs psychiatrist, you’re probably asking, “What’s the difference?” Primarily, psychiatrists take a more pharmacological approach, whereas Psychiatric nurses tend to focus more on holistic care, counseling, and forming close bonds with patients. There is also a difference in education. Spring Arbor University offers psychiatric nurse programs, such as the post-master’s certificate for psychiatric mental health nurse practitioners (PMHNP). This online program provides nursing professionals with the necessary knowledge and skills to assess and manage patients suffering from acute crises by testing, prescribing, and administering medications that can help patients improve.

PMHNPs are usually the first practitioners to interact with patients, build rapport, conduct assessments, and initiate safety measures while operating in a high-stakes and emotionally charged environment. Below are five essential skills for psychiatric nurses.

Five skills psychiatric nurses must have while working on acute cases

Nurses are often at the front line of medical cases, and the following skills are essential in emotionally charged environments.

Rapid risk assessment

Rapid risk assessment is the quick and comprehensive analysis of a patient’s current condition. Rapid risk assessment helps the nurse gauge any immediate dangers the patient can pose over themselves or others. These include self-harm, aggression toward others, or elopement (leaving a facility without notice or medical clearance).

For example, a patient pacing back and forth in the common area, mumbling unintelligibly, and clutching their head, are examples of behaviors that might be of concern to a nurse. When a patient is displaying such behavior, a nurse must assess whether this behavior indicates a risk of aggression or another crisis.

The failure to conduct a rapid risk assessment means the nurse has compromised their duty. Depending on the case, it may lead to devastating consequences such as self-inflicted injuries or harm to other patients or staff. For example, if a nurse doesn’t promptly assess and recognize early signs of aggression in a patient, the situation might escalate into a violent outburst, causing the patient to injure themselves or others.

Now, how can nurses develop this skill? First, by taking specialized training that focuses on rapid risk assessment strategies. This exposes nurses to case studies and gives them an opportunity to practice their responses in crises. Nurses can also consult experienced colleagues and supervisors on campus to learn from their experience. Experienced staff can share details of cases they have worked on and challenges they have faced. Trainee nurses can learn from these experiences and implement the teachings in their own careers.

De-escalation techniques

De-escalation techniques are a set of verbal and non-verbal cues designed to calm down a potentially harmful situation. Nurses can use these techniques to help reduce anxiety, aggression, or other disruptive behaviors by connecting with patients and creating a safe space for them.

For example, imagine a patient screaming aggressively at another patient. Rather than respond or scream back at them a nurse would approach and speak calmly. They might call the patient’s name, use open body language to tell them they’re okay (or anything they need to hear at that moment), and cater to their immediate needs. While a nurse’s response may not mitigate the crisis, it can help the patient feel seen as it redirects their focus and allows them to feel safe and secure.

Why are de-escalation techniques essential? Effective de-escalation helps achieve patient and staff safety by preventing any slight issue from escalating. It works to avoid physical altercations between patients and between patients and staff. It can also prevent self-harm or the need for physical or chemical restraints. Physical and chemical restraint is a last resort solution and is best avoided due to potential adverse consequences for the patient’s well-being and therapeutic progress.

How can nurses develop this skill? It takes years of experience to predict what patients want to hear, see, or know when they’re having an outburst. However, nurses can understand how to navigate these situations by attending workshops focusing on crisis intervention and de-escalation in mental health settings. They can also learn more by listening to the experiences of experts, especially those with active social media channels dedicated to the discussion. In addition to these, a nurse’s time at a clinical placement can expose them to valuable insights that will shape their careers.

Clinical judgment

Sometimes, there is no blueprint to handle certain situations in a psychiatric hospital. Nurses must possess the cognitive ability to evaluate complex healthcare situations and make decisions accordingly. This involves synthesizing information from multiple sources to arrive at a reasonable conclusion and action plan. These “sources” could be insights from a patient’s behavior and clinical history, and environmental cues.

Using these multiple sources is important in high-pressure situations where a slight mistake can have life-threatening consequences. For instance, if a patient with a history of bipolar disorder suddenly becomes hyper verbal and grandiose in behavior, a nurse experienced in handling patient-psychiatric relationships will assess the patient’s commitment to medication, evaluate the patient’s sleep patterns, and consider any recent life stressors. Based on these insights, they would decide whether the patient needs medication adjustment, closer monitoring, or even hospitalization.

This form of holistic assessment helps identify the best course of action in emergencies. Nurses must understand that poor clinical judgment can endanger a patient’s health when you delay essential intervention. So, how can nurses develop this ability?

First, they must deepen their knowledge base by studying different psychiatric disorders and treatments. Being well-informed provides a foundation for making sound decisions. Also, they should put themselves in places where they’ll gain more clinical experience, as this increases their chances of making accurate assessments. To put it simply, the more knowledge and experience of clinical practice a person has, the better. To supplement this, nurses can learn from senior healthcare providers who have honed their clinical judgment over years of practice. Their insights can provide invaluable shortcuts to effective decision-making.

Emotional regulation

Emotional regulation is managing and controlling emotional responses in high-stress situations. As earlier referred, psychiatric hospitals are often high-stress and high-stakes places, but a nurse’s calm demeanor, patience, and restraining impulses can go a long way in calming provocative behaviors from patients.

For example, a patient verbally abusing a nurse expects an extreme reaction from that nurse. The nurse needs to maintain their emotional composure and respond professionally. This way, the patient’s comments do not affect the nurse’s ability to provide adequate care. After all, most patients in psychiatric wards don’t mean what they say when they insult or demean someone else.

Why is this level of emotional regulation necessary? It’s simple: a nurse’s ability to regulate their emotions directly impacts the quality of care. Losing emotional control could escalate conflicts or impair the nurse’s ability to perform essential tasks.

For context, when a nurse becomes visibly upset during a crisis, they can transfer emotions or escalate an already tense situation. This may cause the nurse to lose control and eventually compromise the health or recovery process of the client.

How can nurses learn to be more emotionally restrained? One way is through mindfulness training. These trainings provide techniques that help nurses become aware of their emotional states and how they could influence their actions. Nurses can also engage in stress-management workshops. Participating in these can help a person uncover how to handle the pressures of nursing through deep breathing exercises and cognitive reframing techniques.

Situational awareness

It’s one thing for a nurse to be educated in the profession. It’s another thing for them to be able to read the room and make decisions based on what they see, hear, or feel.

Situational awareness is the ability to perceive and understand the elements in the environment. In psychiatric nursing, it means being conscious of the patient’s behaviors, emotions, and words – in other words, empathy. It also means being aware of factors such as room layout, security, and exit locations.

For example, if a nurse is in a patient’s room, they must consider the patient’s emotional state, the positioning of the furniture (if any), and look for sharp objects within reach. Nurses should even look out for the quickest exit route. Doing this sort of 360 assessment helps nurses understand the patient’s body language and decide whether they need to be monitored.

This is important because psychiatric cases are vulnerable cases. Nurses must be highly aware to identify potential risks or opportunities for intervention before any issue escalates. This proactive approach can lead to effective action that prevents harm.

Nurses can develop their situational awareness by learning to scan the environment to quickly see potential hazards. They can also engage in mindfulness practices to enhance their ability to focus and sense of awareness. This can make it easy to pick up on the details of situations, make mental notes, and react when necessary.


The acute psychiatric crises nurses face are not mere hurdles. They’re profound moments that can reshape a patient’s life trajectory. As such, nurses must understand how to perform rapid risk assessment, de-escalate tensions, build strong clinical judgment, and learn to control their emotions. These skills can help nurses excel in this essential profession and ensure patient safety with ease.