Julia Houfek, PhD, APRN-CNS
Professor, College of Nursing, University of Nebraska Medical Center
How long have you been a nurse, and how long have you worked at UNMC CON?
I started working at UNMC in 1972 when I graduated from my BSN program. I also became a student in the College of Nursing masters program in Psychiatric Mental Health Nursing, graduated from this program in 1975, and then taught Psychiatric Mental Health Nursing at the Lincoln Division of UNMC College of Nursing. I taught in the Lincoln Division until 1981, when I began doctoral study at the University of Texas at Austin. I returned to the College of Nursing in Omaha in 1990. So, I have been a psychiatric mental health nurse for about 45 years.
What have you enjoyed most about your work?
I have enjoyed all aspects of my work. I was drawn to academia from the beginning of my career because of the diversity of the university’s mission: teaching, practice and research/service. During my career, I have had the opportunity to contribute to developing both registered and advanced degree nurses who can provide quality psychiatric mental health nursing care. I also have been able to contribute to the research, practice and service missions, with various degrees of emphasis over the course of my career.
My research focus has been in the area of health promotion and disease prevention, specifically how a person’s perceptions of their illness or problem affects the way they try to cope with their illness, whether this is managing their treatment, adhering to the “prescribed” care, or coping with the effects of their illness on their everyday life. Because nursing is focused on holistic care of individuals and their families, we have much to contribute to self-care management. I have always been interested in how individuals perceive their situation, whether they are coping with a mental health or physical health problem or both. Recently, I have been focusing more on how the profession needs to use our evidence-based knowledge to affect healthcare policy, particularly with regard to psychiatric care and developing the psychiatric nursing workforce.
Why is it important to educate nurses about behavioral health?
When I first became a psychiatric mental health nurse, I remember reading that the psychiatric nursing specialty was the smallest number of the number of nurses practicing psychiatric mental health nursing. I believe this is still accurate. Psychiatric Nurses comprise only about five percent of the nurse practitioner workforce.
Over the years, we are more aware of the need to diagnose and treat mental health problems early, and more patients are seeking mental health care in primary care as well as specialty care. Psychiatry as a specialty recognizes the need to integrate behavioral health care into primary and other specialty care. So it is important for all nurses, those who practice at the generalist level and advanced practice nurses in all nursing specialties, to have effective communication skills to help patients and their families express their needs and find appropriate treatments or help for their mental health problems or issues. Early identification of a mental health problem (e.g., depression or substance misuse) by all nurses, and then providing appropriate interventions or referring to a psychiatric specialist can decrease suffering and improve the quality of life for patients and their families. Certainly, we have better treatments available than ever before, both medication and psychotherapy, which we need to deliver effectively and efficiently.
One of the areas that psychiatric mental health nursing has traditionally emphasized during nursing education is self-awareness about the nurses’ role in the therapeutic nurse-patient relationship, how the nurse affects the patient and their situation and vice-versa. With the acuity of patients seeking care and our fast-paced healthcare system, self-awareness is critical knowledge for the psychiatric mental health nurse. It not only helps assure quality patient care, but also self-care of the provider, which is essential for a strong and healthy psychiatric mental health nursing workforce. I have tried to emphasize the importance of students’ developing self-awareness in my teaching.
What advice would you give to students interested in psychiatric nursing?
I think students really have to like the patients and the specialty content and skills as well as the day-to-day work involved in psychiatric mental health care if they are considering commitment to the psychiatric mental health specialty. Sometimes students have an “ah-ha moment” when they know the specialty is the “right” one for them. They are “drawn” to the specialty in some way.
For others, the specialty is the last one they believe they would like, but after having the course content and clinical experience in their undergraduate program, they find they really like the patients, content and practice more than other specialty practice or are at least willing to work in the specialty.
So I think there are several “paths” to psychiatric mental health nursing, and several subspecialties in which providers can focus. Importantly, though, there needs to be an “attraction” to the specialty, which will help with motivation, perseverance, and commitment, even when success is not easily attained or their practice, research or service experiences are not going as well as expected.
What are your plans in retirement?
Good question! I plan to continue my research activities. Some of my doctoral students who have graduated are working on manuscripts for publication from their research, so I will be part of this work as well as get my own research into print for dissemination.
Finally, I plan to continue some of my activities on BHECN’s Psychiatric Nursing Summit Committee and other BHECN workforce committees. These activities will keep me professionally active, which is my goal, yet give me more free time to spend with family and friends.