Rethinking nurses' observations: psychiatric nursing skills and invisibility in an acute inpatient setting

In sociological, managerial and clinical investigations of psychiatric nursing, the skills of observing patients are compared unfavourably with nurses' ability to listen, to interview and to engage with patients. This paper examines how nurses in an acute psychiatry unit used observation as a significant part of their everyday assessments of patients, through a working shift. We argue that the knowledge generated in observations is essential to the nurses' gaze in this setting. Based on an ethnographic study of the assessment practices of 11 psychiatric nurses and the first author in an Australian hospital setting, we found that nurses' observations of patients were rich in situated assessment detail and a powerful strategy for producing civil conduct among patients. In particular, we noted how nurses deliberately obscured their practice of observation, in order not to provoke patients. While such discreet practice is productive for everyday clinical work, the invisibility of nursing observations undermines the status of acute inpatient psychiatric nurses. Devaluing of tacit practice may encourage experienced nurses to leave inpatient units, at a time when hospitals struggle to address nursing shortages worldwide. We recommend instead that the productive value of diverse and situated practices be investigated and articulated.