When you reach that point of "Yeah, no."

[rumwynnieRN]

I want to preface this post with the following: I know I'm very much a new grad (graduated last December), and I'm happy to have a job. I'm happy I have an RN job, and my coworkers are amazing who guide me through making decisions which help get me out of nursing school mode. I have been at this job for almost three months, and it's definitely getting my feet wet. I have an easier time speaking to doctors and giving report (and receiving), though I still have quite a way to go before getting to my coworkers' level.

All of the previous said, I'm trying to find another position at another hospital. I never liked psych nursing in school, but as this was the only place out of 5 places to offer me a position, I took it. This experience isn't a waste, and I was fully aware a lot of people don't get their dream jobs after nursing school (I actually wanted a night shift medsurg position, but I'm guessing I just sucked at my other interviews, or maybe there was just a better candidate), but earlier this week, something happened that has left me a little shaken. A patient with a dx of psychosis NOS had been stable since said patient's admission a few weeks ago (said patient was hitting a few people at said patient's nursing home). We had gotten this pt's behavior (poor impulse control with a bunch of other things) to calm down, and said patient was actually pretty pleasant after a while.

(I apologize for the lack of pronouns, but I would like to keep this patient's confidence as much as possible.)

I heard over the weekend said patient (SP) was rushed to the ICU for choking. When SP returned, SP's previous symptoms came back. The first day I cared for SP, SP threw magazines at me and punched me in the stomach (the punch wasn't hard). I heard in report SP slapped one of the attendings and knocked his glasses off. The attending's response was, "I don't have to listen to your lungs, and when you're medicated, I'll come back. Your behavior is inappropriate."

Fast forward to SP's discharge, I needed SP to sign some papers. I should've known better (I thought I had given myself enough space, and next time I'm giving him a crayon to sign papers), and SP with my pen almost stabbed me. SP got a punch in and started laughing. SP apologized for it before leaving.

I work on a gero psych unit, and the overwhelming majority of our patients have dementia of some time. A lot of their behaviors, I can put up with, but this particular behavior, I'm not sure. My manager pulled me aside because I reacted a bit loudly (it caught me by surprise), which I'm really grateful for. Of course, as SP had her in a headlock the day before and almost punched her while she was trying to keep one of our techs from getting hurt, that might've been why she didn't chew me out.

I'm wondering if I should wait out the year before finding another job or be more aggressive about finding a new job now.

Oh, and to the experienced psych nurses: how do you deal with these types of patients? To my knowledge, SP owned his/herself. Do you just forget the signature? give them a stamp?

[oceanblue52]

I just started Nursing school but have been working in Psych as a Tech for two years. Patient aggression is very scary and, despite how well you are trained to manage escalating aggression, there is always still a risk. It can never hurt to apply for other jobs IMHO, Psych is not for everyone and I would hope other hiring managers would understand that, especially if you can pick out the positive experiences you've had. You could always stay PRN to enhance your resume if you take another job...

The best suggestion I have for avoiding future situations like the one above is to try and pull another staff member aside to back you up if physical intervention is needed; that is, if staffing levels and policy permits it. This is especially prudent if you are aware of the patients prior history of acting out. I wish I had other advice to give!

[Underoo]

I work in Med/Surg and more often than I'd like, I have contact with patients who act like your SP, whether it be from dementia or substance abuse (usually substance withdrawals unfortunately). I had never experienced that behavior until I moved to a larger city where drugs and alcohol are more prevalent. You're going to find psych issues in every aspect of nursing. I hated L&D and post-partum in school due to the crazy drama. Psych as a specialty is absolutely not for me either. I would think community nursing would also have it's strange encounters as well. If you're really unhappy, don't torture yourself. Yes you're a new nurse, but that doesn't mean it's okay for you to be in those kinds of situations. Start applying for other things!! You should probably get a year or two of Med/Surg because that's the foundation for everything and will get you anywhere. Also Med/Surg is like a casserole.. there's a little bit of everything there. You'll be more likely to find your niche there. You'll probably have days that you hate, but at least not every single patient will have psych issues. Good luck! Hang in there, don't give up yet. :)

[katynurs22]

Wow, :/ well you should be proud of what you have learned and put up with so far, i wouldn't be able to last more 3 days on a psych unit. I'll just tell you that in Med/surg you will encounter some patients that will be transferred from psych facilities due to medical conditions that cannot be treated in their own facility. I had some combative patients, most had restraint orders. I once had a pt that overdosed on THC, was combative, and spoke in tongues to me. And one time I was chased by a delusional patient who thought I was ought to get her when I tried to get a blood sugar on her. She threatened to kill me. Thank God we had Security , they got her back in the room. It was close to change of shift , so I didn't have deal with her any longer.

I was only in med/surg for 10months, I would say keep looking for other job opportunities, I think HR and manager would understand where you are coming from. In the city where I live we have many psych facilities, one is very prestigious and expensive, mostly for people who have anxiety, OCD's, professional in crisis, but it is a laid back environment (for a psych facility). I did a clinical there, and the nurses where pretty satisfied with their jobs.

[rumwynnieRN]

I appreciate the responses from everyone. I have been looking at other jobs at other facilities, and some of my more experienced coworkers (save for my manager) are aware I'm looking for other positions. My nursing instructors said to wait out a year before moving, except I don't think I can do this for a year -_-;.

[carolinapooh, BSN, RN]

God bless you for even trying. I mean that sincerely.

[Lucky724]

I am not sure where this "have to work a job for a year" idea comes from..I guess to some it would look better BUT this is a job you don't like, sounds dangerous and you staying is doing nothing for you in regards to what you want to do and if you are able to find another job you open the position you are in for someone else - who may view your job as their dream job.

I can sympathize with you - several years ago I took a job working in a Gero Psych unit that is hospital based. It was a new unit and was a disaster - at least for me. I left in 3 months and have not regretted it. I admire the nurses and aides that work in this area - it takes a lot more than people realize and in my opinion was much more difficult than working Med/Surg or ICU because the instability of the patients and with them being geriatric made for a whole other stress level.

[nrsang97, BSN, RN]

You have done 3 months and hate it. I see no problem trying to find another position. Don't quit until you have another job lined up. Life is too short to be unhappy.

I tip my hat to anyone who can work psych. I just didn't like it.

[MatrixRn]

The first nursing job out of school is often a shock to new nurses. I know mine was to me.

My first job was on Med surg working nights. We averaged 12 patients per shift. It did not matter - sane, crazy or how acute that is what we got.

On one of my first nights post orientation I had 12 patients - 2 on vents. I just walked out of one my vented patients rooms to find one of my other patients - who broke lose from his restraints- walking down the hall yelling "I want to go home", while blood ran down his leg from the cath that was just pulled out. This person had a history of violence so was corralled by me until security could restrain him.

Why did I tell this small story? One to let you know that no matter the floor you go to you will need to learn skills to manage patients who are having difficulties -whether it be dementia, withdrawal, oxygen deprivation or whatever. Leaving psych will not let you off the hook. Sorry about that.

And two, to offer my advice and that would be to hook up to an experienced psych nurse in your remaining days there to watch and learn what she does. I really wish I had seen a great psych nurse in action with patients who had displayed behaviors prior to being cut lose on the other floors.

[nurseprnRN, BSN, RN]

Have you thought about moving this discussion to the psych nursing area? They might be better able to answer some of your questions. They are great over there. You can ask the mods to do that for you.

Me, I think you're doing well.