[seabiscuitRN]

I worked as an LPN in psych for a year before graduating as an RN. Then I worked med/tele. I learned a lot, got really good at IV starts, piggybacks, blood tx, hep drips, etc. But I missed psych, so I came back. I'm glad I had that expereince in tele; I feel like it gave me a background -sort of a little boost- to be a better psych nurse. It's nice to know that if one of my pts crashes, I know what to assess and how to manage a medically-unstable pt.

But that's what worked for me, not what should work for somebody else.

I work with some awesome psych nurses who (by their own admission) don't have any medical skills. Some of them are happy, some of them gripe about it.
We had a pt with a PICC and nobody heparinized it after IVPB abx because in their 20 years of nursing, they'd never worked with a PICC. We had a pt who needed blood and the nurses didn't know they were supposed to be doing anything different than a normal IV fluid and so the pt ID/blood band didn't get checked at the bedside and nobody did frequent vs. We had a pt get IV mag and nobody did any kind of cardiac assessment, muchless tele or an EKG. But things like that don't happen because of a lack of medical experience, it happened because the nurses pracitced outside of their knowledge/skill base.

If you work psych for a few (or many) years and then go medical, you can re-learn your skills. You can re-learn the medical knowledge like labs and heart caths or hip bolsters. You can figure out how to manage a load of medical pts.

But keep in mind that some facilites require medical experience prior to working psych.

Most importantly, do what you feel is best for you and your career, and try not to base your choice on what worked well for somebody else.

[aloevera]

I don't want to do all the med-surg stuff anymore !!!!! I love psych and am still using our basic skills plus some added psych skills as well...sure, we still do draws, EKG's, wound care, foleys, etc. but I wouldn't and couldn't go back to a med-surg setting ever !!!

[seabiscuitRN]

One of the RNs I work with told me that after a few years of working psych, I'll be "worthless as a nurse." Um, no.

I don't totally understand why psych nurses are so often worried about losing their medical skills. Shouldn't we be more focused on honing our psych skills?

[sarmedic70]

Hey everybody..........great input................I have been sitting here doing a lot of thinking about this myself. I, too, am a psych nurse..........and also a medic and worked med-surg, labor/delivery (limited), post partum, et al. The reality check of it is this: Nursing is a multi-faceted profession with vast skills throughout in all of the areas a nurse can possiblyl get into............you are going to loose something in the way of skills somewhere along the line period. Even in Med-Surg where you get the full gambit of nearly everything........but not all M/S RNs get ALL of what M/S entails in the first place...............You are always going to be learning new skills in nursing......and with that you could lose what you have learned when you make a career change within nursing. What does NOT change are the basic assessment skills and having a really good eye/"gut feel" for when there are changes in a patient's condition. I think (no, I know!!!) in psych nursing, one has to be even more on top of things than nearly anybody else in nursing................you are dealing with psych issues primarily; however these patients have all sorts of many other medical issues as well (some related to the medications they are taking, some due to just not taking care of themselves related to their mental illneses, et al)......so you will be up on your skills for the most part...................if you work a geriatric psych section, you have not only the psych issues but also the other medical issues: foley's, et al. There are times you will have to do IVs and NGs (on one of our adult units, we have a patient who sticks stuff up the arm under the skin (and not small stuff either),and as a result IV's have to be started on this individual. Another individual, on the same unit (and these are not geriatric patients either) has an NG tube related to eating disorders. As a psych nurse, you really have to be in tune in that so many patients will have somatoform "illnesses" thereby the "Cry Wolf" Syndrome (and nurses do and can get jaded as a result), but if still not in tune with the patient's condition and really recognizing basic changes in S/Sx and being observant of patients, that "Cry Wolf" patient can actually have something serious that one time. And it could mean life or death for them. That has happened..............a patient in a psych facility passed away as a result of strangulated and thereby obstructed bowel, but because this patient was always complaining about something and yet when checked out would essentially have nothing.........except this time.............because staff was "jaded" some key things were apparently missed in this patient, and this patient subsequently died.

I guess what I am trying to say (and probably doing a very poor job of it) is that there is no way any RN can have all the skills in nursing regardless. It's an ever evolving profession for one with so many pathways in the medical arena/specialties. What does not change are the basic skills: Assessment, vitals, et al.......................and those are always required regardless of where an RN works. Anything outside of those basic skills, hospitals do their own in-services and annual skills testing appropriate for that facility. Change to a different area in nursing, you will go through that facility' orientation and skills training/assessment. If you don't know something, you will learn it......................or in some cases, re-learn it if you had it once before but just out of practice...................

I do strongly feel, though, that before going into something like Psych Nursing that a newly graduated RN spend a minimum of 6 mo-1 year in Med-Surg just to gain the confidence and skills of good assessments and basic nursing foundation before going any place else.............there have been discussions along this line in another thread in this Psych Nursing forum that has been great.................and I believe most are pretty much in the same line of thinking as I just stated...................Other than that.................Skills not used for a period of time truly do come back..........most of the time it is the lack of confidence in ourselves that is the issue once we feel that we have lost our skills.................but it is just the same as riding a bike...........once you get back on, it comes back to you...................no worries.......................and do what you truly joy doing in nursing. You won't TRULY lose your skills............................

I would not worry about "losing" skills if you get into psych nursing. In fact, I think in a lot of ways, they get stronger because you have to be more in tune with the changes of the patient not only with psych issues but recognizing that they will also have (if they don't already) medical issues, and those medical issues will oft be masked by psych issues.

Psych nurses are REAL nurses.......and don't let anybody tell you otherwise...................I dare THEM, who say that, work in our job for even one day and see what they think after that............can they put up with the constant getting hit, bitten, scratched, poo thrown at them, being threatened, et al......................I dare them to work on MY unit at the state facility where I work.....................I AM a REAL NURSE...........I am an RN (of which is first and foremost).............and my specialty area is PSYCH...........and I love it..........always the challenge and never ever a dull moment!

Cheers
C

[Jules A]

Originally Posted by kiwipsychnurse

It's like anything, if you dont use it you lose it.
For me to return to a medical hospital I would need a very good induction.

Skills are there but would really need alot of polishing.

For example wound care, I did it in my training and when I did placements in medical hospitals, however over the past 5 years have probably dressed about 3-5 wounds.

I agree and fortunately in my area the demand for nurses is strong enough that they are willing to train us if we decide to defect. I did clinicals with a great ED nurse who had been a psych nurse for 20 years prior to going to the ED as you can imagine she wasn't exactly a spring chicken but was a great asset to the ED.

[trepinCT]

do what you love..i am graduating in one more year. i wont let anyone talk me out of Psych. nursing..my argument? I am 40 years old, have 20 years of healthcare experience before going to nursing school, and life is too short..lets say i go right to psych nursing and "Jane" does 1 year of med -surg first..she works with me a year later...5 years down the road say we both want to go to med surg..guess what? we are in same boat and "Jane" has no advantages over me...so whats the point? That is the old fashioned way of thinking and now most places will recruit straight to the ER, ICU, CCU, OR, Maternity, psych..all places you could never have worked as a GN...

again..do what you love..life is short

[Iowa_I_Care]

I am in the same boat as you trepin. I too am 40, but have been in healthcare for only 5 1/2 years. I am not 20 and do not have 20 years to dink around in other units to figure out where I belong. The minute I stepped into the Psych unit I knew this is where I wanted to work. I just started a position where I will work 32 hours one week in Psych and 32 hours the next week as a float nurse to any unit. I'm kinda getting the best of both worlds!!