[medic2ernurse2b]

Hi everyone...next semester I will be studying psychiatric nursing. I read a couple of the links on this forum and found out some of a psych nurse's duties, but what can I expect to be doing on the unit during my clinicals? Or, more specifically, could somebody describe a typical day on the unit? I don't know much about psych except for characteristics of certain mental illnesses and the names of some common meds that treat them, and I'm sure it's a lot more complicated than that. I have also heard that psych can be difficult. Any advice on how to succeed?

[PsychRN45]

Psych can be hard if you can't handle the mental games that patients and staff play. It can change at the drop of a hat! You always have to know what's going on.

I'm the charge of a Child / Adol Unit. Some days are better than others but basically my day is assessments, passing meds, making sure staff is doing what they're supposed to and making sure everyone is safe. You have to make sure you have precise communication skills and can think quickly especially if there is a Code Green / Restraint.

There is a lot of legal stuff that is interesting and you need to be on your toes all the time regarding the legal stuff. Last thing you want to do is **** off a Pt Advocate or someone's attorney.

[MidnightTang]

I just finished my psych clinicals. The nurses do a lot more than we students did during clinicals. As far as clinicals went, we passed meds and did some communication studies. We also observed groups and occasionally participated if called upon. A few of the students were asked to lead a group on assertiveness. Really, as a student, I just spent a lot of time listening and trying to use all those theraputic communication techniques they teach you (it's hard not to try to "fix" the problems). The best advice I can give you is know the rules of the floor, don't let yourself be manipulated. Just because a patient says "Well they let me do that yesterday!" does not mean it's true. Most importantly. . .KEEP AN OPEN MIND!!!

[PsychRN45]

Originally Posted by MidnightTang

The best advice I can give you is know the rules of the floor, don't let yourself be manipulated. Just because a patient says "Well they let me do that yesterday!" does not mean it's true.

Patients have done that to my team a lot..."Well the PM staff let us do it." I always tell the kids "That's great but this is the AM shift." The kids usually don't push it after that and if they do I break out the rules &/or policies (if there is one) then they leave it alone.

[LoriAlabamaRN]

As an RN on a child psych unit, I have to agree with the manipulation bit- don't ever take a patient's word for it! And keep a close eye on your pens, notebooks, paper clips, even staples. I have had patients who swallow pens, cut themselves with staples, pierced their tongue with a paper clip, etc... you wouldn't believe it.

[PsychRN45]

Originally Posted by LoriAlabamaRN

keep a close eye on your pens, notebooks, paper clips, even staples. I have had patients who swallow pens, cut themselves with staples, pierced their tongue with a paper clip, etc... you wouldn't believe it.

I know exactly what you mean.

I've had the kids break apart their soap dispenser to cut with or last week this boy broke a PS2 game and used it to cut. What gets me is when they ask "Why do you give us sheets when we can hang ourselves with them?" or "You can't keep me safe" and start scratching on their arms with their fingers.

I had one girl purposely look though the entire bookcase to find staples then show it to me with the smart comment of "You can't keep me safe."

I always tell my patients when they start being unsafe, "You make your own choices. You can either make a good choice or I can make your choices." You have to be able to make a decision and stick with it. Once you draw that line in the sand you have to stand by it. When you show a patient you're wishy washy then they know they can get a way with stuff. Kids need rules and boundries. That's how they feel safe and know we care about them.

[medic2ernurse2b]

Interesting stories. I have transported many psychiatric pts (adults and adolescents) and I once heard about a teenage girl who somehow got ahold of a lightbulb, broke it and cut herself. (only superficial) Just out of curiousity, PsychRN45, have you or other psych nurses you have worked with ever encountered a successful or near-successful suicide attempt on the floor?