A (Long) Note to New Grads

  1. A note to fresh, new, excited graduates and any other nurses that are considering a career in psychiatric nursing. This is my story, advice, and two cents. Maybe three.

    So you graduated, eh? Now you're in the big leagues. Maybe you're getting ready to graduate and on the brink of your journey into and onto the field. The only thing in your way that separates you from those sweet, delicious fruits of your labor is the NCLEX. Go kick its ass. Why? Because you can. Believe it.

    But then what? So many of your classmates are lining up jobs at ICUs, NICUs, ERs, and telemetry floors. But not you. Oh, no, not you. You never liked those things. The smell of death too much for you, maybe? Don't feel comfortable around the terminally ill? Seeing too many family members bereave at bedside taking a toll on your heart? Can't stand the thought of working 12 hours in a HOSPITAL of all places?

    You may be wondering why you even entered the field at all. You thought it was to help people get better. To be a good provider of care. To exercise compassion to your fellow humans. To promote and propagate health and good habits of living. Yes to all. But why doesn't the thought of hanging an IV bag of Flagyl excite you? I'll tell you why. It doesn't have to. In fact, none of the things a nurse would typically do in the traditional hospital setting has to excite you. If you've ever considered, or are open to, a career in psychiatric nursing, read on. If not, find something you like to do and good luck (you won't make a good nurse).

    I... "disliked" the traditional hospital setting from day one. It was interesting, sure, and sometimes fun. But I did it because I had to. The experiences I had in clinicals were fundamental to my growth as a student and, ultimately, as a nurse. They were stepping stones to my ultimate destination. They were necessary. I learned how to interact with patients, I gained confidence in my ability to target the areas of care that they each needed, and I learned about the procedures and medications that would be around in the field for as long as I'd be in it. Those days of getting up at 0500 in December on a short night's rest when it was still dark, cold, and often rainy outside, by and large, were of paramount importance. There's a line in an Oasis song ("All Around the World") that really stuck with me as I'd listen to it on the path to my clinical destinations, and I hope it sticks with you too:

    It's a bit early in the midnight hour for me, to go through all the things that I wanna be.

    Read that one more time. I'll wait here.

    That one line summed it all up for me so well that I'll never forget it. I did my time and got through it, just like you did or are doing. Even though I knew I would never be a "medical" nurse. Ever. From day one, and well before I ever got accepted into nursing school, I knew that I wanted to and would be a psychiatric nurse. So as soon as I finished up my bachelor's degree in psychology, I applied to the nursing program at the same school. The only school I applied to. If I got in, I'd be a psychiatric nurse. If I didn't, well, I didn't have a Plan B. I got in.

    The field interested me from the time I decided to get a bachelor's degree in psychology. It's new, it's fresh (relatively speaking), and there's a whole hell of a lot that we still don't know about it. Just like the patients we serve have, historically, had stigmas attached to them for being born different, psychiatric nursing has its own. First of all, don't ever let anyone think psychiatric nursing is "easy", or that psychiatric nurses "don't do much". We may not read EKGs all day, hand over surgical instruments, get STAT orders for an IV antibiotic, start a PICC for chemotherapy, or triage 20 patients with stuffy noses in an ER, but we work just as hard as any other nurse you'll ever come across. So don't be fooled yourself. Don't think it's a walk in the park, easy money, or "just listening to people's problems". It's work. Hard work. And doing it well will make you a better human being. You will, and I promise you this, make a difference in someone's life. You will also save lives (although not necessarily in an exciting, right-before-the-commercial-break-in-a-made-for-TV-medical-drama way). You know, without the AED pads.

    "What's so hard about being a psychiatric nurse?" you wonder to yourself, having made it this far in my meandering post. The hardest part about being a psychiatric nurse is this: doing all the things they don't teach you how to do in school. Knowing what's going on where without looking. Recognizing "that look" in someone's eyes before they explode. Picking up on when someone's actually suicidal versus the borderline with the short end of a broken plastic knife making empty threats for an extra snack. These skills are all skills you will acquire in the trenches. What about your other skills? The Foleys and the IVs and the... just stop. Relax. Take a breath. Now reach into your pocket of skills, remove the ones you don't need right now, and put them up in a mental shelf. Now close it, lock the door, and tuck the key somewhere safe. Those skills aren't going anywhere. They may collect a little dust, but they're still there. You can wipe them clean later and freshen them up a bit if you ever have to. Do you use every skill you've ever learned your whole life all the time? No. You'd go crazy (and be crazy) if you did. You use what you need to use to get the job at hand done. If you find that one day you suddenly have the burning itch to remember how to put a Foley in, I assure you with 100% confidence that someone, somewhere in the world, will know how to do it and can show you. And if you're one of the millions (billions, maybe?) of people on the planet with access to the Internet and nobody's reading this to you over the phone due to the fact that you're not, there's always YouTube. It's 2015. You can look up just about any instructional video on any skill in any field from anywhere in the world... in an instant. Amazing, ain't it?

    I assure you that you'll still keep the necessary knowledge of general medicine with you in your career as a psychiatric nurse. Who the hell told you that mentally ill patients don't get sick? They do. All the time. You'll still know what Metoprolol is. You'll still know the therapeutic range for an INR. And I guarantee you'll get your fair share of wound dressings. And who doesn't like wound dressings? Oh what fun! (and I mean that!) You'll still be calling the medical doctor for orders, deal with the damn pharmacy (yes, it's always their fault), and have to explain Synthroid to a curious party of the patient's family. So really, what are you afraid of losing? So what if you have to look something up later in life to remember how to do it? Do you think physicians remember everything they ever learned in school? Hell no. Why do you think Physician's Desk References are about a quarter mile thick? Nobody remembers everything. Nobody has to. And nobody will ever need to.

    Now I can see the gears churning in your head, cranking out all the possibilities. You're starting to feel a little better about being part of the dirty stepchild of nursing that is psychiatric nursing. And you should. If that's what you're considering or that's what you know you want to do, take pride in it. That goes for anything you do in life. Stand up for what you do and the people you serve. I can't stress this enough: they need you to. They can't always do it themselves. Your patients will be part of a demographic of the human population that is globally stigmatized. No other type of patients were ever tied to a pole by the hundreds, thousands, and were literally beaten and enslaved to their label like psychiatric patients have been. No other type of patients can be stereotyped from across the street as they're seen talking to themselves while others shuffle over to the other side to stay away from "them" as if they're sub-human. No other type of patient needs a voice in today's world more than the ones you will serve. Look around you. Read the headlines. Police have been on trial for killing them over the most trivial, frivolous, non-violent offenses. Why? Because of this exact reason. I told you earlier that the field of psychiatry is young. It's the new kid on the block. Not everyone understands it, so what do people do when they don't understand something? They become afraid of it. Maybe a small part of you is afraid of it too. Perhaps that's a natural response to everything you've ever come to know about it through popular media and everything else that's been force fed to you before you decided to become a nurse. But that's where you need to look inside yourself and realize that you became a nurse to help others. To do this, you must first understand others. Take that initial step, for when you do, you can then help them. By "them", I'm not only talking about the patients but everyone around them. It's your job to help break the stigma associated with the individuals whose only crime was being born with a neural anomaly that gives them the gift of seeing the world in the unique way that they do. Nothing else.

    That's why I did it and that's why I love it. I've been doing it for all of six years now, mostly inpatient. I started out as a new grad and got hired without any experience as a per diem nurse and worked the floors as a charge at a small 35 bed hospital. To this day, I have never set foot in a medical hospital as an RN providing care and I haven't one regret about it. I jumped straight into what I wanted to do because I knew I would love it. I knew it would be a challenge, but one that I could rise to. I also knew the reward was rather a mystery. In other departments, the rewards seem rather obvious. It's not as flashy as running a code blue in an ICU with 20 people around you while you pump out compressions and save a dying man. It's not as sterile as an operating room, either, where every minute and movement is so precisely calculated and planned for all to go accordingly. Nor is it as fast paced and edgy as a busy emergency department in a metropolis where lives are saved by the minute based on keen observation and assessments. So what IS the reward of psychiatric nursing? I'll give you my answer and, hopefully, someday you'll have your own: making my patients feel like everyone else, no different. You'd be surprised how many times I've had patients come in to my assessment area as transfers from emergency departments who had been there all day and were never once offered a bite to eat or a sip of water. It infuriated me. The patients aren't all going to ask for what they need. Part of being a good nurse in general is knowing what they need before they even have to ask, because many won't ask at all. Ten, twelve, fourteen hours or more in an ER at some of the worst times in their life, often feeling ashamed of themselves and unable or unwilling to speak up, and never offered the most rudimentary, basic, and necessary elements of care all day: food and water.

    Note to ER nurses who may be reading this: Please, be a kind human and make sure this isn't you.

    Although I did one semester of being a mental health clinical instructor for the BSN students at the university I attended (where the clinical site was my main job site, which was nice since I knew the staff and patients), I eventually got out of inpatient nursing. Towards the end of my career at that hospital, which was all of 5 years and a month, I also was on the clinical informatics team for a year where I helped design the charting system that would eventually (and to this day) be used there. I left because the administration was becoming a problem and at odds with what I thought was proper nursing care and because I felt patient safety was being compromised in the interest of saving money. I left and started teaching again (I have a BSN so in my state I can lecture and be clinical instructor for LVN students). Teaching was fun, though short lived. It was nice to be able to give back to academia. I was lucky enough to have been able to give about four to five lectures on psychiatric nursing to the students at a vocational school. It felt good to stand up there and talk about it to a room full of young, enthusiastic people, providing real life experiences and putting my own little flavor into the content and delivery. If you've ever wanted to be a teacher at any point in your life, consider being a nursing instructor. The beauty of being a nurse are the endless permutations and pathways you can take to providing a variety of experiences to both your life and career.

    I would have kept at teaching had my dream job not landed right in my lap when I least expected it. During a lecture I was giving, a recruiter from a large, well known health care organization called me with a mental health opportunity at a nearby clinic. The job? Serving as a liaison between patients and their psychiatrists. Monday through Friday, nine-to-five with weekends and holidays off. Full time, benefitted, $140K/year (it makes for comfortable living, yes, but don't ever do it for the dollar sign alone. Nurses who do can be spotted a mile away, just ask their patients. I only mentioned money at all to share what's possible with a BSN in California since this site is seen coast to coast and it may influence someone's decision to make a move out west!) In my head, during some of the most stressful, infuriating, and seemingly helpless nights working the floor, this was what I had in mind for myself... some day. This offer was seven years in the making and I wasn't going to turn it down. If you ever feel like you're getting burnt out where you are, that's okay. Chances are, no matter what you do, you will at some point. Even if you don't, you'll want a change after awhile. You'll want new experiences and to learn new things. You may have something in mind already for your future. A company you'd like to work for, a city you'd like to live in, a pay range you'd like to be at. Just remember one thing, everything you've ever done to this point and everything you'll ever do, EVERYTHING (every experience, every patient, every interaction, every good day, every bad night, every medicine you give or forget to give, everything) matters. Not only does it matter, it makes you who you are; as a nurse and as a person. Be your best and the best things are yours. Even if it doesn't look that way now, it will later. Even if it's dark, cold, and possibly rainy outside and you're tired, burnt out, and hungry; and even if it's a bit too early in the midnight hour for you, to go through all the things that you wanna do, it will be worth it.

    Peace, love, and compassion.

    Sincerely,

    A nurse who has never worked a medical/surgical floor his whole career and still found happiness.

    P.S. - Don't ever let anyone tell you the direction you HAVE to take. I didn't.
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  2. 49 Comments

  3. by   smoup
    Goodness this all hits home for me! Psych has been my dream job for over half of my life and I am very excited to start working in psych as my first job out of nursing school! Thanks for a great write up!
  4. by   CT Pixie
    I don't understand this line --> If you've ever considered, or are open to, a career in psychiatric nursing, read on. If not, find something you like to do and good luck (you won't make a good nurse).

    Is this a typo or am I just reading it wrong? Why won't they make a good nurse? Maybe if they aren't interested in psych and go into psychm that wouldn't be a good thing and they wouldn't be a good psych nurse. But you are saying find something else you like to do and good luck (you won't make a good nurse) because they aren't open to psych nursing? I'm confused.
  5. by   sjalv
    Quote from CT Pixie
    I don't understand this line --> If you've ever considered, or are open to, a career in psychiatric nursing, read on. If not, find something you like to do and good luck (you won't make a good nurse).

    Is this a typo or am I just reading it wrong? Why won't they make a good nurse? Maybe if they aren't interested in psych and go into psychm that wouldn't be a good thing and they wouldn't be a good psych nurse. But you are saying find something else you like to do and good luck (you won't make a good nurse) because they aren't open to psych nursing? I'm confused.
    I read it as, they won't be a good [psych] nurse if they pursue psychiatry nursing without having an interest in it. This is such a well-written and thought out post that I can't imagine the OP meant it as they won't be a good nurse period if they don't like psych.
  6. by   JMCP
    only a psych nurse would sit around writing such a long post lol... we all know psych nurses are amazing for dealing with very interesting cases... we also know you have to really have your little drum beating at an off-pace from the rest to like psych.


    good on ya!
    Last edit by JMCP on Feb 27, '15
  7. by   CT Pixie
    Quote from sjalv
    I read it as, they won't be a good [psych] nurse if they pursue psychiatry nursing without having an interest in it. This is such a well-written and thought out post that I can't imagine the OP meant it as they won't be a good nurse period if they don't like psych.
    I agree, it is a wonderfully thoughtful post, that's why I am/was confused. I thought they were saying without an interest in it you won't make a good nurse. But I read it again and thought differently.
  8. by   Ambiguphobia
    This post really hit home for me. I was made fun of and ridiculed (during nursing school, no less!) by my very own peers during classes for wanting to get into psychiatric nursing. My final goal in nursing is to become a doctorate-educated PMHNP. I was told by my classmates and instructors that psych nurses have a cushy job and they do nothing all day. They were SO wrong.

    My psych rotation was with a director of nursing for a huge psychiatric center in New York. She taught me so much, and she was the most caring of all the professors I've ever had contact with. She showed me that psychiatric nursing includes medical, surgical, and more. You get all kinds of patients. There are times where you call codes, times to give meds, and times where you just help your patient feel like they are getting quality treatment. You still practice most of the nursing skills you oh-so-perfectly honed in school. I enjoyed this clinical the most, by far.

    In the end, it is an individual's choice on where to work, and no one should make fun of those that want to get into psychiatric nursing. All fields need special nurses that are good fits in order to run optimally.

    Thank you so much for this post.
  9. by   ellienurse3
    I love this post because it really hits home for me. I have always loved psychology but never went to school for it because I didn't know what I wanted to do (I've always been very interested in counseling though). I loved volunteering at my local hospital in high school and helping others. I got my first degree in biology (thinking I wanted to do med school... but later figured out I loved patient care) and my second degree is in nursing from an accelerated program. During mental health, all my fellow classmates were moaning and groaning about how boring and awful it was but I loved it! When I told others I did, they made comments like "YOU can do that, I definitely wouldn't" or "only those who are actually crazy work in psych." One of my absolute favorite days of nursing school was when I went to a outpatient transitions program and got to sit in on group therapies. I also loved talking to patients in the unit and even if I got them to tell me one thing they loved doing per say, I felt like I was helping. The attitudes of others who don't understand psych or don't like it bother me because every speciality needs nurses who are passionate about going into it. I understand it is not for everyone (I personally could not do med-surg) but the theme of ridiculing others or criticizing them for liking something that's different needs to change. Thank you for posting this for all new grads to read, especially those interested in psych.
  10. by   fawnmarie
    Quote from Ambiguphobia
    This post really hit home for me. I was made fun of and ridiculed (during nursing school, no less!) by my very own peers during classes for wanting to get into psychiatric nursing. My final goal in nursing is to become a doctorate-educated PMHNP. I was told by my classmates and instructors that psych nurses have a cushy job and they do nothing all day. They were SO wrong.

    My psych rotation was with a director of nursing for a huge psychiatric center in New York. She taught me so much, and she was the most caring of all the professors I've ever had contact with. She showed me that psychiatric nursing includes medical, surgical, and more. You get all kinds of patients. There are times where you call codes, times to give meds, and times where you just help your patient feel like they are getting quality treatment. You still practice most of the nursing skills you oh-so-perfectly honed in school. I enjoyed this clinical the most, by far.

    In the end, it is an individual's choice on where to work, and no one should make fun of those that want to get into psychiatric nursing. All fields need special nurses that are good fits in order to run optimally.

    Thank you so much for this post.
    Wow. I have never been ridiculed or made to feel like a lesser nurse because I work in psych. Some people have preconceived ideas of what psych nurses do, or don't do, but I'm always happy to explain my duties to anyone who asks. And people certainly are curious! I enjoy dispelling the myths of psych nursing...no, we do not keep patients in padded rooms, we rarely use restraints, we medicate appropriately, but we do not aim to sedate all of the patients. I do feel strongly that medical experience is helpful when working in psych. I have never worked in an acute hospital setting, but I worked in LTC, where I gained a very good understanding of disease processes. I have seen some new graduate nurses come straight into psych, and some of them lack the confidence that comes from having medical experience. Great post, OP, it's always nice to see the mental health field get some positive endorsement!
  11. by   Aliareza
    Honestly, the reason psych scares me is because every time I have a clinical at a psych place, there's all kinds of warning about safety of the nurses and what medicaid will/will not pay for. You can't wear a normal pony tail because it has to be pinned to your head so as not to make you a target. You have to cover up your last name because these aren't normal people. Everything is locked down because the patients are dangerous. You have to be very careful what you document because even if they tell you they aren't suicidal/homicidal and don't have a plan, they could very well be telling a lie just to get out of the facility, and if you chart "No" to those questions, the facility won't be paid for keeping them there any longer, but will be responsible if they kill themselves or somebody else within 72 hours of release. That's even more ridiculous than the law stating if patients come back within a month, the last visit doesn't get paid for (for acute care in a hospital).

    I love psych. But at this point, the cons list is stacked way higher than the pros list for working in a psychiatric place. I was exploring doing it part-time on my days off, but after seeing these things in all 3 of the psych units within an hour of me, no thanks.
  12. by   Chesterton1
    This was an incredible post and I vote for it to be stickied and put in the FAQ or made into an article or something. OP please stick around ! This post was a big boost for me because thus is what I want to do when I'm finally finished with the whole nursing school thing.
  13. by   JoseQuinones
    Do the cuss words add to what you are saying here or am I missing something? Isn't this supposed to be a forum for professionals?
  14. by   Chesterton1
    I would say you are definitely missing something if a couple cuss words are all you got out of that post. I cannot even remember any cuss words, I was too focused on the message.

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