Hi Molly, and Mia, also: I've worked in psych for waaaay long and it is still my true love in nursing. It is a field rich in experiences, frustrations, and satisfaction. It has taught me patience like nothing else has (with the exception of having my own teenagers
!!) Right now I am working on a pysch unit in a community hospital, but I have also worked in state hospitals which tend to be much more long-term. I like both, but sometimes I do miss the opportunity to develop a deeper relationship with patients and families. 3-5 days feels like drive by therapy to me!
How to de-escalate? Like anything else, try to prevent situations from reaching melt-down if possible. That means knowing your patients, identifying times that may cause unrest on your unit(change of shift, that kind of thing) and being alert for changes in individual patient's behaviors. My first concern is always for safety for the patient, other patients and staff. Maybe that means getting the agitated patient out of the environment and away from whatever is triggering the agitation. Talk, quiet music, diversion, what ever works. Obviously there are times when the patient escalates so quickly that these measures aren't practical....or safe...then maybe prns, time alone in a quiet area, whatever.
I don't work often with adolescents, our unit takes above age 16, but sometimes we have to assess emergency admissions under that age and then refer to a more appropriate facility. To be honest, it is not my favorite area, but that may be because I have little experience there (aside from the aforementioned teenagers!!) I will say that I think treatment for this age group is abysmally lacking in this country and too many kids who really need help end up in detention facilities where they further decompensate.
I keep compassion for chronically ill patients because I do. I never thought about why or how before. I think there is enough stigma still attached to this illness, and such fragmented care due to a whole variety of factors, that patients at least deserve my professionalism. Perhaps that sounds naive and if so, fine, but I have been a nurse for a very long time, and that is the only way I can continue; losing compassion would be the quickest way to burnout for me.
And now to the biggie, should you get med surg experience before going into psych. I don't know; I did, but in all honesty, I don't know that it made a huge difference in my practice. Regardless of what area we practice in, it is up to each of us to stay on top, go to workshops, read professional journals etc. I have taken care of patients with mental illness who are also pregnant, have barely controlled diabetes, heart problems, MS, and on and on. I certainly couln't rely only on the education I received back when I went to nursing school
. So, I don't know. You'll get opinions that are strongly pro med surg experience and some who will say go for what you love. Whatever you decide, remember it is your professional responsibility to stay aware of changes in practice, updates and so on. And anyway, why doesn't anyone think you should have a year in pysch before going to med surg?
Good luck to both of you, I love hearing that new nurses are interested in psych.