Being a Psych RN

Meriwhen, ASN, BSN, MSN, RN · Nov 5, 2013

Answers:

1. Yes, yes we are. They think that psych is where old or washed-up nurses come to die. That we must have as many mental problems as our patients. That we don't do anything for our patients except drug them. That we don't have the skills to hack it in one of the "glamour" specialties. That we chose psych because we wanted the "easy" life. And yet they think that working in psych is like working a shootout at the OK corral.

As you, I and every other psych nurse/tech knows, all of these myths are utter crap. Well, we do administer a lot of medications but that's damn well not the only thing we do. Yet these myths persist. The media doesn't help: say "psych nurse" and one of the first things people think of is Nurse Ratched. Nor does the stigma that mental illness itself carries, because a lot of that stigma seems to carry over to us.

But like you--really, I also started out in psych with the intent to put in my year and move on, but here I am years later --I feel like I'm making a difference. It may not always be the big, drastic difference that you see in non-psych nursing where the patient is wheeled into the hospital sick and walks out cured. It may only be small, subtle differences, and they may not be seen right away or even before the patient leaves your care. If you're all about instant gratification and results, psych isn't for you. You need a lot of patience for your patients :)

If you love psych and see your future in psych nursing, don't let what other people think get to you. And if you think about it, EVERY single specialty is looked down by others for some reason or another. So do what you love and don't worry about what others think.

2. I've never done travel psych but I'm told there is some demand. I do agency psych as a second job, and there's a pretty good demand.

3. I'm no PHMNP so I can't tell you exactly what they do. I believe it's more prescribing, med management and psychotherapy. Hopefully a PHMNP will come in to give us the scoop on the role. But that doesn't mean that you as the floor RN aren't making as much or as importance of a difference.

Orca, ADN, ASN, RN · Nov 5, 2013

I literally opened an adult mental health unit in the first hospital I worked in, taking in our first admission. In the beginning, many staff were afraid to come onto the unit, believing that it was a combat zone. When they finally came through and saw how calm things were, then the perception was that we didn't do anything. We would hear the comments in the elevator on the way to the floor: You aren't real nurses because you don't wear uniforms (our usual work attire was dress casual rather than scrubs or whites). You aren't real nurses because you don't perform medical procedures. Half the hospital didn't believe that we did anything worthwhile. A lot of our nursing interventions were verbal, so people would see us sitting in the day room talking to patients, coordinating activities and so forth. Since we weren't always running codes or constantly performing life-saving medical procedures, we were less a part of the team - or so the story went. It took a long time for things to improve. As happens with most things, it took a dramatic event for things to change.

One evening I heard the code called overhead for a mental health emergency, but the location was our telemetry unit. I went to the floor along with the charge nurse from our companion gero-psych unit. What we found when we arrived boggled the mind. There was a female patient who appeared to be in her late 70s in a virtual fist fight with the tele charge nurse. I told the gero CN, "We had better take this over." We talked to the woman, who was simply confused after falling asleep. She awoke, convinced that she had been moved to another hospital and she wandered into the hall, wanting to leave. The tele CN had decided that she was going back into her room, right now, whatever it took. The patient resisted. We spent about ten minutes talking to the patient, and we convinced her that she was in fact in the same hospital, and this was her room. She went back to bed. The tele staff was amazed. One asked what kind of restraints we used to keep her in bed. I told her that we didn't use any, because none were necessary (which disspelled another myth, that we handled all psych emergencies with drugs and restraints). I explained that we had rather spend 20 minutes deescalating a situation than five minutes tying somebody down and giving them a shot.

After that, we started getting calls for similar situations without codes being called. ICU called us to make sure that they had properly applied leather restraints to a patient who was in danger of injuring himself. ER would call us to talk to patients to see if they were suitable for admission and were willing to accept treatment after they heard about our program. Respect came gradually, but it came. The comments in the elevator stopped.

This is not to say that there aren't still prejudices and ignorance among our more medically-oriented colleagues. However, them seeing first hand that we still have skills did wonders in this case.

PeacockMaiden · Nov 6, 2013

It amazes me how our society degrades the mentally ill as second class citizens.

I recently started as a psych nurse and I love it. I didn't plan on going into this specialty, but the opportunity came along and I decided to give it a try. I love it so much that I'm pursuing my psychiatric NP.

taydian · Nov 10, 2013

I've only been in government. First for the state. Now for the fed government (VA nurse).

If you want to make a difference, don't go government. That's all I'll say. Good luck to you.

TheDude77 · Nov 11, 2013

Background: I am in nursing school and graduate in May '14. I decided I needed to get a job in the hospital as a tech so after graduation it would be pretty easy to get a full time position as an RN. The catch: the only place hiring at the time in the hospital was psych. I reluctantly took the position with the idea that after 6 montsh I could transfer to another part of the hospital. Problem is if you want to call it that, 14 monthe later - I love psych. Issue: The patients just break my heart over and over. Admittedly I have a huge soft spot these pts, when it appears others dont. It seems that mental health is just a revolving door, especially in Alabama, and would I really be making more of a difference in another part of the hospital? Questions: 1) It seems that psych nurses are looked down on much like our pts 2) I would love to travel nurse later on but is their a need for psych travel nursing? 3) If I stay in psych, i feel as though I can make a bigger diff in pts lives as a PMHNP, thoughts. Thats a mouthful - fire away. Thanks in advance.[/quote']
Same situation. Graduates and could only get a psych job . Planned in transferring and never did. I start my PMHNP program in January!

Retired APRN, MSN, RN, APRN · Nov 13, 2013

1) It seems that psych nurses are looked down on much like our pts

That is all too frequently the case. Psychiatrists also have the stigma of not being considered "real doctors" in a certain way. I don't know what to tell you about that. In my opinion, it is an issue that requires a lot social education and awareness.

2) I would love to travel nurse later on but is their a need for psych travel nursing?

Sorry, I know nothing about that.

3) If I stay in psych, i feel as though I can make a bigger diff in pts lives as a PMHNP, thoughts.

That's the route I went, but not because I felt I could make a bigger difference in my patients' lives. I wanted the challenge and autonomy of the NP role. I also had discovered that I had a knack for psychotherapy and wanted the opportunity to practice as a therapist.

Given the very high readmission rates among this patient patient population, I think it is actually the floor nurse who has more immediate impact on their daily lives than a PMHNP. There are a lot of issues in that career choice.

psychRN2005 · Nov 13, 2013

Orca, you are a rockstar! Good for you! I wish all hospitals would open their eyes and be more receptive to letting us intervene in situations like these. I had to laugh though because "medical" nurses think that we are the dumb ones and all you did was listen to the patient. LOL

psychRN2005 · Nov 13, 2013

jmhillis,

I love psych and like you started as a tech many years ago. I did however go in to critical care after graduating. I felt like I should do some "medical stuff". I guess I'm glad that I did it. I learned a lot. (like psych is everywhere :)) Now I'm back in psych and feel like I'm back home. I will finish my psych np up in May and there are many opportunities if you want to advance your career. As for making a difference, we make one every day to someone. Don't worry about what others think because they are usually too afraid to come and work with us.

I have no idea about travel nursing with psych. Good luck!

JM_RN · Nov 13, 2013

Thanks for all your input. Staying in psych or moving on after graduation is a discussion I have weekly. Retired APRN, can you expound on this below, you have piqued my interest.

3) If I stay in psych, i feel as though I can make a bigger diff in pts lives as a PMHNP, thoughts.
That's the route I went, but not because I felt I could make a bigger difference in my patients' lives. I wanted the challenge and autonomy of the NP role. I also had discovered that I had a knack for psychotherapy and wanted the opportunity to practice as a therapist.
Given the very high readmission rates among this patient patient population, I think it is actually the floor nurse who has more immediate impact on their daily lives than a PMHNP. There are a lot of issues in that career choice.

Johnyer Sanyet · Nov 18, 2013

Psych is a great field. Been in it for 18 years and I can't complain. Just remember Empathy not sympathy when dealing with a psych patients. Their stories are sincere and close to the heart, but if you get too involved you can lose the track of treatment. Focus, educate, and empower. :)

TerpGal02, ASN · Nov 25, 2013

Hey there, also thought I would chime in on your post. I have been a psych nurse for a year and a half. I always loved psych in NS, but did try to get that one year med surg experience. As you know it's tough out there for new grads, and after months of no bites by med surg, I was offered a job in psych which I gladly accepted. As for your questions

1) Yes there is a LOT of misconception about psych nurses. I had instructors in school look at me like I had 3 heads when I said I was interested in psych. Other nurses tend to think you "aren't a real nurse" because you don't give IV push meds, or start I've or do Foleys, etc. On MOST psych units, the pts are supposed to be medically stable. This is why in my hospital as a free standing psych hospital, we don't HAVE a LOT of the equipment a med surg floor would have.

DO you get medically unstable pts transferred from time to time? You betcha, and you have to keep them as stable as you can until they transfer. And because of limited resources, you sometimes have to McGyver creative solutions.

2) A friend of mine travelled for a few years. She says there is quite a bit of demand for psych travellers.

3)In my state generally PMHNP do med management so essentially spend their day doing med checks. I think it would be so cool to be a PMHNP, there is an art to prescribing psych meds moreso than in any other field, IMO. If you really want that pt contact, PMHNP might not be the space for you. Maybe nurse psychotherapist, or maybe just stay on the floor.

I can say the biggest difference I've ever felt I made was when I worked psych nursing in the community. I had a caseload and saw some of my patients 3 and 4 times a week. Talk about getting that 1:1 time and feeling you're making a difference! I may go back to that someday. Just remember that with psych though, it's all about small victories.