Crossing Over to Psych Nursing...advice please

  1. I have been a nurse for a loooooong time. I have spent most of my years in geriatrics/acute care and now have accepted a position at the State Hospital here. I worked at a State Hospital years ago and have had psych experience (in a hospital based unit and private hosptal) but it has been so long ago that I would appreciate any advice from you more experienced psych nurses. What can I do to be more prepared for this position? It is on a chronic/long term ward. Any offerings would be appreciated.
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  2. 23 Comments

  3. by   Blackcat99
    State psych hospitals are dangerous. Be sure you are in peak physical condition. It wouldn't hurt to take some self defense classes in case you should ever get attacked by a patient when you are alone. Good luck
  4. by   CHATSDALE
    psych patients can be very mantiulative and yes they can be dangereous...but t hey are people with people problems also...never assume that they are vieing for attention when they c/o for the 200 time it may be real this time
  5. by   lovinghands
    Congratulations on your new job!

    I don't know about the above posters but I do work in a state psych hospital and I would not deem it as "dangerous" work. I am on acute unit so I deal with unpredictable patients at times but we are trained for those situations. Our top priority is safety so when problems flare up, we as a team act fast and follow hospital policy.

    I encourage you to brush up on your psych meds, s/s of eps, neuromalignant syndrome and tardive dyskinesia.. Since you will be in long term care, many of the psych meds will be antipsychotics and probably some mood stabilizers. Here's a list of some common psych meds: clozaril, risperidone, risperidone consta, , haldol/haldol dec, geodon, zyprexa/zydis, seroquel, abilify, vpa/depakote, lamictal, topamax, cogentin. Most of these have extensive lab protocols, which you will become familiar with when you begin.

    If it helps any, the long term rehab units in my hospital are usually quite calm. They have a routine and like to stick to it. The patients and staff become very close and sometimes are like second family. I hope some of this info has helped. Best wishes!
  6. by   Blackcat99
    When I worked at the state psych hospital one of the male staff members got his ear bitten off by a patient. Another female staff member got attacked by a female patient and will have to use a cane to walk for the rest of her life. Anyway, best of luck to you. Hope you will have adequate staffing at your facility.
  7. by   debRN0417
    Quote from lovinghands
    Congratulations on your new job!

    I don't know about the above posters but I do work in a state psych hospital and I would not deem it as "dangerous" work. I am on acute unit so I deal with unpredictable patients at times but we are trained for those situations. Our top priority is safety so when problems flare up, we as a team act fast and follow hospital policy.

    I encourage you to brush up on your psych meds, s/s of eps, neuromalignant syndrome and tardive dyskinesia.. Since you will be in long term care, many of the psych meds will be antipsychotics and probably some mood stabilizers. Here's a list of some common psych meds: clozaril, risperidone, risperidone consta, , haldol/haldol dec, geodon, zyprexa/zydis, seroquel, abilify, vpa/depakote, lamictal, topamax, cogentin. Most of these have extensive lab protocols, which you will become familiar with when you begin.

    If it helps any, the long term rehab units in my hospital are usually quite calm. They have a routine and like to stick to it. The patients and staff become very close and sometimes are like second family. I hope some of this info has helped. Best wishes!
    Thanks for the info. This will really be valuable to me to know where I need to get started. Thanks again!
  8. by   Houstonnurse
    I think you will know fast if the place is not for you. IF they don't give you an excellent course (FOR SEVERAL HOURS/3 or so days,not IN 1 day)in a PMAB program of some type BEFORE you go on a floor your in for a bad time probably, and COULD be unsafe.
    I am a female in my late fifties, NOT in good shape at all, and work in a VERY acute/chronic level, and I am totally safe on my normal unit (adults PICU) because we practice over and over with a refresher course at least every 3 months, and then practice on the unit at quiet times. We know each staff members step, and don't play around by not being safe. I don't want my pt's overmedicated, but I will give prns if I notice them becoming agaitated BEFORE they get to an unsafe level. We NEVER (and no-one should) confront anyone by ourselves, and NEVER go in a rm without someone close to us unless we are extremely sure of ourselves. I've never been so much as slapped in twenty years except when I worked agency one time in a
    nursing home and had a little ole ninty yr old woman wop the heck of me!
    GOOD LUCK. Nita
  9. by   JohniePea
    [B]Not only State hospitals are dangerous, the possibility of being attacked by a patients exists when you work on a Psych unit within a hospital, work within the community visiting clients at home, and administering their meds, or a stand alone Behavioral Center, just be vigilant at all times, and close to a door, in case a hasty retreat is warranted......
  10. by   StuPer
    I have to say I have been appalled by some of the posters here offering 'advice', clearly there are facilities where practice is very poor, and the staff are under paid over worked and put in dangerous positions. However, it is patently untrue to imply that working in a mental health facility is akin to dong 15 rounds with Hannibal Lector.
    Without doubt the level of safety staff have is related to the staffing ratios, training and the medical staff onsite. The vast majority of people suffering with mental health problems are no differnet than you and I, and live relatively normal lives. For those who have chronic problems, which respond poorly to treatment, they have to endure the misery of institutional care. Imagine calling a psych ward home for the rest of your life, not just for the length of a shift.
    Often patients in this setting can be challenging and difficult, but once you get to know their 'quirks' can often be managed and helped very well. Try to remember these are people 'not' axe wielding maniacs looking for any opportunity to take your head off.
    Anyone who works in a facility where they are genuinely in fear of their life should leave because of either/all of the following, a) for their own mental health, b) because they are unsuited to work in mental health or c) the facility is so badly managed that very real dangers do exist to staff.
    regards StuPer
  11. by   lovinghands
    Quote from StuPer
    I have to say I have been appalled by some of the posters here offering 'advice', clearly there are facilities where practice is very poor, and the staff are under paid over worked and put in dangerous positions. However, it is patently untrue to imply that working in a mental health facility is akin to dong 15 rounds with Hannibal Lector.
    Without doubt the level of safety staff have is related to the staffing ratios, training and the medical staff onsite. The vast majority of people suffering with mental health problems are no differnet than you and I, and live relatively normal lives. For those who have chronic problems, which respond poorly to treatment, they have to endure the misery of institutional care. Imagine calling a psych ward home for the rest of your life, not just for the length of a shift.
    Often patients in this setting can be challenging and difficult, but once you get to know their 'quirks' can often be managed and helped very well. Try to remember these are people 'not' axe wielding maniacs looking for any opportunity to take your head off.
    Anyone who works in a facility where they are genuinely in fear of their life should leave because of either/all of the following, a) for their own mental health, b) because they are unsuited to work in mental health or c) the facility is so badly managed that very real dangers do exist to staff.
    regards StuPer
    Well said. Thank you!
  12. by   elkpark
    While I have not been employed by a state hospital, I did teach psych clinical for a few years at a nearby state hospital, and I have worked in psych at a VA and in a few "cushy" community hospital psych units. I have not observed one setting to be safer or more dangerous than another. I believe it depends more upon the staff, and their attitudes and training, than the type of setting.

    A word of caution about "self defense" techniques -- in my state, and probably plenty of others, the state dept. of mental health mandates that only behavior control techniques reviewed and approved by them can be used in psych settings. Your new employer will provide training in the de-escalation and physical behavior control techniques they want you to use. In my state, it is state mental health regs that all staff must be trained and certified in an approved behavior control program before they provide any direct client care. If you find yourself in a physical confrontation with a client and use any kind of physical interventions or techniques other than the hospital's approved program, even to defend yourself, you could be fired and even open to criminal charges. Please stick with the hospital policies/procedures!

    Best wishes with your new job -- I hope you will enjoy it!
  13. by   PFDGB
    I graduated in May 04, waited to sit for boards until Jan 05 because everyone kept telling me that I had to do med-surge first. I put everything off because I just couldn't bring myself to comit to something I really did not want to do. My interest and reason for going into nursing was to do psych nursing or Hospice Care (neither area will hire new grads). I went on my 1st interview yesterday and was told that few hospitals would hire a new grad in psychiatry. How do I go about getting into this area of nursing if I'm not given so much as an opportunity ? Could someone experienced in the field please give me some guidance as to how to do this....I was even thinking community nursing. Wherever I can go to get the chance to begin my nursing career?
  14. by   Blackcat99
    Quote from elkpark
    While I have not been employed by a state hospital, I did teach psych clinical for a few years at a nearby state hospital, and I have worked in psych at a VA and in a few "cushy" community hospital psych units. I have not observed one setting to be safer or more dangerous than another. I believe it depends more upon the staff, and their attitudes and training, than the type of setting.

    A word of caution about "self defense" techniques -- in my state, and probably plenty of others, the state dept. of mental health mandates that only behavior control techniques reviewed and approved by them can be used in psych settings. Your new employer will provide training in the de-escalation and physical behavior control techniques they want you to use. In my state, it is state mental health regs that all staff must be trained and certified in an approved behavior control program before they provide any direct client care. If you find yourself in a physical confrontation with a client and use any kind of physical interventions or techniques other than the hospital's approved program, even to defend yourself, you could be fired and even open to criminal charges. Please stick with the hospital policies/procedures!

    Best wishes with your new job -- I hope you will enjoy it!
    I don't work in state psych hospitals anymore. I worked at the state hospitals years ago when they were severly understaffed on a regular basis. I never had to use my own self-defense tactics. However, if I would have had to I would have. I'm not going to stand there and be permanently maimed for life because I might get fired for defending myself. The way I see it I have a right to defend myself period. Yes I might have gotten fired but who cares? I can always find another job or another line of work.

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