Do I NEED Med-Surg training to be a psych nurse? - page 2

I'm sure this has been posted a gazillion times before, and I appreciate in advance any replies! Do you guys think that psych nurses need experience in med/surg before going into psych nursing? ... Read More

  1. by   CHATSDALE
    I work psych and i would say that over 90% of our residents have a chronic physical ailment....whether cause, result, irrelevant to issue who can say....but you need to know what to look for...esp in dealing with pts who are confused and unable to articulate their needs and/or pains....if you choose to go into psy ch you may not need a lot of M-S internship but you must be observant to the needs of those who depend on you for care
  2. by   Thunderwolf
    Do you "have" to have Med Surg experience?....the answer is NO. However, the best psych nurses that I have had the pleasure to work with have had previous medical or med-surg or critical care experience under their belt. Psych patients rarely are "just" psych patients. Many have genuine physical health care problems that need addressed concurrently with their mental health problems. Often, you will see an overlap between the two. Nothing is more disheartening than to work with a fellow psych RN who has a very poor knowledge base on assessment and interventional skills with regard to common physical ailments...such as CHF, asthma/COPD, sepsis, diabetes, dehydration, anemia, TB, liver disease, substance abuse, head injury, stroke, pneumonia, etc. No, you don't "have" to have med surg to be a psych nurse. But, at least, consider broadening your skills beyond just psych. Your patients are more than just psych patients. I've met my fair share of psych nurses who treated the psych needs but the patient crashed and burned physically because of not assessing or knowing how to assess the tell tell signs of physical problems for days. To my shock as well, I've had the poor pleasure of having some psych RNs tell me that "If I wanted to be a medical/med-surg nurse, I would have been one". Personally, I think all psych nurses need to have a good working knowledge base on physical assessment skills, critical thinking skills that if patient "A" has CHF...I need to assess for such and such, blood lab skills regarding chemistry and other blood lab value normals, ABG ranges and does that patient require some Oxygen?, basic understanding of EKG results (due to cardiogenic effects of key psychotropic meds), and so on. Education is an ongoing process. I've worked both sides of the fence. Some of the better med surg nurses have been previous psych nurses. Some of the better psych nurses have been med surg nurses or such. What counts is that you are well rounded. Sometimes, having the knowledge base of physical health problems, how to assess, and how to intervene, may help a psych nurse to better understand why that patient has had a change in mental status in the first place.
    Last edit by Thunderwolf on Oct 10, '04
  3. by   EarthChild1130
    Well, that makes a lot of sense to me...I'll be honest with you...I think the reason I'm feeling intimidated by med/surg so much is that this clinical has been nothing but endless paperwork!! I actually love doing the 'technical' stuff but the paperwork is altering my view of med/surg in general LOL...

    My teacher told me something very interesting today...she said 'You know, 2 areas of nursing that you'll NEVER get away from are med/surg and psych...You'll always have med/surg issues with your psych patients and you'll always have psych issues with your med/surg patients'...

    I think I would like to do at least a little med/surg, for the experience...My psych teacher from last semester also suggested that I work primarily as a psych nurse to begin with and also prn as a med/surg nurse...she suggested that I talk to potential employers about that...We'll see!

    Thanks for a great post...I appreciate it!
  4. by   normj
    I just started my first RN job on a med/surg floor ... and spent all of last night dealing with the typical shenanigans of a galloping borderline who has a multitude of medical issues.

    Orginally got into this because I want to be psych nurse ... and I am already glad I have chosen to do med/surg first. I'll probably do no more than a year because I am not happy with my current unit, then switch to psych.

    Quote from EarthChild1130
    I think I would like to do at least a little med/surg, for the experience...
  5. by   Thunderwolf
    Normj, hang in there. Your med surg experience will come in handy. Borderlines, they are like the bread and butter of acute psych. Just be grateful that you have your limited exposure to one now on a med surg unit. When you become a psych nurse, imagine having several on your unit every day, planning to make your daily life interesting. But, in all seriousness, Borderlines can be great teachers. They show you what skills you still lack because that is their job to expose them...with great relish.
    Last edit by Thunderwolf on Oct 12, '04
  6. by   Gompers
    I would say yes. Some hospitals I've worked at not only had regular psych units, but also detox or med-surg psych units. Having some basic med-surg experience in your pocket will help down the road because you ARE going to be responsible for these patients and if they have other medical problems, it's up to you to find them. Don't forget that in general we have an aging population with multiple medical problems, and that there are psych patients of all ages that do not take care of themselves...

    Now, I ran into so many great nurses during my nursing school clinicals, especially in psych - they were awesome psych nurses!!! BUT the only time I was "that annoying know-it-all student" was one day during my psych rotation. This was a regular psych unit, and one of my patients was an older man who was scheduled for once a day vital signs - and on paper, they looked fine for the two whole weeks he'd been on the unit. But when I checked him out, I immediately noted a heart murmur and wildly irregular pulse. I told the nurses and they seemed surprised and annoyed, saying "everyone else has reported his vitals as normal," and trying to brush me off. Well, by the end of my short clinical day this guy was transferred to CCU, and the cardiologist who came up to check him out told me this wasn't an acute problem, but something chronic that had been going on and he couldn't believe it took a nursing student to notice something.

    Again, this was just ONE incident, but it always sticks in my head.
  7. by   Thunderwolf
    Gompers, you provide an excellent example as to why physical assessment skills are important on a psych floor. Probably why the cardiologist couldn't believe it took a nursing student was because seasoned nurses should have picked this up and documented it. Your intellectual curiosity is what sharpened your skills. Don't lose it. Intellectual curiosity is the beginning of critical thinking. Good job. Like any muscle, if you do not use it...it atrophies. Unfortunately, in psych, you may find a lot of weak, flabby muscles on staff.
  8. by   lcsw2aprn
    Our DON will not consider anybody without 1 to 2 years general nsg experience. That having been said, we are understaffed and have a lot of dead weight, because she can not afford to train anybody. Then if and when anything medical turns up all the nurses panic and ship the patient off to a "real hospital."

    I was hired at another hospital on a PRN basis the day after I passed the NCLEX. Some of the older nurses gave me ****, excuse me... all of the older nurses give me...... but I understood that they were just eating their own and in time they would come to love me,.... they were and they did!

    In my opinion, give me a new grad and I would train him/her.

    Al
  9. by   Hukilau
    I never did a day of med/surg nursing after school. But I have been fortunate in working on psych units with a good mix of nurses who have always done psych and those who have a lot of experience in other areas and have come to psych recently. When teamwork and trust are working properly the combination of skills of 3 or 4 nurses can handle just about anything.

    LOL, but if I were forced to answer the question, I would say YES, get a year of med/surg if you can stand it! For one thing, I have always envied the nurses who could, if they wanted to, float to a medical floor during low census on the psych unit. It would be dangerous for everyone if I did that!
  10. by   Birdie RN
    That one year med-surg exprience has helped me- trust me -I only did one year and really hated it, I am glad I did. I wish I could of done more but iIthink I would have required hospitalization myself if I had!
  11. by   EarthChild1130
    What I have found interesting during this rotation (OB/Gyn) is that some of the hospitals here have floors specifically for GYN surgeries, which is interesting to me...perhaps I could do a year of THAT type of med/surg and then hit the psych floor running...

    I am starting to think that no matter how hard I try I can't get away from med/surg LOL...so I think I will try to do at LEAST 6 months of it before my psych job, unless I can get a job where I can do psych primarily and float down to med/surg (or something)...Thanks for all the replies on this thread guys...I really appreciate everyone's point of view!!
  12. by   Interested Party
    Hi, I am a comprehensive nurse with a grad dip in psych working in Australia. When I was doing my Bachelor of Nursing, I indicated to some nurses that I would prefer to work in psych, and was advised that I should do med/surg first before 'retiring' in psych. Since I cannot resist challenge, I started in psych and then did one and a half year in a number of med/surg wards and I yearned for psych all that time. I have now gone back to psych but the experience med/surg gave me was/is invaluable. I can now relate to med/surg nurses' frustrations with psych patients and vice versa. And I am able to be a 'real' nurse when the need arises. The hospital I work for allows psych nurses to be seconded to med/surg if the nurse request it.

    My advise..............if you are passionate about psych nursing, do psych first and then venture into med/surg part time or PRN, if possible. Hope this helps.
  13. by   midnitelpn
    w/psych, you gotta be familiar w/it all....usually psych pts have a co-morbitiy of some sort! is their mental illness being exacerbated by an underlying medical condition? etc. does the facility you plan on working at detox on their psych units? some do.... the potential for a medical emergency can arrise at anytime, any unit. i went fresh out of school to an acute psych unit that detoxed, so i got alot of that type of exp. right out the gate...iv's, frequent v/s monitoring etc... s/p gsw's, stabbings, ingestions of foriegn bodies etc, etc, etc....then your iddm's, copd's, htns,reactions to medications, nms, sz disorders...the list goes on & on.... the meds in psych have numerous side effects & interactions (most all meds do i guess)i dont feel i needed any med-surg, as i am an lpn & my practical in med-surg was long & extensive and the last rotation i had, before going to work as a gpn, a week after graduation. also as i said, the facility where i work, exposed me to alot of medical in the psych setting..and still does....you will always gain knowledge from any experience...

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