Don't be a Psych nurse if..... - page 2

I've seen a lot of questions from new grads re: psych nursing. In that vein, I offer up the following: Just because you want to go into psych nursing doesn't mean you should. Stay far away... Read More

  1. by   IMustBeCrazy
    Quote from Meerkat
    Many people are drawn to their specialties on account of personal experiences. And no matter where you work, you develop relationships that often lead to sharing experiences.
    We call this having "boundary issues" on my unit.
  2. by   IMustBeCrazy
    Forgot to add...

    Psych nursing is not about YOU and YOUR experiences...it's 100% about the patient and their experiences.
  3. by   rn/writer
    Quote from IMustBeCrazy
    Forgot to add...

    Psych nursing is not about YOU and YOUR experiences...it's 100% about the patient and their experiences.
    As a former long-time psych nurse, I couldn't agree more. I took your original post to mean, "Don't choose psych because you want to be the center of attention. Or you can't keep your own issues from surfacing. Or you think you will fit right in with the patients and be their buddy. Or, by osmosis, you'll somehow get the care you should be getting on your own time from your own practitioner."

    There are many wonderful psych nurses who have worked through all kinds of "stuff." Eating disorders, mental illness, PTSD, substance abuse. I had to fight my way through debilitating depression before I could go to nursing school. Many of my co-workers had psych history and some had ongoing diagnoses that would be with them for the foreseeable future. No one was anywhere close to perfection.

    The difference between the good, effective nurses (and docs and techs and social workers) was an unshakable awareness of boundaries AND an acceptance that a therapeutic relationship cannot ever, by definition, be mutual. In other words, while you can be there for the patient and both of you may act in a friendly manner, you cannot develop a friendship in the typical sense. A therapeutic relationship requires caring without the need for reciprocity. It also involves challenging patients, telling them things they may not want to hear, holding them accountable, and helping them to realistically evaluate their progress. As soon as the caregiver's emotional needs enter into the picture, the therapeutic aspect of the relationship is lost. The focus is no longer entirely on what the patient needs, having now shifted to include the practitioner as well. This can lead to inappropriate bargaining, staff splitting, and over-dependence in either direction.

    Ineffective, even downright damaging, caregivers often have a conflict of interest between meeting their own needs and meeting those of their patients. There is potential for harm even when the needs converge as this can lead to a feeling of collusion between the staff member and the patient. Unhealthy attachments can form and the naive or the calculating can use such alliances to meet their own needs at the patients' expense.

    Practitioners who have current or ongoing issues need to make very sure that they are receiving adequate care away from the unit. Ideally, there will be healthy oversight and accountability so that if someone is starting to cross the line, caring co-workers or managers can address the situation and change assignments or do whatever else is necessary to help the staff person get back on track.

    Caregivers who have worked through their own psych issues sufficiently can, under select circumstances, share their experience in a way that lets patients know that this person, a) does understand what they're talking about, b) will not be easily fooled, and c) represents the thought that they can hope for a meaningful future.

    Again, this has to be handled judiciously with the patient's well-being as the first and only concern. No glorifying past unhealthy behavior or getting into arguments about whose experiences were worse, etc.

    Bottom line--get your own needs filled on your own time. When you're at work, keep clear boundaries and maintain a therapeutic relationship in which the roles of patient and caregiver are exceedingly clear.
  4. by   traumaRUs
    Miranda - you are so right! This is so important but especially in psych. It is not about you, its about the patient.

    Personally, I think this can be stretched to fit just about every nursing situation: its not about self-disclosure of most personal matters.

    I was with another nurse yesterday who is "friends" with some of our shared patients. They know her entire life history. I found this to be bizarre - my patients know my name, but beyond that, my care is about them, not what I do in my life.

    There are also safety issues involved with self-disclosure.
  5. by   abbythetabby
    Thanks for your post, IMustBeCrazy. I'm considering going into psych nursing when I graduate in a few months. I think your guidelines are very reasonable. At school, they teach us that you really have to know yourself and your opinions before considering a psych career.
  6. by   Meerkat
    Quote from IMustBeCrazy
    We call this having "boundary issues" on my unit.
    We call it appropriate self-disclosure for the patients' benefit.
  7. by   elkpark
    Quote from Meerkat
    We call it appropriate self-disclosure for the patients' benefit.
    Well, y'all can call it whatever you like , but I've been a psych nurse for a v. long time (10 years as a staff nurse, 12 as a CNS), and I've very rarely seen staff self-disclosure be therapeutic for clients. In nearly all situations I've known of, it is about the staff person's issues/needs, not the client's ...
  8. by   traumaRUs
    Self-disclosure crosses the barrier of patient/nurse. You should not be self-disclosing of any information remotely personal. Occasionally, I have commented that I live in the country and the drive through the snow took longer. But that is all! My patients don't know my husband's name, my son's issues, my family information at all. And...that is the way its staying.
  9. by   risabovit
    Meerkat, I am considering a change to psych nursing, and very much appreciate your encouraging remarks. Thank you. Hospice RN
  10. by   nursesaideBen
    Quote from traumaRUs
    Self-disclosure crosses the barrier of patient/nurse. You should not be self-disclosing of any information remotely personal. Occasionally, I have commented that I live in the country and the drive through the snow took longer. But that is all! My patients don't know my husband's name, my son's issues, my family information at all. And...that is the way its staying.
    I totally agree. While it's true that a lot of times we choose our path in nursing based on our own personal experiences, it simply isn't appropriate for your patients to know about you. We're not here to be friends with our patients, we're here to be their care givers and to help them with their issues. I get very uncomfortable when patients ask personal questions simply because it's not appropriate for them to know about me. Just my opinion
  11. by   PMHNP10
    Quote from Meerkat
    We call it appropriate self-disclosure for the patients' benefit.
    Self-disclosure is not particularly something I'd recommend, but if you insist at least be aware that with the psych community you could be disclosing something to someone who can interpret what you say in any number of ways, react accordingly, communicate what you say to other who can then re-interpret how they want, and what you considered an innocent, therapeutic self-disclosure ends up biting you in the hind.
    For example, say you have a previous Dx of any Axis I d/o (even though you've been treated and continue treatment), and somehow share that info w/a pt.; and let's say you haven't disclosed that info. to you BON, but it somehow gets back to them...guess what, you're in a bit of trouble. An extreme example, I know, but when it comes to folks who are hospitalized for psych issues, I find the boundaries for extremes are widened more and more.
  12. by   WANTAFUNJOB
    Psych Nursing is facinating! And, as in everything else, there are different areas of psych nursing which some nowdays refer to as BEHAVIORAL HEALTH! (I had a mother get angry with me for saying that her child was admitted to a psychiatric ward.) Do you want to work with the children and adolescents or with the Alcohol and Drug/Chemically Dependent or would you prefer and Adult Psychiatric Unit or perhaps Gero-psych.
    My personal advise would be to attain some good Med-Surg skills prior to going into Psych. Basic med-surg skills will play into any area that you choose as a specialty. You need these skills. Lots of Nurses skip over this very basic step and later do not feel qualified to do a lot of jobs because of not having good basic skills. I feel that it would be harder to go back and get these skills later. I personally started out in NICU. When my husband transferred and I took a job on a med surg floor it was like starting all over.
    People expect a nurse to have certain skills. You are really not able to develop those skills in some specialty areas.
  13. by   JeanettePNP
    My belief is that all patients should be treated with dignity and respect, whether they're admitted for psych issues or any other type of treatment. While there is no reason to disclose intimate details to a patient, I see nothing wrong with "personal" information like, I'm married, I have a daughter, I like the color red (assuming that it comes up naturally.) Refusing to discuss anything even remotely personal can come across as unfriendly, especially if you have a long-term relationship with this patient.

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