Quote from windsurfer8
I would disagree with the idea that doing med surg is "just because". I did two years med surg when I got my BSN before switching to psych long term. I am telling you what I learned in med/surg stays with me to this day. For one..confidence. My assessment skills are top notch. I do not get nervous during medical emergencies. I went through endless code blues and I honed my skills. I learned how to give IM injections. I learned how to understand lab values. I learned how to place IVs. PCA pumps, NG tubes.
Now many of those things may not seem important working psych, but it made my confidence level skyrocket.
It isn't "just because" that many of us did med/surg first. Many do it to create a strong foundation to build off. I don't care what others do. That is their business. However I don't like the notion that people who work med surg for a year or two are "settling" or "have no choice". I made a decision based on what I felt would provide me the best skills for the long term.
Sorry, gotta disagree with ya on this one. I went into psych straight out of nursing school. In my experience, I never STOPPED looking at and understanding lab values, doing physical assessments, inserting catheters (mostly just straight cath though). My first job in a community mental health agency was more medical than psych. We had social workers and therapists to deal with much of the psych stuff. We were in charge of keeping the clients healthy. I learned more about health promotion and prevention at that job than any other jib I have ever head.
Psych patients get sick too. On average, the severely mentally ill die 25 years sooner than non-mentally ill folk. When I worked at the free standing psych hospital, we had no medical floor to send patients to, no ICU, no IMC. We had to be able to assess to a pretty good degree whether that chest pain or SOB was because of anxiety or because there was some cardiac problem going on. If it was the latter, we were SOL until EMS showed up.
I work on a psych unit in a general hospital now. We take pretty medically sick patients as well. We also take alcohol detox. Those patients get VERY sick quickly. I manage IV fluids, hang IV meds, do wound care, etc. About the only med-sug tasks I don't do are IV starts or NG tubes. Its actually nice we have respiratory to do neb treatments. I did them myself at the free standing. I think your physical assessment skills have to be pretty on point in psych because to get a doc to take you seriously you 1) have to prove to the doctor you know what you are talking about because most doctors think psych nurses dont know what we're talking about 2) Be able to have real, solid evidence something is going on because most doctors dont take the patients seriously either. Its always "just in their head".
Did I mention we do TONS of IM's? In my first job I ran an injection clinic where all the Pts on long term antipsychotics came to get their IM's every other week or every month depending on the med. You learn confidence in psych, at least I have. I have learned how to keep my cool in a crisis. I have learned how to be confident in my assessments. I have learned to manage my time. Having an assignment of 5 actively detoxing alcoholics can be pretty time consuming
Ive learned a lot of skills I wouldnt have learned in med surg. In my facility, 2 members of our team are required to respond to any code greens (combative person) in the hospital. I have foiund it very interesting how a lot of med surg nurses (we have a LOT of code greens on the medical floors) are just not able to de-escalate patients or even calm them down. From dementia patients climbing OOB to schizophrenics admitted for medical reasons. Half the time I show up and they are standing there like a deer in headlights. For example. we just went to a code last week wherein an actively hallucinating high fall risk schizophrenic was trying to get OOB and swinging at the air. We were able to get the situation under control quite quickly, and the house supervisor at night relies pretty heavily on us during any behavior in the hospital.
Dont get me wrong, I have much respect for med surg nurses. Their work is often thankless, and unsafe due to high ratios, but really if what you want is psych, I say go for it. When I went into school, I was pretty surprised that I immediately felt "home" during psych clinical LOL. I too felt like I needed a year of med surg, and believe you me, I tried. This was 2011 though and it was quite difficult for new grads to land that first job. It just so happens the position I was offered after umpteem interviews and resumes sent was with a community agency.
And if you really feel like you might want to branch out someday, I would advise anyone to work on a psych unit in a general hospital. Units are much more likely to put in the time to train internal transfers