Interview this week in Acute Adult Psychiatric Unit!

[kingvonnBSN2017]

Good day Nurses!

I am a new graduate unhappily working in med/surg. The unit is not that bad, I just know it's not where I want to be and where I plan on continuing my career. Fortunately, I was offered the opportunity to come in for an interview in adult psych this week and I am so excited. Mental health has always been a HUGE passion of mine and I am so happy that I get this opportunity. Growing up with a mental illness was very tough but allowed me to be empathetic to people who are suffering from mental illnesses. The only issue that I am having is that I used to be a psychiatric support technician in an acute adult unit and let's just say...it didn't go so well.

I loved it when I started, I loved the patients and I loved the environment. Unfortunately, I wasn't properly trained and there was a predicament where I was thrown a cup of water on my face and was called some very bad things from one of the patients and I did not know how to react. I ended up quitting eventually because I was in shock and wasn't prepared, I regretted it weeks and months after that.

I want to be prepared this time, I want to thrive in the field of mental health because I know it is where I see myself forever to be honest. I want to be more prepared to handle insults and manipulation from patients and what to do when patients are rude and tend to be aggressive. I want to care for this vulnerable population and be the best possible nurse I can be. Any advice to help a new grad become a successful psych nurse will help! I've read numerous posts from the psych nursing board and love reading everything. I am very excited about this opportunity. Thank you guys!

[kingvonnBSN2017, BSN]

If it were me, I would take adult pysch over geriatric. As the poster above stated, geriatric psychiatric patients with medical issues can be a handful. I find it difficult to deal with them in med-surge, and I don't have them as patients on a daily basis.

It's good that you'll get five weeks orientation. If you take the job, don't let them push you out on your own before you are ready.

I would also ask to shadow a shift. That will give you a real feel for the job. I did that with my current med-surge position. It gave me a chance to see the work flow and how nurses interacted with one another.

Just something to think about.

Good luck, and let us know what you decide.

Yeah, I definitely think I may be up for this challenge. I know it's definitely going to be tough but I have such a soft spot for the elderly and mental health together so I feel as if this may be ideal. It's only this year when I realized there are geriatric psychiatry units. I guess it could never hurt to keep up with med/surg skills. After this interview tomorrow, I'll have a better idea or what I may lean towards.

[kingvonnBSN2017, BSN]

I feel like it's like working a nursing home but with extremely aggressive patients. My facility takes the worse of the worst that no other place can or will handle. I'm a float, you couldn't pay me enough to work that unit full time. God bless my coworker's who can though.

In my facility, the techs on that unit are responsible for cares primarily--CNA type stuff. They're also responsible for going hands on if needed, such as if a patient needs to be secluded for their own safety and the safety of others on the unit. The nurse's job is to do assessments, give meds, treatments, give IMs if needed, obtain orders, review orders, and oversee things. I'm a noc RN, and our geripsych unit is an admission unit so we get admits at all hours of the day or night. There's usually 2 RNs on, sometimes 3. Techs can range from 4-6 or more, depending if we have any 1:1s and suicidal precaution people. We have 17 beds. This unit is more physical than any other, and that should tell you something considering our population is forensics.

What's the most difficult part for you in geropsych? Is it the medical tasks, the aggression? I'm curious, other than the high medical aspect in geropsych, what else is different compared to adults?

[kingvonnBSN2017, BSN]

On day shift, its 13 patients to 3 nurses and 2 techs and night shift, its 13 patients to 2 nurses and 1 tech. Does that sound like a safe ratio?

[GeminiNurse29]

What's the most difficult part for you in geropsych? Is it the medical tasks, the aggression? I'm curious, other than the high medical aspect in geropsych, what else is different compared to adults?

For me, it's the aggression. By nature I'm pretty mild mannered and calm, and it can be unsettling at first to deal with combative patients. But at least with old folks, they have some underlying medical issue, usually dementia, behind their behaviors. For adults, they're more stable medically but you get a whole mix. Throw in the forensics aspect that I deal with and it can be a **** show.

How medically complex are the patients you get? That ratio sounds kind of unsafe. And if you get admissions, it can be a real headache. We usually run with 2-3 RNs and 4-6 or 7 techs depending on if we have 1:1s, suicidal patients, -'d medically needy like we've had cancer patients and such.

[kingvonnBSN2017, BSN]

For me, it's the aggression. By nature I'm pretty mild mannered and calm, and it can be unsettling at first to deal with combative patients. But at least with old folks, they have some underlying medical issue, usually dementia, behind their behaviors. For adults, they're more stable medically but you get a whole mix. Throw in the forensics aspect that I deal with and it can be a **** show.

How medically complex are the patients you get? That ratio sounds kind of unsafe. And if you get admissions, it can be a real headache. We usually run with 2-3 RNs and 4-6 or 7 techs depending on if we have 1:1s, suicidal patients, -'d medically needy like we've had cancer patients and such.

The nurses told me that there are IVs, ostomy care, wound care, diabetes, htn, antibiotics, alcohol detoxification, things like that. Each nurse will have 4-5 patients, doctors are there until 5. The aggression is probably the hardest aspect of the unit, but I am so ready to learn how to care for the elderly with mental health issues and how to handle an aggressive patient. That's what I really want to accomplish, I am pretty sure it will take some time.

[HumbleBuddha]

Hi, worked as mental health advocate on psych wards in uk for 4 years now. Without Vipassana meditation no way I could stay calm and not personalise things. Keeps me grounded, grateful and client centred.

Anyone working in this field needs some spiritual cleanser, be it Reiki, meditation or yoga. Important to detox before and after working day. Lots of processing done during sleep and morning meditation really helpful.

Good luck with new job. Hope you find your fulfillment. You sound like a nice person with right attributes...í ½í¸

[HumbleBuddha]

.....

[BigBrownPotato]

Hi. I have 3 years of experience in a Max Security Psych hospital. My tips for you are:

1. Get a decent shoes. You'll be chased by some psychotic patient LOL

2. Don't take anything seriously. If a patient insulted you just shrug it off. These patients are mentally ill.

3. Learn how to differentiate medical and psych emergencies. Some are fake and some are real.

4. Don't leave your pens around!!! (personal experience)

5. Have fun! Take care of yourself and be sure to destress.

[PixieRN1]

I work geropsych. I really enjoy it. That being said, I get screamed at daily, called all profanities and measure of very personalized insults, get threatened physically daily, and routinely get swiped at or slapped/punched at, but I'm quick on my feet and dodge fists well. It's very typical to have a hot cup of coffee thrown my direction a few times a week. Sometimes they develop a Incredible Hulk move and chuck a tray table at me.

Remember, dementia and Alzheimer's can happen in people's 40's, so you may have some burly, strong 50 year olds on your unit who are confused as hell but still physically able to take you out. Also, we get ALOT of indigenous, homeless folk who basically are violent on the street and end up threatening suicide to the cops, but they are over 59, so they get plopped on our unit...acting very violent and not so much suicidal.

One doc calls this phenomenon the avoiding jail, three hots and a cot”. They act out, end up chemically restrained, simmer out, and when they don't demonstrate active suicidality, unfortunately, they get discharged back to the shelter. 30 hours later, yup, suicidal again, and back on the unit. Lather, rinse, repeat ad infinitum. The system is broken.

Gero won't save you from intimidating scenarios, crappy outcomes, frequent flyers, and people who are pulling a fast one. There is so much patient drama, the unit is nicknamed The Young and the Restless Unit”. I mean, a elderly schizophrenic lady and a prone to violence 50-something year male with dementia trying to forge a romantic dalliance on night shift, only to both fly into a physical, violent rage when they weren't allowed to get it on. Two codes for one unit at the same time with one nurse and one tech! Oy vey!

I'll be honest, gero is awesome. But you need a very thick skin and you need to be able to be firm, set boundaries, and enforce them. These are mentally ill adults and it's very sad to see the state they are in and it's not really a warm fuzzy” unit. Gero's can have borderline personality, raging bipolar, schizophrenia, antisocial personality, and most mental illnesses that the younger folks have; and sometimes you get to add dementia to that already challenging diagnosis.

I'm NOT trying to scare you off, although it may seem that way. But if you quit over water in your face, you need to understand that that kind of behavior is quite common on gero. You learn how to keep your personal space safe, stay at a safe distance, and absolutely keep your personal emotions under lock and key.

I love it because it's fast paced, your moving all the time, I do enjoy adrenaline so the drama suits me, and I'm a bit of an emotionally blunted person, so threats and insults don't get to me. It's a nice blend of sweet and sour” patients.

I am concerned about the medical acuity you mentioned. The most invasive thing we do is IV fluids and antibiotics. We will do maintanence CPAP for sleep apnea if it's not a new thing. If they need blood, a temporary foley, or anything more advanced, they move to a medical floor. Our ratio is too high to do much more safely.

Our ratio is team nursing, so 12 patients, one RN, one LPN, and maybe a Tech if staffing is good.

Good luck in your choice!

[NPvampire, MSN, RN, APRN]

I've been in psych for 11 years now, going strong.

#1 if you've ever read harry potter, "constant vigilance!" Never forget where you are or why the patients are there. They did not get to the hospital by an accident. They are there because they have a history of instability or violence to themselves or others. Do not assume because they talk sweetly or are intelligent, and so on that they will not beat/mess you up. It is like jail in some ways.

#2 Avoid power struggles. The old saying - don't wrestle with a pig, you both get dirty but the pig likes it? Yeah, that applies to psych too, especially the axis 2 population. You will never win and it will only get ugly - 90% of violence I have seen was due to a power struggle that could have been much avoided. Know and use your hospital policies and stand by them.

#3 pick your battles. You will learn when to intervene and when to let things go. I have also seen the worst violence start over trivial things that were not a threat that staff felt required that level of failed intervention. For example, consumer has a plastic paper clip and threatens to kill himself. He weighs 100 pounds and is a foot taller and 10 years younger than the fittest staff you have on hand that day. The staff attempted to rassle it away, and ended up with 3 grown men in hospital and woman with permanent kidney damage. Patient didn't get a scratch. He also didn't kill himself. That wasn't worth the threat.

Now, second case, patient goes into seclusion and ties her clothing around her neck and is turning blue. That is where you will have to intervene, the threat is real, even if she went into seclusion for an attack on staff.

#4 As in any nursing job, take care of yourself, and do not allow the employer to work you to death/like a dog!

[kingvonnBSN2017, BSN]

Thank you all for the wonderful advice, all of this is going to help me greatly! I was offered both position, but I accepted the adult unit. I am so excited to start my career in mental health!

[kingvonnBSN2017, BSN]

Actually, it's pretty funny. The patient who threw the hot water on me when I was a tech at another hospital, was a patient on the unit I interviewed for.

But altogether, it seemed like a very good unit with good security. The patients are medically cleared. It's 19 beds and each nurse gets 4 patients.