I'm a psychnurse in a state facility. We have 1 psychologist for every unit (9 units) and there are usually psychology interns helping as well. On my unit, which is an acute civil population, the psychologists meet with the patients (1 to1) who have been through trauma or if they need grief counseling and also when the psychiarist refers a patient for testing (MMPI, etc..) until their discharge. On the longer-term, forensic units the psychologist runs (among other things) a Restore To Competency program and is half of the Forensic Review team and/or half of the Risk Assessment team. All psychologists and interns run two-three groups a week that are broad and generalized information usually about anger management or coping skills and sometimes just discussions about mental illness diagnoses. RNs are also required to do 11 groups per week. Topics include; illness and symptom management, medication education, smoking cessation, substance abuse/mental illness and coping skills.
The sad truth where I work is that the groups are desperately needed and could be the most important piece of patient care that is lacking. The reality is that the RNs are so bogged down with redundant but required shift notes, treatment team and treatment plan updates, admissions and discharges, MD orders, management of behavior issues and stat medication, medical monitoring, staff management and patient families (and much more that can't even be listed). Rollerskates couldn't even help ease my load on any given day. RNs have a piece in everything... but we're spread so thinly that there is almost never a time when I can relax and engage in a group effectively... so I hate them. We meet our requirements most of the time by plopping in a DVD or handing out some info sheets or giving patients some art activity to color. Its really bad. It's also frustrating because I know there are staff who wish they could do nothing but groups all day but they need some training/education so they don't just randomly make up things that aren't based on fact or sometimes even consistent with unit rules.
In my opinion, the counseling and talk therapy is what nearly every patient desperately needs for one reason or another but they need it long term. If they get it in the hospital the one area of focus should be about what they need to know about obtaining it, what to get out of it and sticking with it after dischargebecause seeing a psychiatrist for 15 min a month to renew their medication doesn't address their other issues. Apparently there's a conflict of interest that prevents a hospital psychologist from seeing patients outside of the hospital in private practice and we don't have any hospital-run, out patient support groups. We don't even know or communicate with community agency counselors, beyond some of the case managers at discharge. No continuity. So this population of uninsured, mentally-ill people who are very vulnerable to physical, sexual, emotional abuse and exploitation rarely get exposed to resources and effective therapy to improve their situations at all. (I have always wanted to do something to focus on women's issues and relationship counseling, maybe even mother/baby wellness for our female patients.)
My best advice is to try to think about what you wish to be your main focus. As an RN the work will be fast paced and while it is quite often rewarding and the money IS fairly good, it's also exhausting and can be frustrating because of a ridiculously dysfunctional chaotic system. I believe that with some thought, organization and diligence you could create a niche for yourself. Possibly find a way to make a dream job within a community psych agency serving the mentally ill by counseling them outside of the hospital. If you were near me I'd team up with you and refer clients! Or brainstorm for a better way. Good luck to you.