New to psychiatric nursing and would love any and all advice/suggestions!

[LilRedRN1973]

I am brand new to the world of psychiatric nursing and am finding it VERY interesting. I have had several years experience in trauma ICU, then about 6 months of dialysis. So obviously, my knowledge base is very limited when it comes to psych. I have just started a new job with the state in an outpatient medication clinic. I will be seeing patients who are somewhat stable (when on their meds) but would eventually like to move over into the inpatient hospital down the road. We deal with a lot of CD when it's co-occuring with a mental illness but I am getting the impression that the main focus of this facility is with the mental illness. I have a pretty good foundation with the CD/recovery but none with things like schizophrenia, severe depression, personality disorders, etc.

I would love to hear from those who have experience in this fascinating area of nursing and especially advice on how to survive! And if anyone has suggestions on good books to read, websites, etc., I would love those as well. Also, I would like to hear some personal stories of how to handle agitated/aggressive patients and how you de-escalated the situation. I'm very nervous about not handling that kind of situation correctly and putting myself in more danger than is necessary. I took a class today on Crisis Prevention and Response Training where we learned how to deal with the more heated situations but I would like to hear from those who have been in those situations and how they handled them.

I already know I'm going to love this job and it's a type of nursing I've never done before. Very interesting, never boring, and I love the feeling that I'm truly helping these patients. I never thought I'd end up in psychiatric nursing but I'm very glad I'm here! Thanks in advance for any responses!

[msslim]

Congrats Meriwhen on your new position in psych nursing. I hope all goes well.

[bringtherain]

be openminded - compassionate - yet firm. Stick to the rules. Some pts will try and split staff and manipulate. Treat them respectfully, but remember - there is a REASON they are in the hospital. They are not well, as normal as some of them seem. Do not be trusting of them - because the second they see you trust them, they will run with it.

Encourage participation in group activities. Some are there because they are there under warrent or the family had them admitted. They feel like they should not have to do any of the activities. This gives them a feeling of superiority over the other pts. This can be harmful. It may also cause them to become more isolated and depressed. Once they start participating - they will learn the other pts - and gain coping skills.

[bringtherain]

Also, do not show them fear - even if you are intimidated by them. During a psych crisis you need to be quick to act because things can easily break out into a code (fight) You are the nurse, you are in charge and not them. You are here to help them. You need to be able to make quick decisions about PRNs or the choice to restrain or seclude. Be ethical, and be SAFE. Pt saftey is FIRST. Worry about the details later.

Also, practice communication, ideas for coping skills, and verbal de-escelation. When a child is holding a chair in the air- ready to toss it at you - clear the room, and TALK to them. WHY are they upset. What can you do to make them calm. What do they want? How can they achieve what they want without throwing the chair.

And pay attention to them. There will be some that just want attention, but you will learn to see who really needs to talk or not. Sometimes a pt will act out violently because they didnt get attention or someone to talk to when they needed it - sort of "look, i have your attention now - now you have to listen to me"

And be positivie! It really is interesting and fun at times :]