Is psych getting me down, or is just my unit?

  1. 0
    Hello friends,

    I've been working in an acute care psych unit for 6 months now. I'm feeling fed up with my unit. When I first got there I loved it. I really thought that I wanted to be a psych nurse. I came to work every day excited to be there, excited to work with my pts and help them however I could. But the more time passes, the more I feel dragged down by the unsavory aspects of my work place. the administration doesn't care about what type of pts we have as long as the beds are filled. my unit is more of a drug detox than a psych unit. The unit is "voluntary" but the ED tricks pts into signing in instead of being committed. The staffing is poor. The docs don't assess the pts, they wave at them in the hallway and bill them for a 20 minute session. People who med seeking linger in the unit for weeks, and pts who are still actively hallucinating get discharged. I don't know, I could go on and on with a list of things you have probably heard other people complain about.
    How long do I wait before I run? and where do I run to? I truly thought I wanted to be a psych nurse, and go and get my NP in psych, but I dont know what I want anymore. Maybe I'm just having a wake up call to the reality of bedside nursing. Or maybe it's just the place I work in now, and not every place is like this. Its just getting harder and harder to drag myself to work every day.
    Does anybody have any thoughts of advice?
    Thank you!

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  2. 11 Comments...

  3. 1
    it can and will get you down. Being a ex-psych nurse. its frustatring to see all your good work being down the toilet, when they go out for weekend passes, and return blitzed..why?
    the next of kin. In your unit, you have structure. Out in the cold cruel reality, there is NO structure. the patient usually winds up, being in their room or house all weekend. so much for rehab-ing.
    Perhaps, psych nursing is not for you. OR its the unit that is not for you. Similar to working in an office. BS nursing maybe be better. Try it!
    Davey Do likes this.
  4. 1
    Quote from cherubhipster
    But the more time passes, the more I feel dragged down by the unsavory aspects of my work place.
    We had a bad psych week at my ED. Suicide attemtps, OD, homicidal thoughts, and of course the ones that are working the system for meds. I got really run down after 2 days. Having to physically restrain pts is not my favorite. I worry about being injured every single time. I was at my ropes end after 3 days. Some of the Baker Acts we had were in our ED for 4 days, and a few were frequent fliers. In our ED, we don't try to dump pts, but we move them out ASAP. It is too hectic dealing with someone that is physically agressive and trying to keep the restraints on and dealing with 5-6 other pts. A sitter does what their title entails, and they do not help with care, restraining or verbally de-escalting the situation.

    All I have to say is kudos to those that work psych. It is demanding, physically but much more mentally. I could never do it. I commend those that work in this line of care. I know it is not easy, and I could not imagine it day in and day out.

    Maybe try floating to another unit every once and a while. And definitely talk to your charge nurse and/or nursing supervisor about staffing and doctor interaction. Yes they are psych, maybe demented or schizo, but they are still people.

    Good luck, and thank you for all you do!
    Davey Do likes this.
  5. 1
    Yes, consider a NP with a concentration in Child/Adolescent psych. Then join an emergency services team.
    Outpatient is a challenge, but rewarding. Many areas would welcome the Child/Adolescent psych NP specialist.

    As to the current workplace, depart as soon as possible. Its a danger zone ready to activate. You or your
    team could get physically assaulted and seriously hurt, the patients are most likely they are not safe and
    protected (low staffing) and that energy may boil over.

    Proud of the work you are doing, and best wishes to you that you find an environment that will appreciate
    you.
    Davey Do likes this.
  6. 1
    Oh my Cherubhipster. This was my experience also. 6 months into my shifts on everything from children's enhanced unit to senior psych care, I did not once see or hear of any success stories. I would most likely still be there had it not been for an merger buy out of the hospital and we were suddenly layed off. But the fact remains in my mind that all we do or can do is merely for the time the patient is there whether it is voluntary or involuntary. I did not see any remarkable patient scenarios play out. I felt bad for the pt that I was administering a Geodon gluteal IM with two MH techs holding him down on a tile floor screaming incoherently, and the 8 yr old that couldn't toilet properly because someone in the family had been touching him inappropriately. They all returned, sometimes three times in less than 6 mo. Sometimes I question the validity of psychiatric hospitalization, excluding near successful suicide attempt. The most draining units for me were the adolescent and chemical detox units. I did feel as though I was spinning the same tire in the same mud week after week. I did prefer psych nursing far more than any other area of nursing, but honestly do hear you speaking to me. It will remain the same. Perhaps can you look into maybe a specialty area of psych like eating disorder facilities or case management? Only a suggestion/idea. Best wishes.
    Davey Do likes this.
  7. 1
    This sounds like a poorly run unit. Be careful about your own safety-ie being assaulted. Since you want to be a psych np you can use the time you are there to learn about diagnoses, assessments, criteria for discharge, course of treatment, and med combinations. The nursing role should be the milieu, running groups, participating in treatment planning. When places get busy and crazy care suffers. You might want to interview at other places to see if there are more opportunities for you to develop skills and learn more about psych nursing. Good luck!
    Davey Do likes this.
  8. 1
    This could have been me writing this original post, I just resigned from my position in an acute care mental health facility (we do not call them "psych" hospitals in California because of stigma associated with it..), after only 4 months. My goal on a daily basis was to get done with my shift without being physically assaulted by the patients. The goal of the administration was to keep the beds filled and monies rolling in. There was not thought as to the type of patient that was being admitted. My favorites were the ones coming from the prison, this was a fast ticket out of jail to us if they stated they were having "thoughts to hurt themselves". Many times these patients were paranoid, and extremely violent. It was unsafe for staff and other patients.

    Nursing management was a joke. When I was first hired there was only an interim and she only stayed 3 weeks. When a permanent one was hired, she felt her role was to task nurses with more work, and what I mean, is filling out stupid forms, double and triple charting. Absolutely ridiculous. I always did what was best for my patients but could not give them the total attention I would have wished. I would run a therapeutic group BUT the paperwork afterwards to document every single thing would weigh us down so much that we often skipped doing the group, because we knew we could not complete the charting in a timely manner and NOT have to work overtime, which was a big NO-NO!

    The unit was full of behavior problems, NOT true psych patients. The behavior problems, drug seekers were very scary to work with as they knew the system and they knew how to get the staff in trouble. The last straw for me was when I had a patient have a seizure, who had no history of seizures. While we were tending to this patient, and calling EMT for an emergency room admit, 3 other "behavior" patients, decided to throw themselves to the floor, writhing and banging their heads on the wall, yelling.."is this what I have to do to get attention around here!"...and their idea of attention was receiving their constant diet of Norco, SOMAs, Vicodin, etc, etc...It was high stress. The patient that had the seizure is all right, but then our nurse manager asked me...What could I have DONE BETTER to prevent the other patients from acting out...SERIOUSLY??? you want me to control their bad drug seeking behavior.

    Also, psychiatrists who as ME how the patient is doing and then bill the patient for a visit without ever really talking to the patient. Saw that all the time.

    I am so lucky as I am also a PHN and have a new job as a case manager in the county health department where I live helping families find medical services for their children that need help. I start that job on Monday and I could not be happier.

    By the way, I am 55 and nursing was my second career. I loved psych nursing and was VERY GOOD at it and very effective, BUT, management was the downfall, and I figured they will never be pleased. I took a pay cut to take the job I have now, but it will be worth it. My advice, if you feel UNSAFE search for something else, do not put yourself through that, it is not worth it.
    Davey Do likes this.
  9. 1
    I'm so sorry you are feeling discouraged working in psychiatry. I think you are describing the barriers that are so often faced in psychiatry. I personally think that this may be a combination of the reality of mental health as well as a tough unit milieu. I'd certainly give psychiatry another try on another unit before throwing in the towel. Psychiatry can be so rewarding if it's where your passion lies, but the reality of health care today can really get you down fast. I hope you find the answer you are looking for soon!
    Davey Do likes this.
  10. 3
    I remember you from Past Posts! Who can forget a user name like "cherubhipster?

    First, I want to convey my empathy for this stressful time you're experiencing.

    However, you do realize that we grow in consciousness through trials, tribulations and the subsequent illuminating revelations. And there is no problem without the gift of a solution in your hand. We seek problems because we need their gifts.

    Next, the Previous Posters need to be commended for their appreciation of your situation and for their comments, ideas and suggestions.

    Finally, Neil Diamond sang, "Except for the names and a few other changes, you could talk about me- the story's the same one".

    I started out in Mental Health Nursing nearly 30 years ago and desparately wanted to get into the Medical end of Nursing. Somehow, I always ended up back in Psych.

    Even as a Nursing Supervisor for a Home Health Agency, I was assigned to initiate and supervise an "At Home Mental Health Program".

    It seems that The Fates had decided that I was to be a Mental Health Nurse. And, as you know, The Fates lead them that will. And those who won't, they drag.

    So, I decided to Bloom where I was Planted. I found things to like about My Work in spite of Negative Conditions. I memorized, and use as a sort of mantra, sometimes repeating several times a day: "My happiness does not depend on what others do or say or what happens around me. My happiness is a result of being at peace with myself".

    And in order for us to be happy, to be at peace with ourselves, we must adhere to our Principles.

    You do a good job, cherubhipster. You care about your Patients and the job you do. Everything and Everybody else are just Things and People you're gonna hafta learn to deal with. You can do it. You know you can.

    Otherwise, to paraphrase some of The Others: "If you can't stand the heat, get out of the kitchen".

    Whatever you decide to do, I wish the very best for you, cherubhipster.

    Dave
    Last edit by Davey Do on Mar 28, '12
    Leonurus, Meriwhen, and Whispera like this.
  11. 0
    I feel the same way on my unit most of the time. I barely have time to be therapeutic with any of my pts. I wonder where the docs are, how management can seem to be so oblivious, and the lack of commitment to staff safety floors me. I write in the books, chart, and pass things on so they can be addressed at team meetings. Nothing changes until something really bad happens. We are reactive instead of proactive.

    Still, I enjoy psych nursing. That one day where I do actually get to stop putting out the little fires and spend time with some pts reaffirms my commitment to them. Not that I don't haunt the want ads weekly, but it feels more like a stress reliever than an actual attempt to leave, lol!


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