Psychiatric nursing... do you really lose all your nursing skills? - page 2

by lilmoongoddess

24,286 Unique Views | 41 Comments

Hello! I'm a new grad and I have accepted a position on the inpatient unit in mental health. I'm excited to start my career in this field, but I have a question for those who have or already work there. I keep hearing rumours... Read More


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    psych nurse! My first day on a psych unit, I showed up with a stethoscope and a pen light, everyone on the unit made fun of me. You can literally go for days in a psych unit without touching a patient, talk less of performing any skill. The only thing you get out from a psych unit is communications skills which turn out to be slightly different from a regular medical unit and maybe mastering all kinds of psychotropic drugs.
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    When I was studying nursing I worked in psych care. I found the nurses around me had no idea on the stuff I was learning as they had lost their medical practical skills (and replaced with the psych practical skills) as well as some other information that we get taught.
    As you are new, and your skills are new, you may loose them quicker. They need to be practiced before you loose them.
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    In my 9+ years in the one of the three local ER's here only once did a nurse from our psych unit try to transfer to the ER - she stayed for 1 hour and requested to go home, she stated to us that the ER was too hectic and she was not comfortable with our medical protocols. We had sets of protocols to follow for say kidney stone patients, shortness of breath, chest pain and so on. The nurses often had to start treatments prior to the physician seeing the patient.

    When I was in nursing school after my psych rotation I was asked to specialize in that area because I had such a good bead on PTSD, the topic I chose for my paper. I was able to get Vietnam Vets to open up about experiences they had during the war they had never opened up about before. I declined. However that ability served me well in the ER.

    I went straight to the ER after graduation, had a 3 week orientation on days and then went to nights and there I stayed. I was sent to the psych unit several times for "emergency" situations - they did not keep a crash cart in the unit we had to bring it from the ER. I and others from nights routinely went to start IV's and to transfer patients back to the ER if they needed advanced care.
    All that being said, depending on you and your interests and strengths, try to get into the area of nursing you want to do for a long spell of time. Perhaps you can "float" to the ER or to another unit? But I will say this - nurses that came to the ER from other units in the hospital I worked in never stayed - their biggest complaint was - too busy! (Had I not developed a severe latex allergy I would still be in the ER).
  4. 1
    Not much left to add. Good advice especially the NO EXPERIENCE IS WASTED!! I've wanted to tat something like that on some co-workers who made fun of my unit (Adult total joint) not being real Nursing.
    Meriwhen likes this.
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    The inpatient psych ward I worked on had yearly skill checks for all staff that matched the med-surg area (that's where we had to do our check list). We were required to stay IV certified and attend all in-services that the other RNs had. I mean seriously...how hard is it to put in a foley.

    I think it all boils down to the psych unit itself and how well educated the RN is.
    rainyn, pyriticsilence, and Natkat like this.
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    I am excited for you...I am starting my trek from LPN to BSN and have been pondering what I would like to focus in on, and it always came back to Mental Health/Psychiatric nursing....that is where my true passion is....I have lived a lifetime with friends and family that have been affected by mental illness so my heart has always been there....I currently work in corrections nursing and enjoy the balance of some acute care along with obvious mental health issues, I simply want to do more for these folks but doing so is out of my scope of practice (at least for now)....I am rooting for you and wish you nothing but success!, please keep us informed of your progress....I will be eager to see how it is going....
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    Our BH units include a fair amount of detox and rehab areas- the former especially keeps up my med surg skills as all types and conditions go through various withdrawals, from alcohol, pain meds, crack, street rx drugs, etc.

    I do stoma cares, trach cares, wound care, incontinence care, foleys, IV checks and blood draws. We also look out for DTs and seizures- all told an excellent combo of medicine and psych. Whether your workplace includes detox in behavior health or not can vary, but even on the psych units we find ourselves doing a fair amount of wound care and foleys, just not as often as on a med surg floor, but to me not seldom enough to completely lose the skills, and we get the added bonus of the patients not staying in their beds
    Retired APRN and Meriwhen like this.
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    I think one of the biggest misconceptions in psych nursing is that there is no medical care given. Psych patients have medical conditions too. You will be surprised at how many medical cares you actually perform in psych.
    mystory, Meriwhen, and pyriticsilence like this.
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    Okay, I'm just a little ol' nursing student, but I do work at a psychiatric facility. I've taken more than plenty of residents to the emergency room for a variety of things. The emergency room isn't like TV; people come in for the mundane and the seriously life threatening. One of the things people come to the emergency room for is suicide ideation, delusions, or otherwise being unsafe. Furthermore, people with mental illness get other diseases and disorders that require treatment. They too, have heart attacks, cancer, diabetes, COPD and many other issues. In fact, they may have more than the general public, as the life expectancy of someone with a severe and pervasive mental illness is like 65. Last time I took a psych patient to the ER, they had me, a non-employee, lead her back into the "secured" ER because the medical staff was literally deer in the headlights. I don't know anything about transferring, but telling someone that they might lose their Foley and IV skills kinda sounds like some people don't think you're a "real" nurse unless you do these things all the time.
    boushie87, Valnoslo, and rainyn like this.
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    @Feistn - awesome points. A large percent of ER visits are related to mental health disorders, domestic violence, and intoxication of some form. These patients encounter a lot of stigma and are often labeled by their disease and their complaints neglected as a result (yes, people with bipolar actually can have a stroke!). Admittedly, psych is not the best place to start if the ER is where you want to be, but it is not because of losing your familiarity with physical tasks, but with the differences in prioritization and time management. If there is any way you can float to a med-surg unit with monitored beds or to a step-down unit, you would have the most comprehensive foundation for an ER career. Or, you may like mental health so much that you will want to work in the psych-ER!


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