Psychiatric nursing... do you really lose all your nursing skills? - page 3

by lilmoongoddess 32,060 Views | 42 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


  1. 5
    I agree with the last 2 comments above. I have worked at the State Hospital (obviously psych) for 5+ years and graduated in Dec. 11' with my ADN. At first, it was difficult for anyone to call me for an interview in a medical field, and I was getting frustrated, cuz let's face it, if you work psych for a period of time you will get easily irritable and burn out! Finally, after 6 months I stared getting calls for ER positions, L & D positions, and Med Surg positions I applied for. They were offering me jobs left and right. ( Keep in mind I've been in psych for 5 yrs and a CNA before then) I was a total believer that if I didn't get out of the psych field I would lose everything I dreamed of going to school for. ER gets SOOOO many psych cases, they actually benefit from someone with experience since a seasoned psych nurse knows how to handle a manic, grandiose pt that comes to the ER thinking he's Obama and recites the Bible with his eyes closed. Every field has psych related somehow. Depression, anxiety, you name it. I decided to stay in psych and I absolutely love it. Just remember, anyone can say they worked in ICU, Med/Surg, Neuro, ER, OR, or whatever field, but how many can say they survived years in psych? Not many. It takes a special person to work in this field. PLUS, the pay is so much nicer, and working for the State offers way better benefits.

    For the " you don't use it you lose it" part: I've removed countless sutures and staples, removed IV's that "medical nurses" forgot to take out, responded to many codes for cardiac arrests, seizures, anaphylactic reactions, you name it, I've pretty much done it. The only lacking part is IV's. I am not trying to talk down about any other field, but no one single person can say they've handled a day in psych AND survived until they dealt with a borderline pt cutting themself and leaving a blood trail up the hall, a person detoxing off whatever drug they were using with a CIWA score of over 20 and b/p thru the roof among other withdraw symptoms, 4 admissions, a man who thinks he is Jesus and "saving" all the other pts for their sins, a pt whose blood sugar dropped thru the basement and gotta get it back up ASAP, and then convincing the old man that the person whom he is speaking with is just his reflection in the window, and not his boss. ( these are all examples btw...)

    So if you wanna try psych, go for it. Don't let anyone elses opinion make you choose otherwise. You won't if you like it til you try it! Every day is unpredictable in psych. Mental health is just as important as medical health!
    OmegaRN, KimberlyRN89, mangopeach, and 2 others like this.
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    I want to give an update on my earlier post. I was initially scared about losing all my 'clinical skills' and I must say that the first mental health unit I got hired on was not an overall positive experience. The older nurses were mean to the younger nurses, as well as the patients. Nurses on the unit were not allowed to start IVs or take blood. I am happy to say that I have since moved on to a different mental health unit in another hospital and since the unit takes patients even before they are 'medically cleared,' nurses have many opportunities to practice their 'clinical skills'. I will be IV certified, I will take my own blood samples, I will perform blood transfusions, etc... so things are looking good and I have fallen in love with psychiatric nursing now my long-term goal is to work in the psych ER or in the community
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    Quote from lilmoongoddess
    so things are looking good and I have fallen in love with psychiatric nursing now my long-term goal is to work in the psych ER or in the community
    Another one joins the dark side

    Psych ER is fun, you'd like it. But it's not as medical as the name makes it seem. In the psych ER, you're dealing with patients who are in acute psychiatric crisis--a majority of them are/will be under holds when they arrive, but there's a fair number of voluntaries. There's also lots of intoxicated/stoned/high patients coming in too. But if the patient is medically unstable (e.g., unresponsive, MI), they're going over to a medical ER.
    Retired APRN likes this.
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    I am so glad to hear this, as I too am getting ready to start a new position in a state facility. I graduated in may this year and at first I was disappointed that I did not land the "new grad" med surg job at a local hospital; however, I have always liked psych and feel like this will be the place for me. I have heard hat it's good to start in med surg but now I believe psych is where it's at. My facility does med surg skills as well as long term psych and I am excited to be a part of their team! Congrats to you on hanging in there, I hope I will be the next to post a good experience
  5. 5
    Hi there

    I'm an RN (gradded 2012) and work full time in Psych Emerg and Psych Intensive Care in BC, Canada. I can tell you that it has been nothing less than an incredible experience. My clinical decision-making/judgment, assessment, and communication skills have developed substantially since working here. I also work in medical ER on the side (but less and less over the days) and have found that yes, skills do fade a bit, but it has been worth the trade off for my new psych skills. A lot of experience/exposure gives you some excellent psychosocial knowledge as well as ethical critical thinking (treating involuntary patients, for example). I would encourage you to try and keep your understanding of disease pathology and what not through research on your downtime. I've done that and was able to pass the NCLEX-RN (recently) and have barely worked in med-surg the last year and half.

    Psych is simply amazing!
    roxy1710, OmegaRN, Meriwhen, and 2 others like this.
  6. 0
    Quote from NurseCard
    As a psychiatric nurse, you will use your critical thinking skills, your assessment
    skills, your communication skills... invaluable tools that are difficult to relearn
    once gone.

    As a psychiatric nurse, you probably will not start too many IV's, give blood,
    insert foleys... except for on rare occasions. After a while you may lose some
    of your hands-on skills, but those are so much easier to relearn.

    Having said all of that... if you spend six years in psych, you are much much
    less likely to get hired to an ER crew than if you spend say, six months to a
    year in psych. I've known new grads who started their careers in psych, and
    then moved on to ICU, Med Surge, wherever. Good luck!
    How is it that so many arrogant nurses feel as if they're the only people capable of applying critical appraisal to making a decision?
  7. 1
    As a new graduate, I am conflicted about which area to work in. Yes, I would love med surg - yet there are not a whole lot of these jobs available to new grads, presently, in my area. However, I also am really interested in psychology and have a decent chance of working in a comprehensive psyche residency program. I am puzzled and discouraged by the lack of support many nurses offer one another. We are taught that comprehensive nursing involves a holistic approach. Holistic nursing incorporates the physical and the mental components of the patient. How sad it is we do not respect all aspects of nursing, and nurses, who provide different areas of care. It seems we are sometimes our own worst enemies.
    WantAccel.BSN likes this.
  8. 1
    Quote from Dragonnurse1
    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.
    Wow - they don't keep a crash cart on a psych inpatient unit? I thought every place in a hospital had a crash cart. I mean, anyone can have a heart attack or anaphylactic (did I spell that right?) reaction.

    Also, just wanted to comment that I once floated to our locked inpatient psych unit to work as the med pass nurse (for 26 patients!) and had a great day. It was fascinating being there, seeing how things worked. Also, while I was there a medical doc came over and decided to order a bunch of labs and an IV for some fluids on a patient and the other nurse (a psych veteran) literally had NO idea how to enter them into the computer or start the IV. I was happy to help her and she was so thankful. Then, a patient went completely pyscho and watching the veteran psych nurse handle the situation was amazing - calm, skillful, confident, kept the situation completely under control. Impressive.

    So, yeah, this med-surg nurse could start an IV and draw some labs but was CLUELESS with the rest of the psych world!
    Meriwhen likes this.
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    I hope my post didn't come across wrong - I was trying to make the point that while psych nurses may "lose" some basic hands-on skills, they gain so many other amazing skills and in-depth knowledge. I enjoyed the few times I got to float there as a med nurse.
  10. 1
    Just to play devil's advocate... you might just fall in love with psych nursing and lose your interest in emergency care. Regardless, go for it, and as others have said, you can always look for a per diem med/surg job. Also, there is an emergency nursing course offered at a university near me (So California). Perhaps there is one near you. That would strengthen your appeal to an ED Manager beyond possession of ACLS and PALS certifications.
    Meriwhen likes this.


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