Should I Stay or Should I Go?

  1. So, as the title says, I'm having issues with whether to stay in psych. I went straight into it after school and I've loved it from day one, it's fascinating and I really love my current position. But lately, my job and me just aren't getting along.

    I have ADHD and SPD, and while this makes it easier to get on the level of patients who also have it, it can also make everything so much harder. I feel like I make a lot of mistakes about charting and forgetting paperwork and stuff like that. When I float to another unit, being out of familiar territory makes me so anxious. If the unit is higher acuity or louder, it can cause flat out sensory overload. I've actually had to take a minute to go cry in the med room--more than once!--because of the horrible results of executive dysfunction + nursing. I've gone home and bawled for the next couple hours over mistakes and just generally being frustrated. And it doesn't feel like it's getting better. Lately, due to staffing changes I'm floating more, this is happening more, and I hate it. I'm considering leaving psych. But I'm afraid that leaving would make things worse, not better.

    If I left, I'd be going into a different field entirely with much more to learn. Maybe it's different in other geographical areas, but around here psych nursing is seen as this gravy train, easy money specialty. (No offense to any of the awesome people on this board, this is absolutely not how I personally feel about psych. It's not easy for me at all! I work really hard at my job and can't see how it could be considered easy. But all my coworkers ever talk about is how this is barely real nursing and what a joke it is.) So if I can't cut it in psych, what if I go to cardio or med surg and make a mistake there? In psych, it would be a missed assessment that I could go grab, quickly, and punch in, or a precaution change that I could flag down a passing tech and go "hey, heads up". In cardio (or neuro or med surg, etc etc) the patients are sicker, the mistakes are bigger... I might make a med error, or hurt or kill a patient. At least in psych, no one is (usually) that sick.

    I'm really stuck on what to do, and I don't feel like I can ask anyone who works with me for obvious reasons. I'd love to stay in psych but I'm getting frustrated and I'm not willing to go home crying 20% of the time (that doesn't feel normal. Is it normal?). I didn't pour my blood, sweat and tears into a degree and license to be so upset and discouraged so frequently. But what if my coworkers are right, psych really is "easy mode", and I'd be setting myself up for an even worse job if I left? I'm so confused, and I'd be so grateful for any advice on anything here at all. Sorry for the rant, and thanks in advance for any help.
    Last edit by Brian S. on Sep 18
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  2. 19 Comments

  3. by   Davey Do
    First let me say that I admire you, HealSpec, for your determination and perseverance in becoming a Nurse and working in Psych while having to deal with your maladies!

    I can identify with you in many ways and one is the sensory overload thing. Too much stimulation terribly irritates me. I deal with that irritation through animated humor; sort of taking all that energy and sublimating it. I play DJ or MC and will give a play by play or a summary of the action which is entertaining to Staff and Patients and helps me at the same time.

    As far as the floating to another unit, I am realizing that I'm not as sharp as I once was. I've never been 60 years old before. I have to take things more slowly and remind myself to focus by means of an inner dialogue.

    I, too, am considering taking another position at another Hospital after being in this position for nearly 15 years. The change isn't going to be as easy as it once was. I'm really going to have to maul that one over.

    I like to relay on old sayings and axioms for guidance sometimes. The one that popped into my head as I was reading your post was "When you're lost, stay where you are". Unless we have a well thought out plan, we shouldn't change things just because we're not 100% happy with the situation. We should "Bloom where (we're) planted".

    I don't cry much anymore, but did so somewhat regularly when I was younger. Crying is an okay way of dealing with stress, so I wouldn't be overly concerned. Nowadays I exercise and workout a lot to deal with my stress. I also think I'm in a better place now than when I was younger. I'm pretty much okay with who I am. Most of the time.

    I was recently reminded by a Newbie of something I said when I came in on a Friday for my three twelves: "Every Monday I clock out thinking I'm going to get fired for something I did or didn't do during the weekend, and every Friday I come in and see my name on the schedule".

    The fears and feelings don't go away as we age. We merely take those feelings more in stride.

    Good luck and the very best to you, HealSpec!
  4. by   HealSpec
    Thanks for your post. I appreciate the advice, and your response made me realize that I probably should have been more detailed about my rationale. Here are some of my reasons for potentially doing better out of psych:

    Longer orientation. I didn't get enough shifts to feel comfortable and I feel like in a more medical setting, where orientation takes weeks to months, that might be avoided.

    Less (different) floating. Right now floating could mean also working with adolescents, like usual; working acute instead of RTC, with very frequent holds and yelling, or doing adult (so many meds and so many comorbidities...), or pre-ads (100% of which have RAD and 200% of which get in daily holds and I just cannot with this demographic). At least if I "floated" in non-psych it would be from 4 East Nephrology to 5 East Nephrology, instead of 4 East Nephrology to 2 Dozen Screaming Toddlers.

    If they happen, mistakes are caught and dealt with early. I'm so glad you put the line in about still being on the schedule because that is exactly how I feel; especially because it takes so long for documentation to "trickle up" to someone who might take issue, then they come find you four days later. Coming back after the weekend feels like walking into a minefield!

    However, these aren't meant in argument, just clarification. I think you may be right about staying in psych for now, and without a clear plan, a move could definitely make things worse. I don't even know where I'd go. Thanks again and have a good day!
  5. by   litbitblack
    Are you taking medication for your ADHD? I took concerta and I could tell when it started to wear off. Maybe if your not you need to look into it....I now take my meal breaks in peace and quiet where I won't be disturbed just to get away from the constant bustle and it has helped. Maybe you should try some peace and quiet as one of your breaks as well.
  6. by   HealSpec
    I don't, but I'm afraid to do so because I remember trying meds when I was a kid. They turned me into a zombie. I felt like my brain was moving through cold mud and couldn't think at all, and while obviously not everyone has that response to meds, I don't think I could do nursing in that condition. I do try to get off the unit now for break, but I used to hide out in the report room in case the phone rang or a restraint happened, especially when I was the only nurse on the unit.
  7. by   adventure_rn
    I don't have any psych (or med-surg) experience beyond nursing school, so take my advice with a grain of salt.

    First, you start by saying that you're happy in your current position, and that you find psych nursing fascinating. Most people don't find that in their entire career. If psych is a good fit for you, then that's awesome.

    Second, it sounds like what's stressing you out is the floating issue, not working in psych. That sounds like something you should discuss with your manager or educator if you feel comfortable. It isn't fair for them to expect you to function as a med-surg nurse when you've never had a med-surg orientation. I've only ever worked in a super-specialized area (NICU), and I can guarantee you that I'd be a total mess (and probably quite unsafe) if I were floated to med-surg. It's totally reasonable that you're feeling overwhelmed and underprepared. Maybe you could work with your managers to figure out a solution (for instance, coming in for additional orientation shifts specifically related to med-surg). If feeling inadequately prepared to float is truly the root of the problem, perhaps you could work at a stand-alone inpatient psych facility in which you wouldn't be required to float.

    Third, it seems like the things that are currently stressing you out would be exponentially worse if you transition to med-surg. There are tons of meds, never enough time, and a ton of pressure not to make life-threatening errors. You also get the added pressure of patients and families frequently complaining that they're not getting enough attention. Yes, you'd hopefully get a thorough orientation. However, given what you've said about your strengths and areas for growth, it doesn't sound like it would be a great fit (especially given your experience with ADHD).

    Fourth, do you see a counselor? As a psych nurse you probably know way more about this than me, but it sounds like counseling might be very beneficial in your situation. They may be able to help you if you've seen an acute change in your mood or you need help strengthening your coping skills. I think that crying about work comes with the nursing territory; nursing a high-stress profession, and nurses from every specialty (LTC, ICU, med-surg) post on this site all of the time about coming home from work and crying about feeling so overwhelmed. However, if this is something new, or if it's starting to affect your life adversely, I'd definitely try to seek out resources to help.
  8. by   BedsideNurse
    (This is totally hilarious. LOL!!!)

    "I was recently reminded by a Newbie of something I said when I came in on a Friday for my three twelves: "Every Monday I clock out thinking I'm going to get fired for something I did or didn't do during the weekend, and every Friday I come in and see my name on the schedule".
  9. by   HealSpec
    Thanks for the advice. I did want to clarify that I'm not floating to med surg, just to a different psych unit. We are standalone, but there's one unit in particular that is really challenging and I really hate it. However, since my home unit is RTC, we're often asked to float there if we're not full. This other unit is a sensory minefield, full of screaming kids and literally multiple holds per shift. It's not med surg though, and I think you're right about the pressure and time management aspects (I'm awful at both so it would be a bad fit). However, I already know my manager/ leadership's opinion on it, which is basically that my unit is going to keep floating over there to cover them. So discussing it with them, I'm not sure if it would get me anywhere.
  10. by   Amethya
    Hello! Not a nurse, but I'm a CMA. I have ADD-I type and I had it since I was 9. I never took medications, and I did struggle a lot in school, but I got older and I got used to it and used it with my advantage. But once I went to college, I noticed how much I was all over the place, not being able to pay attention. I went to the school counselor and she suggested to see a Psychiatrist to see what's going on. I took my old paperwork when I was 9 and she wanted to do another test to see how it is now an adult and once again I was re-diagnosed with ADD-I and started on medications. I know how you feel, but if you remember some medications react differently to others. To me Vyvanse and Concentra made me too hyper and anxious, I had to take Klonopin with them. I was under a lot of stress at that time with my old work and I wasn't happy. I was fired/quit that job and I still wasn't okay. Now I'm on Adderall XR, but in a better job with less stress. But i still feel I'm not concentrated enough like I should. I work at medical aide at a school and it's much more better.

    As someone who knows your struggle, I would say this:

    1) Find ways to keep yourself on track. I noticed while working by myself how off track I can be (Like now... on this forum instead of working.) and I can be so in the zone that I forget the time. I bought myself a smart watch that vibrates and set up times on it along with my phone to ring and vibrate when it's time for me to work again. I have this app that every 30 mins, it tells me to work, then to relax by surfing the net, the back to work. And along with that I have my alarms for my students who require medications. I have a checklist on my view that reminds me what I should done and I make sure to write down and remind myself on my phone for dates and other things I need done outside of home. I'm going to say, your phone can be your lifesaver. If you figure out how to make it remind you of things, especially of dates and other stuff outside of work, it can be super helpful. For example, let's say I have a doctor's appt at 2:00 pm on friday, I got on my phone, put that time and date and I have to option to remind me at least 1 hr to 30 mins before I'm suppose to leave to the event so I can prepare for departure.

    2) Try your best to be organized. I know it's hard, I get it. But if you have a method to organize yourself, do it. You were able to to go through nursing school with your ADHD, so remember back how you kept yourself organized and on track.

    3) Don't knock out medications. I know you had a bad experience with ONE medication, but there's various of combinations of medications that may help. Find a trusted psychiatrist, that is willing to help and listen to you and a therapist as well, and with that team, work together to find which medication works for you. It's all about trial and error, so don't fret if one doesn't work

    4) Don't be so hard on yourself. I know, I do the same thing. I mess up on one thing, I automatically want to punish myself. I got this because of all of the year of some horrible teachers and my last job as well, and my CMA teacher too. It was hard to go over the trauma but after getting myself a therapist, I know that I shouldn't be so hard on myself, we all make mistakes and we just need to learn from it. If you mess up again, just try again and again until you got it. Don't sell yourself short, you gotten yourself to this point in your life and with this disability. Don't let it define you! I believe in you!
  11. by   HealSpec
    Thank you so much for the reply. I feel like we have a lot in common! I haven't tried different meds and so that is possible, although I'd still be anxious about starting them and then coming in to work.

    As far as staying organized, I'm trying to start doing that with a brain... psych brains don't seem to exist online so I made my own. But while it's helping, it's not helping "enough", if that makes sense.
  12. by   Ruby Vee
    Quote from HealSpec
    So, as the title says, I'm having issues with whether to stay in psych. I went straight into it after school and I've loved it from day one, it's fascinating and I really love my current position. But lately, my job and me just aren't getting along.

    I have ADHD and SPD, and while this makes it easier to get on the level of patients who also have it, it can also make everything so much harder. I feel like I make a lot of mistakes about charting and forgetting paperwork and stuff like that. When I float to another unit, being out of familiar territory makes me so anxious. If the unit is higher acuity or louder, it can cause flat out sensory overload. I've actually had to take a minute to go cry in the med room--more than once!--because of the horrible results of executive dysfunction + nursing. I've gone home and bawled for the next couple hours over mistakes and just generally being frustrated. And it doesn't feel like it's getting better. Lately, due to staffing changes I'm floating more, this is happening more, and I hate it. I'm considering leaving psych. But I'm afraid that leaving would make things worse, not better.

    If I left, I'd be going into a different field entirely with much more to learn. Maybe it's different in other geographical areas, but around here psych nursing is seen as this gravy train, easy money specialty. (No offense to any of the awesome people on this board, this is absolutely not how I personally feel about psych. It's not easy for me at all! I work really hard at my job and can't see how it could be considered easy. But all my coworkers ever talk about is how this is barely real nursing and what a joke it is.) So if I can't cut it in psych, what if I go to cardio or med surg and make a mistake there? In psych, it would be a missed assessment that I could go grab, quickly, and punch in, or a precaution change that I could flag down a passing tech and go "hey, heads up". In cardio (or neuro or med surg, etc etc) the patients are sicker, the mistakes are bigger... I might make a med error, or hurt or kill a patient. At least in psych, no one is (usually) that sick.

    I'm really stuck on what to do, and I don't feel like I can ask anyone who works with me for obvious reasons. I'd love to stay in psych but I'm getting frustrated and I'm not willing to go home crying 20% of the time (that doesn't feel normal. Is it normal?). I didn't pour my blood, sweat and tears into a degree and license to be so upset and discouraged so frequently. But what if my coworkers are right, psych really is "easy mode", and I'd be setting myself up for an even worse job if I left? I'm so confused, and I'd be so grateful for any advice on anything here at all. Sorry for the rant, and thanks in advance for any help.
    First let me say that Psych is a demanding specialty that scares the ever-lovin' bejesus out of me. I am ever so thrilled that there are nurses who WANT to do psych because I know that I could never do it. Those who say it's an "easy" job probably aren't looking at the whole job and are only seeing that there's relatively little poop to clean up and fewer heavy lifts.

    All specialties in nursing are valuable. I've seen a lot of LTC nurses complaining on here that they aren't respected, but LTC is a specialty that requires stellar time management skills, assessment skills and quite a bit of psych nursing as well. In addition, they do "skills" such as tube feedings, catheterizations, injections, diabetes management, etc. That's another specialty that scares me silly, but there are nurses who truly excell in LTC and I am eternally grateful to them. My mother-in-law is in LTC and my mother spent years there before her death -- those nurses make their patients feel special and loved. I am so glad there are nurses willing to do that job!

    If you love psych still and love your position, stay where you are. Jobs and specialties that we love are sometimes difficult to find. Remember that those who disrespect your specialty probably have very little understanding of just what it is that you do.
  13. by   Amethya
    Quote from HealSpec
    Thank you so much for the reply. I feel like we have a lot in common! I haven't tried different meds and so that is possible, although I'd still be anxious about starting them and then coming in to work.

    As far as staying organized, I'm trying to start doing that with a brain... psych brains don't seem to exist online so I made my own. But while it's helping, it's not helping "enough", if that makes sense.

    I would start out small, usually they give you the lowest dose and from there go higher, until you get the effect you want.

    I'm not sure what a psych brain is.
  14. by   hawaiicarl
    If you go there will be trouble, if you stay it will be doubled.

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