What to do?

CharlieRN · Jul 4, 2006

I am a 59 yr old man who has worked in nursing since 1972, been an RN since 1979 and has worked in psych since the mid '80's. I am now the night supervisor at a small, freestanding, psych hospital.

I am strongly of the opinion that a psych nurse is a nurse first. The job is "nurse". "Psych" is the modifier. Granted if you are functioning at the "NP" level you may be filling the physician role, more than the nurse role but to my way of thinking that increases rather than reduces the need to be solid on the nurse part.

Nursing is one of the few generalist professions. Your licensure will not spicify your area of practice. It will just proclaim you to be safe to function as a nurse. The law says you are qualified to function in any type of nursing job, from the operating room, to cardiac care, to emergency department, to med/surg floor duty, to psych. Now, everyone knows that specialized orientation to thes areas is necessary for you to be competent but the laws make becoming competent primarily your responsiblity.

Don't freak over specific things like the female cath. They are just physical skills. Doing a cath is about as complex as wiring a table lamp. Just as in doing simple electrical work there are basic safety rules to observe, like shut off the power before working on the lamp, in medicine there are things like using sterile technique.

What you do need to be prepared for is that nursing is often physically hard work. Nurses need to make important decisions, involving the health and welfare of others, rapidly, while under pressure and doing physically exhausting work at the same time. You mention that nursing is a secure career path. Indeed it is. You can always get a job as a nurse. The problem is that you may not want the job you can get. 30 years ago I had a barber who had an RN. She made more money, for less effort and with much less responsiblity, cutting hair. The situation has gotten worse since then. Health care is under great financial pressure. Nursing is the soft spot. Nurses are being required to care for more and sicker patients in every area of medicine. Financial compensation is inadequate. Even if the saleries were doubled, spread too thin is still, spread too thin.

All that being said. I encourage you to go for it. With your background in financial matters you will be sought after for administrative positions.

tobehealthy · Jul 4, 2006

CharlieRN,

Thank you very much for your response! I sincerely appreciate your advice and wisdom. I am coming to the conclusion that very many people share the same opinion as you regarding nurses being nurses first. I am realizing that I was being very naive in assuming that I could go straight into a NP role and be able to function as such without practicing as an RN first. In fact, the director of the program that I am considering essentially said the same thing as you: that I should not expect to be considered for NP roles straight out of their program but that I would have no problem being hired as an entry level RN.

So now it is up to me to decide if I am truly passionate enough about nursing to put in the time and enjoy the process along the way and move my NP desires to an ultimate goal at the end of a journey rather than an immediate goal. I read through the entire thread in the NP section of this site regarding this same debate - do direct entry NP's need RN experience first. At this point the idea of functioning as an RN is still a bit scary to me, but I am hoping that like you said, it is scary because I do not have the necessary skills, rather than because I do not like the role in general. I am hoping to clarify this by volunteering at the hospital. And I just recently discovered that the local mental hospital (free-standing, not associated with any of the hospital systems in the area) takes volunteers to work as "friends" of the patients. So I am going to do that as well to see how I fare in the psych environment.

One more question for you, if you are still with me through this long response. Is there any opportunity for psych RN's to provide counseling? I was reading in the NP thread that essentially they are the medical experts and thus function in a purely medical role -- thus the needs for strong med/surg experience. This dichotomy is what leads me to reconsider nursing and investigate social work or counseling instead -- because at this point my interest in psychotherapy trumps my interests in the medical/biological counterparts. However, I am not discounting any career path until I get more experience -- at the very least at the volunteer level.

Thank you again!!! Your wisdom is much appreciated.

CharlieRN · Jul 5, 2006

Yes, nurses do some counseling, but its not their main reason for being on the behavioral health team. The behavioral health environment is lousy with various flavors of psych specialists. Psychiatrists, psychologists, social workers, ocupational, chemical dependency and art therapists are all part of the mix. The only one with a general medical background is the nurse. If necessary nurses can do most of what the other specialists can do in a pinch but the reverse is not true. A social worker or a psychologist can't medicate anybody, neither can they legally take a Dr's order over the phone. Therapists are not trained to even take a blood pressure.

I encourage you to try the volunteer thing. Once you are in the psych care environment I think you will see what I mean. Psych patients get just as many if not more physical illnesses as the general population and psych meds are not benign, they have serious side effects. Minding the physical health of the population, while maintaining of a safe environment is a big job. There is not a lot of time left to do other specialists jobs.

From your earlier remarks, I think you may be better suited to the social worker/therapist role. There are pros and cons to this. You get to do the counseling without getting involved in the "icky" stuff and with little need for medical training. You will need at least a masters degree and even with one in most states you are limited in your freedom to practice independently. In New England, a masters level psychologist has virtually zero employablity. My facility hires Psych BA's to be "mental health workers", essentially nurses aids. In a hospital environment, masters level social worker/therapists will be paid about what an RN with an associates degree makes, and will have none of the job security. They do have more status though.