Acute psych questions

Orca, ADN, ASN, RN · Sep 16, 2013

I worked a lot of acute, and I didn't find it scary at all. We received proper training in handling crisis situations, and it both increased our confidence and decreased our restraint situations.

As far as practicing with a mental health history yourself, it's a double-edged sword. It can give you an insight into some people's problems that those who have only read about their conditions cannot imagine. There is also the issue of going too far in self disclosure. You don't want to give away too many personal details for a couple of reasons. You don't want to give patients a way to find you outside of the hospital, and you also don't want to scare some patients by making them believe that the people caring for them are no better off than they are.

Your statement regarding your concern about your possible reaction to "old memories and feelings" makes me wonder about your motivation in pursuing acute psychiatry. Is it for the patients or for you? A lot of people with mental health issues seem to seek out psychiatric nursing. Some are very effective, and some I had just as soon never work with again. The ones who could identify with patients and convey appropriate insights generally did well. Those who spent their time comparing mental health episodes and treatment programs with the patients did not do so well - ditto those who discontinued their meds AMA and proceeded to tell everyone who would listen how well they were doing without them, when it was apparent to everyone else that they were not.

Burnout happens in every specialty. Selecting one over another is no protection from working with burnout cases.

Long Term Care Columnist / Guide · Sep 16, 2013

I would definitely think twice about working acute psych with a mental health history, especially since you yourself have been hospitalized. I don't know what your illness is, but a relapse could be triggered by exposure to the environment and the patients who are in such distress.

OTOH, I don't believe having a mental illness necessarily precludes working in psych---in fact, you will probably be much more therapeutic because you can empathize. After I was diagnosed with bipolar disorder in early 2012, it was so much easier for me to relate to and be compassionate towards people with MI (even my own psychiatrist thinks I should consider outpatient psych nursing as my next job).

But I do believe you'd be better off if you hold out for what you really want; don't take a job in acute IP just to get your foot back in the door if you can avoid it. As you know, full remission in psychiatric illness isn't easy to attain, and you really should be stable for a good 6 months or more before making any big changes in your life.

Just my humble opinion. Best of luck in whatever you decide to do.

Nursejesssica, MSN, NP · Sep 16, 2013

Thank you for the input. It gives me something to think about. Just to clarify, I was diagnosed with major depression eight years ago, but I had dealt with it long before then. I think the worst of it is behind me and with the exception of a small blip about 2 years ago, I haven't had an episode in at least 6 years. I am no longer on meds, no longer see a counselor and am generally a content, healthy person.

I guess my main motivation for going into psych is to be a good nurse and to help people when they are at their worst. In my own personal experiences I encountered some mean, judgmental and uncaring mental health professionals. I wanted to help tip the scales in the other direction and be the caring, non-judgmental psych nurse that these patients deserve.

Long Term Care Columnist / Guide · Sep 17, 2013

That puts a different spin on things. It sounds like you are totally stable and could probably handle the acute environment, although you're right to be concerned and I still think you should hold out for what you really want.

Your goals are laudable and your motivation is great. I would hope to have someone like you as my nurse if I ever have to go inpatient.

SoundRN7 · Sep 18, 2013

Working in acute psych will definitely give you the opportunity to practice nursing in a non-judgemental and caring manner to people who are at their worst. It's not as scary as you might think. There are some in the psych profession who are judgemental, seem non caring, and are burnt out, but you will find this in all areas.

TerpGal02, ASN · Sep 23, 2013

I would definitely think twice about working acute psych with a mental health history, especially since you yourself have been hospitalized. I don't know what your illness is, but a relapse could be triggered by exposure to the environment and the patients who are in such distress.

I gotta disagree with this. I have bipolar type 2, and I've been hospitalized IP 3 times for it. I do not find working in psych destabilizing or triggering at all. I think I commiserate most with the adolescent girls though. I always shudder to think that I easily could have been in many of those girls' shoes (with the self injury, suicidal ideation, etc not drugs and sex LOL) when I was that age. Since I turned out ok, I find it very easy to share with them some positive coping mechanisms that have helped me greatly (although I don't tell them that). I like to think at least a few of them take it to heart.

There really isn't anything scary about working IP to me. Yes you will see many, many psychotic patients. Many suicidal patients. Lots of behavioral issues. Sometimes difficult (esp the behavioral issues) yes, scary, no IMO.

If you don't want to work IP, don't work IP. There are some really truly great nurses who work IP, but there are others that are just so burnt it seems like they really have no compassion left. Outpt psych can be fun too but its really no less work. I started my career in the community on an Assertive Community Treatment (ACT) Team. We had 2 nurses for 80 patients. I stayed very busy. You likely will in residential as well.

I think I might like to work in residential with adolescents at some point. Just love those adolescent pts.