Adolescent Psych RN

Davey Do · Oct 27, 2016

Welcome to AN.com and the psych forum, Nurseladyt!

Adolescent Psych is one of the most challenging areas of behavioral health, sort of like Bob Dylan- either you hate him or you love him.

There is very little medical, aside from some chronic conditions, for the most part. Behaviors run rampant, as you're not only dealing with all the ramifications of hormones, but also the results of poor parenting, abuse and mental illnesses.

Adolescent psych is my least favorite, probably due to the fact that it's the area of psych I work the least in. I can deal with adolescents as well as any other population, but doing so takes a certain mindset. I regularly work geriatric psych, am in the groove, and truly enjoy the population.

Good luck to you in your endeavor, Nurseladyt, and, hey-don't be a stranger!

Yosemite, RN, ASN, EMT-I · Oct 29, 2016

Nurseladyt: Davey Do pretty much says it all. The only point that I might add concerns the mix of personality disorders, those patients who have been through "the system" before KNOW the limits of what they can get away with, your responses/interventions, how to push staffs' "buttons," shift schedules and just when to act out to create the most chaos!

Nurseladyt · Oct 29, 2016

Thank you Yosemite.. Do you currently work home care? How would you say it compares did you leave psych for home care? Home are is good some days bad some.. I love the freedom but just the driving and paperwork is becoming a little old..also frequent flyers getting orders to go back out after I already discharged them just like in the hospital or with any specialty I guess.. Lol

SwampCat, BSN · Oct 30, 2016

Every day I thank the gods of my place of employment for hiring me onto pedi instead of adolescent. I wanted adolescent, now I cringe when I float up there. I've seen 17 year olds trying to kill themselves because mom took the phone away. I've seen 13 year olds with PTSD from sex trafficking. Once in a great while we'll see a psychotic patient. A majority has bpd and are so emotionally draining. Many are runaways who then state they will kill themselves if they go back home. Many are kids having been through the system.

Maybe 1/10 interactions I have with the adolescents make me feel like I made the slightest difference. Most of the time I feel like I am putting out fires and trying to reverse bad parenting. I have zero job satisfaction when I am up there. Of course, ymmv.

May you find your niche. I am still searching, too.

Yosemite, RN, ASN, EMT-I · Oct 30, 2016

Nurseladyt: Yes, my last couple of "gigs" were intermittent home health care. Yes, the driving in between visits is enjoyable! For me, though, home health care became untenable. Although it's been decades since I worked for an agency that pays hourly, @ least one hospital based agency in my area still does. The idea of having to perform 5.5 "points" per day, average (1.5 = start of care, 1 = revisit), that is all inclusive, i.e., assessment, documentation, "skilled intervention(s), phone calls, scheduling, driving, care plans and on and on is too much. Too many 14+ hour days. I didn't even mention case management duties for the LVNs.

Now, back to psych. I agree with Davey Do; if I were to go back & work psych (I would expect to be 5150's if I ever considered it, though!), geriatric population would be my choice. Unfortunately, the 2 facilities I worked in mixed adult and geriatric which necessitated protecting the later from the former.

Adolescent psych, as Davey Do explained and as SwampCat elaborated on, takes a personality that I don't have. In my limited adolescent experience, the Axis II in most cases overshadowed the (somewhat) treatable Axis I diagnoses. I found it similar to the Middle East, the only time they quit fighting or trying to have sex was when they conspired to cause chaos and "mess" with the staff and, as I stated previously, they tended to do this when you could least afford to deal with it (some staff @ lunch/break while you're in the middle of an admission, etc.). Unlike the occasional adult cases, and as SwampCat points out, I never really felt like, nor saw significant improvement/outcomes in adolescent psych population.

Nurseladyt · Oct 30, 2016

Thank you so much for replying and giving your insite having worked both.. I have an interview Tuesday's so hopefully if offered the job I can shadow a nurse one day and see how it is.. Currently im doing HHC 4 days a week still full time at 7.5 points a day (2.3 for SOC and 1 for revisit and discharges) I thought it would be better than the 12 hours shifts with a 2yo and 5yo but that proved To be otherwise when I'm doing paperwork at home for 3 plus hours a day lol

Jules A, MSN · Oct 30, 2016

I LOVE adolescent psych, have worked inpatient, RTC and adolescent detention however times have changed over the years and this is now an even rougher crowd. These units are often fraught with staff injuries and lawsuits. Not that years ago they didn't fist fight nearly every night but there was more of a sense of staff control. This was back when we could and did seclude and or give IM prn medications for unsafe, out of control behavior which not only resulted in that patient remaining safe but also provided a deterrent for the others in the group. This was not done in a punitive manner and from what I have seen in recent years the children seemed to feel safer, more secure, when it was clear that the adults were in control of the unit as opposed to now when there is little staff can do to prevent aggression, oppositional behavior, threats and assaults. Back then male patients didn't assault female staff now I got hit plenty of times in the process of breaking up a fight but it was rare for staff to be the target. If one of the males used profanity in front of a female staff their peers would often speak up. The other thing I have noticed is the parents are now totally out of control also, not that many were fine upstanding citizens years go either however they were at least somewhat respectful to our faces. Now the parents are totally disrespectful to staff, imagine the type of person who curses at a therapist of all people? and in front of their child so there's that. Overall in my experience the parents now blame authority figures, minimize their child's aggression and out of control behavior. It makes me sad because this is my most favorite population however with the current state of mental health care's lack of resources and society's politically correct mindset adolescent psych has become unwieldy and often unsafe imo.

Overall I guess I'd say if you are scrappy and think you'd like it do try a shadow day. These kids can be amazing and although like others mentioned you aren't helping a large percentage I hold out hope we are able to reach one or two. I also enjoy adults but have more hope for the adolescents as compared to a 40-something year old who is back on the inpatient unit for the millionth time. Good luck with whatever you decide.

Yosemite, RN, ASN, EMT-I · Oct 30, 2016

Jules A: Wow, much worse now than when I was doing it just a few years ago; I most certainly do NOT doubt your accounts! As to emergency medications for adolescents, one of my last few encounters (assisting the Adolescent RN charge nurse after I'd moved on) was the kids actually WANTED to get medicated! I have to admit, I've never had an injection of Geodon or a B52, but I doubt that I would want one, yet some of these kids did! Go figure. One of those kids yelled at me that he wants to grow up "just like my old man!" -in prison. Just how DO you get through to someone like that?

Jules A, MSN · Oct 30, 2016

Jules A: Wow, much worse now than when I was doing it just a few years ago; I most certainly do NOT doubt your accounts! As to emergency medications for adolescents, one of my last few encounters (assisting the Adolescent RN charge nurse after I'd moved on) was the kids actually WANTED to get medicated! I have to admit, I've never had an injection of Geodon or a B52, but I doubt that I would want one, yet some of these kids did! Go figure. One of those kids yelled at me that he wants to grow up "just like my old man!" -in prison. Just how DO you get through to someone like that?

It seems the drug seeking behavior comes in clusters probably because one or two gets the bright idea that being high is the way to go and the rest follow suit. In those cases I recommend secluding without any meds which usually extinguishes that behavior quickly.

As for the kiddo with bravado that he wants to be just like Dad I usually hope that he's just full of it and attempting to hid his low self esteem. His could be attempting to deflect judgment about his father â€˜s whereabouts by aligning with him, he might think jail sounds cool or to show that he's a tough guy to his peers although its also possible his conduct disorder diagnosis is on its way to becoming antisocial promptly upon his 18^th birthday. No matter which I approach it as they are just silly kids and would possibly attempt something to reframe it in a positive such as what are some of your Dad's qualities that you admire and want to be like?" or point out is the child's good qualities such as you are so great with drawing I always thought you might go to college for designâ€ keeping in mind they will be snarky but I always figure I'm hopefully planting a seed that things don't have to be complete crap and everyone has some options and choice. These things if done repeatedly with consistency from supportive staff can work to form therapeutic relationships over time. That is what working with these kids is all about, getting them to trust you enough to consider buying into all the corny stuff we are trying to sell them about how life can be respectful, safe and while difficult at times not expected to be as brutal as they have known. There are very few success stories but I would retire happy just knowing I made a difference in one of these kiddos lives.

stevostarko · Oct 30, 2016

Adolescent Psych? try it, you'll like it-

It is very tough but not as tough as what the Techs do...

The first thing you must do

If you're a Psychiatric TECHNICIAN,

Is to swallow your pride

Beyond all RECOGNITION

Bipolar Bad girl,

Bad boy BORDERLINE,

Put these gray socks on,

You're all MINE

You been to facilities,

Group homes Other JOINTS,

You probably don't care

I might take your POINTS

You hit me, You kick ME And

drive me to EXHAUSTION

I'm sick and I'm tired

I'm putting you on I.P...

That's Idiot PRECAUTION

This is what happens

When you major in PSYCH?

That nurse in the glass

Does she know what its LIKE?

Can he have something else?

How long has it BEEN?

If you can't give it to HIM,

Give â€˜ME'â€¦the P R N ! !

Feel like I've been here

Twenty four SEVEN-

Thank God I get off

At half past ELEVEN.

Be patient with the PATIENTS

And avoid the RESTRAINTS

Okay, we'll try

But we ain't no SAINTS

Property damage and cutting

Or they might be ELOPING

Is that the reason

We leave those straps OPEN?

School problems SUSPENSION

Just came from DETENTION?

Try this loss of privilege,

It's our latest INVENTION.

Mom's in jail & Daddy does DRUGS

My sister's on the street, my brothers are THUGS

Hospitals help because it's a CRIME

But they say they can't pay no OVERTIME.

The job is TOUGH

The kids are ROUGH

And I don't get paid near ENOUGH

But who else would do this STUFF?

Psych Tech, may you get the respect that you DESERVE

These â€˜kids' can get on your last NERVE

And may the patients LEARN,

Your actions are out of CONCERN...

So here's to the ones they call P. T.â€

May these kids have some of your strength

Before they FLEE

But not when they're trying

To kick you in the KNEE

You chose this job

And that is the KEY

And patient, before you spit on me,

Before you SWEAR,

Before you kick and pull my HAIR,

Know that I do this because I CARE.

Oh, and one more thing

Long time ago, I've been â€˜THERE'

So be transferred, be discharged

And go along your WAY

I will be here to help the next one

That comes here to STAY

As it happens your â€˜IDEATION'

Is my FOUNDATION

Both my DAMNATION

And my SALVATION

And in spite of INFLATION,

It's my chosen VOCATION

So if you're on PROBATION

Or a member of â€˜Psych NATION'

I'm here to help YOU

If your life is a WRECK

Because that's what I DO,

I am a PSYCH TECH....

Yosemite, RN, ASN, EMT-I · Oct 30, 2016

Stevostarko: please just keep that base down when you pull up next to me in traffic!