Anyone ever do psych nursing at the VA or know anything about it?

elkpark · Dec 23, 2017

I worked in the psychiatric nursing department of a VA many years ago. It wasn't substantially different from the psychiatric staff nursing positions I had in the private sector over the years. There seemed to be a little less acuity in the client population (or maybe I should say a wider range of acuity); because there was no preauthorization required from a private insurance company, inpatient admission wasn't limited to only the most severely, acutely ill individuals, and a lot of families "dumped" their chronically mentally ill veteran family member on us for some respite at home (we got a lot of late night admissions, because families figured out that if they brought their veteran to be evaluated by the outpatient psych clinic during the day, the individual would not be admitted (because there was no real indication for an inpatient psychiatric admission), but, if they brought the individual to the ED after hours and left him there, the ED would admit them to inpatient psych because the ED didn't really have anything else to do with

I enjoyed working psych at my particular VA, liked my co-workers. It was a nice group of people, for the most part, and I found the VA to be a really good employer.

Jules A, MSN · Dec 23, 2017

Its been years for me also but it was a good experience. The number of patients each nurse had was embarrassingly low but acuity was high, similar to the inner city acute units which I loved. Plenty of SUD and more than a few malingerers but also many with SMI. The pay was actually a bit higher than what I had been making and the benefits were quite good. Despite the lore the federal benefits were not significantly better than a good BC package at a large facility but definitely better than many smaller places offered and my 401k type whatever account performs well. It took forever to get in.

I wish their NP rates were better because I would go back. Even with the increases they are still too low to make it a reasonable option for me but as a RN I'd go back in a minute.

3peas · Dec 31, 2017

I have a friend who works there now and loves it. She's trying to get me hired on.

2ndChance · Dec 31, 2017

Does she tell you what she likes about it?

Thanks!

nurse lala, BSN, RN · Jan 10, 2018

Ive been there 26 years. I've worked in every MH clinic and unit, including the walk-in clinic, outpatient, Geri psych, acute psych, substance abuse...and some.

There are many compelling reasons for a VA career. Amongst them are the focus on education, diversity, TIME OFF! Also darned good reasons not to bother. I have addressed a few good points.

My Facility is a teaching hospital. We have access to a tremendous library online and library staff who will retrieve publications in mere days and will even do a search for you. We have interns in most every discipline. Daily rounds is fascinating. There is active engagement with the entire team. The Attendings are always explaining the reasoning behind medication decisions made. There is true collaboration. I relish the opportunities to mentor nursing students, for them to shadow me, then talk about what just happened. And in fact did my own MH rotation at this same facility. The VA Encourages nurses to return to school and will pay for an advanced degree via the National Nursing Education Initiative. There is weekly Journal Club in which a study is analyzed and discussed. We have monthly grand rounds. There are daily classes in a range of subjects.

RNs are encouraged to participate in RN research. Did you know that the practice of using normal saline to flush ports instead of heparin was a result of VA RN research?

We have 10 legal holidays, 26 vacation and 13 sick leave days per year. At least the RNs and Advanced practice clinicians.

Everything is a process demanding redundant documentation. It took them more than a year from hiring me until the date I started work. My pre-employment screening by a VA NP yielded some concern but I could not be told over the phone. So about 3 months after I provided my vital fluids, I was directed to come in person to be informed of the ABN results. I was scared. Do you know what the VA discovered? I might have had a UTI, 3 months earlier!!

Processes have multiple points of potential failure. Sometimes things don't work, like Travel will cancel a planned pick up without telling anyone, including the patient. Usually this happens with the fragile or difficult patient for whom you spent way too much time organizing same day appointments for several healthcare providers. It's ridiculous how hard it is to get things done. The poor communication between healthcare groups and from administration. Many silos of power. Furthermore nothing happens to the dunderheads that chronically mess up because it's cheaper to keep people then fire and hire.

If you wish to develope coping and other skills beyond your wildest dream this is the place. YOU CAN MAKE A DIFFERENCE IF YOU CAN TOLERATE IT.

2ndChance · Jan 10, 2018

Thank you.

If you don't mind me asking another question, can you tell me what your opinion is regarding the patient acuity? I'm wondering how it compares to private psych. I saw another post saying it was less acute. Would you agree with that?

nurse lala, BSN, RN · Jan 11, 2018

On a scale of 1 to 10, with 10 being the most acute, I placed the VA on a range of 5 to 9.

Post 911 Veterans are young and strong. They are trained to kill. Veterans make up 10% of the population and 20% of all suicides. I think that is a pretty daunting number and reflects the damage done.

2ndChance · Jan 17, 2018

Thanks. I have an interview on Thursday. If you can think of anything that I should ask, please let me know. You've helped me a great deal! Thanks!!