Are there less dangerous areas of Psych Nursing than Inpatient Psych?

[Naturally Brilliant, BSN, RN]

I've been working at an adult county inpatient psych hospital for 5 months now, and I don't feel very comfortable where I'm at. It's very frustrating - I work nights, and it's daily drama for me. My mentality is that I have to do my assessments and get this crowd of people medicated, including PRN sleeping meds, so they can go to sleep and I can prevent chaos happening on the unit. I worked three nights in a row over the weekend, and each night was misery.

The first night, two patients got into a fight with each other within an hour of me being on the shift, and one of the patients was screaming at me while the special team of techs was protecting me.

The second night, the supervisor had me go to a different unit and medicate the first night's group of patients because that unit's nurse didn't have access to the Pyxis machine. The third night, another RN's patient ended up clawing my arm and then spitting on my face later on. And I am drained!

Most psych patients are alright, but there's always a handful that will constantly act out, or are just hardened criminals, or are so profoundly psychotic that it's just mental torture where I wish they were stay in their rooms, shut up, and leave me alone. It can often be demoralizing because you can do all that "therapeutic convo" and whatnot, be nice to them, and thirty minutes later they find some imagined reason to go off on you. It's just so stressful and tiring, and I don't want to end up with PTSD later on. I'm afraid that I'll end up mean and jaded as time goes on with this. Plus, it doesn't help that so many techs and nurses I work at are lazy or incompetent, and I feel resentful that I'm filling out restraint paperwork on a patient that isn't even mine. Are there better areas of psych?

[TCASII, ADN]

It might depend on where you live. Some states are a little better about staffing and making the environment tolerable. Where I live companies are not too good about staffing or providing decent work conditions. We have no state ratio limits or unions. It's right-to-work, so they can dump 20 patients on the nurse.

Personally, I don't feel that psych is much better, regardless of where you work. You have to know whether the company is good about staffing and limiting the number of patients a nurse gets. I've worked in psych for 7 years and never been punched, spit on, or physically attacked. I have been accosted verbally, but nothing too awful I suppose. I've mostly worked IP, but did have an OP job. OP was terrible. Way too many patients. An impossible job. Getting yelled at on the phone or in the building because the provider wouldn't prescribe controlled meds wasn't any fun, just like IP.

Every job has it's ups and downs. Psych can be as hard as you make it, and that often means deciding to set limits and be the bad guy, or placate them and make things go smooth. I typically placate them, since we aren't allowed to do holds or anything. We have no leverage.

[Neo Soldier, BSN, RN]

I feel your pain. Psych is drama filled unless you go somewhere where the patients are practically zombies. Unless you become a manager or an administrator, in which case you may not have to be too involved in patient care, it's about the same in most places. One tip is that you could become an psych NP and you don't have to be in the middle of drama, or you switch to another specialty.

[penelopelp]

I was moved from my inpatient unit to outpatient clinic for about 6 weeks. That was very safe. I found it boring. I was doing med refills, calling back patients who had questions/concerns for the doctors, and checking on lab results. The days were really long. However, some people like working in that setting.

[Jason RN]

I have been worked psych IP for 12 years and now have been working in a Psych ED in a psych hospital for almost 3 years. Hospital work will always pay better, but there are other options. Mostly community health clinics. The clinic jobs have their risks also. There are also Intensive out patient sites. Or you could choose a hospital that has only voluntary patients. If you act out you are asked to leave. That hospital has 2 wards. 1) dual diagnosis, 2) Psych. It is a fairly posh nursing job.

I would also ask yourself if psych is what you want to do. It is not an easy field to practice in. Psych nursing has a high turn over rate because of the stressful environment.

[Big Nate, BSN, RN]

Substance abuse is pretty laid back for the most part. Residential level psych may be more your speed.

[GeriLPNtoPsycchRN, CNA, LPN, RN]

Your unit sounds like a nightmare. Seems like evening shift needs to get it together and have things calmer when you get there. Actually, the treatment team should know that these ppl are out of control at night and adjust their meds.

On my state hospital inpatient psych unit...

We have rules on the bedroom level and pt's must follow quiet hour rules. There are some that wander at night, but they usually behave. There have been minimal issues with behaviors in my 1 year on nights.

[boogie_girl, BSN, RN]

Psych is not an “easy” specialty to work in in that you have a risk of getting hurt in whatever type of psych job you have. I work in outpatient psych which is probably a lot “safer” but it’s a setting where we are not allowed to put our hands on patients if they get too out of control. It’s voluntary treatment and they are there mainly by choice. It’s probably the “easiest” job I’ve had but it’s not as action packed as a psych inpatient unit. Outpatient does get slow sometimes but when it gets busy it’s really busy. Patients call or come in the clinic asking about their medications or other psych or case management issues. They also come for their long acting injections. You’re also talking to the doctors about their patients... all in one day sometimes. Outpatient might be more your speed if you are looking for something less intense but it has its challenges as well.

[verene, MSN]

I think setting - in terms of the employer, the staffing levels, unit culture, and the laws that influence care make a larger difference to safety than acuity level alone.

I've often felt safer on high acuity inpatient units - than in outpatient or sub-acute, but a lot of this comes down to the unit culture and staffing (including staff experience/personalities).

[The0Walrus, BSN, RN]

Hi, 5 months in inpatient psych. I helped another nurse wipe down a patient who smeared feces all over his body & ate it. Also had to help medicate patients who were being combative. I'm the state hospital in a city that's been ranked one of the worst in the country. LOTS of substance abuse patients also. With that being said, it may not be for you. It's not for me I have learned that. I'm planning to move to another unit I've been dying to transfer to.

Someone told me outpatient psych is easier as well as military psych. I don't know this to be true as I have never worked there but just thought I'd pass the information I heard. I have a psych NP who will sometimes come in during the weekends and she said she only works inpatient for the money but hates the unit because she doesn't have the personality for it. She loves peds psych because she gets along with them.

Psych is difficult. I don't like it because I prefer medical. I've learned how to de-escalate though as well as learn what meds these patients get and so on. I'm grateful for this experience but I think psych & especially inpatient psych can be difficult. I haven't been clawed, punched or spit on. I have seen patients try to beat up the doctors and I have jumped in and pinned the patient down, but yeah psych is difficult. Maybe it's not for you?

[Safety Coach RN]

Honestly, you run the risk of getting hurt in any part of direct patient care nursing, ED, providing patient care involving lifting and turning patients, etc.

I do intake now which is more case management/coordination. Definitely not the same risk as being on the floor.