Child Psych

elkpark · Jan 23, 2004

I am a child/adol psych CNS, and, although my current job is not clinical, I have spent years on child & adol units in both the staff nurse and CNS roles.

Much of the response to your question depends on the specific facility and how they use RNs, and I'm sure there are regional differences in how psych units are run. I think, also, that I recognize your name as someone who has talked about experiences in a state hospital. My experience in teaching psych clinical at the state hospital in my area was that the RNs did little but pass meds, and most of the programming was provided by the SW, psych, and RT staff. However, having said that:

In my experience, staff nurses on child or adolescent units run the milieu, as on adult units, which means that they are directly involved in personal care (as needed) of kids as well as helping provide a full, diverse schedule of therapeutic activities (working with the rest of the team). Staff nurses lead educational and therapeutic groups on topics like coping skills, anger management, healthy relationships, health topics (nutrition, smoking risks & cessation, sex ed, etc.), substance abuse, med ed, and other needs that might be identified. They also do a lot of 1:1 interaction and recreational/leisure activities with the kids. They take the lead in de-escalating angry and agitated kids, or dealing with them if they blow up (and we all know how moody and impulsive adolescents can be -- kids on psych units are even more so ...). And, yes, they pass meds!

What I like about the child/adol specialization is: Most of the kids you work with are NOT chronically mentally ill and most go one to survive the particular incident/episode that triggered the hospitalization and live their lives without chronic disability ... You get to play a lot as a legitmate part of your job! :) (Esp. with small children -- how many of us can say that playing with Playdoh and coloring with crayons and markers is part of your job!?) ... Working in a residential treatment program often includes chaperoning the kids on outings to museums, the movies, parks, lots of different activities ... Working with kids keeps you honest (everyone knows you can't bull**** kids -- they see right through us!) and *young* ... And I always say, when I'm asked this questions, that the "lows" are lower (you see a lot of really sad, painful, difficult situations (kids who have been abused, etc.)) but the "highs" are higher -- my experience has been that it is much more personally and deeply rewarding to work with kids (than adults). But that might not be everyone's experience.

I've worked with a lot of people who thought they would like child psych, but ended up not being able to find a comfort level with the really gut-wrenching, emotionally difficult situations that arise. It is VERY demanding work, and certainly not for the faint of heart!

PsychoRN · Jan 24, 2004

I have worked in adolescent psych on and off for over 20 years. The most rewarding thing I have found about working in this area is when months or years after you have treated a kid you receive a letter from them or run into them, they thank you for helping them and you hear how successful their life has been since they were discharged.

I have worked adolescent psych in several states and overseas and my main duty as a staff RN has been to run groups and activites such as living skills, functional skills, coping skills, leisure skills, cognitive skills, social skills and illness management. In addition I have run parent education and support groups.

I have rarely been involved in passing meds or assisting with ADLs as those duties were performed by LPNs and Psych Aides in hospitals were I have worked.

PRNMEDS · Mar 21, 2004

I don't do a lot of groups per se - other then a medication education group. The majority of groups at my hospital are run by Therapist, Nurtitionists etc.

That said Nurses (both LPN & RN) do a lot of individual 1 to 1 with the kids. I work with 11 - 17 year olds and deal daily with a multitude of topics including but not limited to: anger management, depression, sex ed, STD prevention, drug abuse. Frequently the patients have a very unstable or no home life and are just happy to have someone to speak with that will listen. Particularly when they are upsest, angry, agitated.

At my hospital 60% (its a geuss) are not "classic" psych hospital patients (Schizophrenia, major depression etc.) but rather behavioral problems with a mix of mood disorder, depression, hyeractivity etc. Most of these have angry and often violent outbursts. We manage this by medicating (mood stabilizer, anti depressants, anti impulsivity meds) and by trying to teach them better coping skills. As the nurse on the unit involved in all of these aspects as well as restraining and medicating if patient becomes overly aggressive.

Some days not sure why do the job as it can be very trying and frustrating. However, since these kids are young you often see a big change (hopefully for the better :chuckle) and that is very very rewarding, and something you see a little less in adults.

LuciGirl · Aug 30, 2005

I have worked in adolescent psych on and off for over 20 years. The most rewarding thing I have found about working in this area is when months or years after you have treated a kid you receive a letter from them or run into them, they thank you for helping them and you hear how successful their life has been since they were discharged.
I have worked adolescent psych in several states and overseas and my main duty as a staff RN has been to run groups and activites such as living skills, functional skills, coping skills, leisure skills, cognitive skills, social skills and illness management. In addition I have run parent education and support groups.
I have rarely been involved in passing meds or assisting with ADLs as those duties were performed by LPNs and Psych Aides in hospitals were I have worked.

I would really like to do some travel nursing in the area of child/adol psych nursing. Where have you worked? You may PM me. Thanks a bunch

TitaniaSidhe · Sep 6, 2005

sounds very familiar to me prnmeds as I am living it right now with teen age step daughter. ? any particular mood stabalizer you have seen work well also how about the antidepressant. They have her now on Wellbutrin, concerta & plan to start abilify. Just curious on your input & what you have observed.

ty

LuciGirl · Sep 8, 2005

sounds very familiar to me prnmeds as I am living it right now with teen age step daughter. ? any particular mood stabalizer you have seen work well also how about the antidepressant. They have her now on Wellbutrin, concerta & plan to start abilify. Just curious on your input & what you have observed. ty

Depakote is frequently used with the teens we see on our unit. Re: antidepressants & mood stabilizers - be alert for side effects and don't be afraid to ask docs to try a different one.

Ex. Headaches are a common side effect for some folks with certain SSRI's - if the headachaches don't subside in a couple of weeks with the help of tylenol and stress mgt techniques - talk with the doc - may take a few different tries, but it is worth it -

Weight gain is another SE - walk with your teen or do daily exercise with them to really help them keep a handle on it. The appetite often increases leaps and bounds - so its super important to W A T C H portion sizes and snacking - find healthy, crunchy, low cal snacks and stock the frig and cupboards - water/water/water :)

READ the blackbox warnings for meds - get well acquainted with the meds and don't be afraid to ask questions of docs as frequently as you feel necessary.

Lots of good resources on the internet. International Society of Psychiatric Nurses has a child/adolescent division which is another good resource. Check out websites for mental health at the top psych hospitals: Mclean in Boston,

Menninger in Texas. Best wishes

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