Confused Student; Please Advise!

Specialties Psychiatric

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I am nursing student with one year of school left to complete. I have thoroughly enjoyed all my rotations thus far (med-surg, pediatrics and psychiatric nursing). I am the type of student who could see myself working in each of the rotations I had. Before I started my psych rotation, I just knew I wouldn't enjoy it.

I must say, it has been the best rotation I've had thus far and truly believe I would enjoy working in this speciality area. My clinical instructor even told me more than once that if I am truly interested, she would recommend me for my school's combined PMH Nurse Practitioner/CNS Program at any time.

I have concerns about whether pysch would be a good area to start out in. My clinical instructor for my rotation started out in psych and she is excellent. However, other psych nurses have told me that I should start in another area like med-surg. One nurse told me that he started out in psych and now he could never do much of anything else because he has lost most of his skills. Another nurse told me that in today's psych world, patients are very much medically compromised, thus having some other experience like med-surg would be very instrumental.

Is it beneficial to start in another area? I am a second-career student, which means I am much older. I don't have time to spend years and years in med-surg and then move to psych, especially if its what I know I want to do. What are your thoughts? What are the pros and cons of going right into psych nursing straight out of school? CNS48

Specializes in Psychiatry and addictions.

I've been a nurse for 8 yrs, doing strictly psych for about 5 yrs. I had planned on being a medical nurse, until I worked on an understaffed vent unit and got so burnt out that I almost quit nursing. Thinking back, I realized my favorite job had been doing chronic psych. Got a job doing acute psych, found out I'm good at it, and never looked back.

If I could go back and change my work history I don't know if I would. The medical experience has helped me remain calm in several scary situations when my coworkers were freaking out. However I frequently work w/ an RN who graduated 1 or 2 yrs ago and started psych right away. She often is more competent than I am medically.

If there is a way that you could split your work hours between psych and medical for a few years I would do that. In my own exp., I didn't lose any skills that I already had (like suctioning a trach)..... they come back quickly. The procedures that I had trouble w/ before (like straight cathing a female) I still stink at and probably always will. Hope that helps!

I would say that if you wanted to start out in psych. then do it. Sure, there could be medical issues going on but for the most part if they are that medical then they would first be on a medical floor. I started out in a nsg. home (before they had IVs and all that other "stuff" and then went to psych. At times I was overwhelmed because we would have a pt. with an IV or tube feed but it really wasn't as stressful as I had thought.

If you want to do psych, if you enjoy it... do it.

Lets take the scenario that you do go into med/surg 1st, if after sometime you've had enough, and decide you want to go into psych anyway, don't you think you'll feel that you've lost some of the psych skills you had gained, just the same as if it was the other way round?

If after some time you feel you dont like psych you'll face the same hurdles, but bear 1 thing in mind... the world is short of nurses... very short... you should still be able to get a job in med/surg if thats what you want.

regards StuPer

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

A piece of advice from one who has been there: start out in an area other than mental health. For some reason, once you work mental health, many employers don't believe you can do anything else. Getting a year of med-surg experience would be beneficial. I didn't (there was actually a nursing surplus when I graduated, and I took the first job I could get, in mental health), and I paid a price later. I worked for a free-standing mental health hospital that was closed by the parent company. It took three months for me to find a job, because every employer saw me as a "psych nurse". Even though I had been an RN for five years at the time, I was told "You don't have the kind of experience we are looking for."

I have to weigh in on the side of getting the year or so of med surg or similar experience. I did, on the advise of the ER supervisor, and I got to say I hated it. I got a bit of GERD, but it was great experience.

I have had the hiring responsiblity for a psych unit and I would prefer to hire medsurge experienced psych nurses.

A psych unit, particularly one that is not attached to a medical hospital, will have many types of psych specialists. The doc of record for the patient will be a psychiatrist, the pt will have a therapist and maybe a social worker, possibly a chemical dependency counselor or a occupational therapist or an art therapist on their treatment team, and a nurse. The only person on that team who is concerned with the physical health of the client is the nurse.

I have seen a good psychiatrist respond to the report that a patient was having black tarry diarrhea by ordering a consult with an internist. The internist would have seen the client in a couple days. The patient needed definative treatment within a couple hours. If the nurse, in this case it was me, had not insisted that the ambulence be called, and an order for a stat transfer to the ER written, the patient would have bleed out.

All that being said, if you are being offered advanced psych training, go for it. I t is always good to be an expert.

Thanks for all the information. I have one more year of nursing school to complete, so it's still early for me. I see the value of getting at least one year of medical-surgical experience as well as starting out in psych. I think it will depend what is going on once I graduate from school.

Thanks again.

Do the med-surg. I worked as a psych tech for many years before becoming a nurse. I am also older (48 when I graduated). I returned to psych right out of school and I'm now looking to do some med-surg for the experience. I love psych and will never ,at this point in my life, go into medical nursing, but please trust me, the knowledge you will gain in med-surg will benefit you greatly. If you are still a student then you surely understand that "nurses eat their young". As a new grad, it is expected that you need to learn and gain experience so it will be much easier for you right out of school. If you wait, there is much less tolerance for your medical inexperience(of course, I would love to see a medical nurse take over on a psych unit).It takes great patience and understanding to be a psych nurse, and good ones are desperetly needed. Good luck to you!

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