Do i need Med Surg experience to be a psychiatric nurse?

elkpark · Apr 26, 2004

I know that a lot of folks would disagree with me, but as a psych nurse of some 20 years, I would say yes -- not that you have to, but that it would be a good idea. Psych patients have medical problems, too -- and even more so nowadays, as only the sickest patients (with multi-system problems) get admitted to inpatient units. In fact, med-psych units (for patients with both medical and psychiatric dxs) are a growing trend within hospitals. Even in outpatient settings, psych people have to deal with lots of comorbidity.

Also, one of the scariest things about working psych has always been, for me, how many staff (doctors as well as nurses) on psych units are so focused on the psychiatric issues that they completely overlook acute medical problems that are staring them in the face. I'll never forget the poor lady on our psych unit where I had my first psych job -- she was a chronic schizophrenic and v. familiar to all the staff on our unit; for several days she didn't want to get up and participate in activities, and complained of abd. pain. Well, we all charted faithfully that she was "seclusive to her room" and "preoccupied with somatic complaints" until she finally passed out on the floor, and it turned out that her inflamed appendix had ruptured a few days earlier, and she now had a belly full of flaming peritonitis! She had a long, difficult recovery following her emergency surgery ... I've never been cavalier about psych patients w/physical complaints since ...

i've seen more psych nurses do more "dim-bulb" things with patients than you would believe because they're so rusty on basic med-surg nursing -- like the experienced psych nurse I worked with at a major teaching hospital who brought a patient to the nurses' station for VS, checked the board and saw that the doctor had ordered BPs "sitting and standing" (I guess they couldn't deal with the term "orthostatic"), and said to the patient, "Well, since you're already standing, I'll do that one first ..." :rolleyes:

You're free, of course, to do whatever you want, and you could probably find someone who will hire you into psych without any additional experience. But, esp. since your previous experience was in a specialty/outpatient area and you've not been in nursing at all for the last 20 years, and since you asked for opinions/advice, I believe it would be a really good idea to get some real med-surg experience.

I heartily recommend psych nursing, though! Best wishes with your new career!! :)

PRNMEDS · Apr 26, 2004

I dont believe it is necessary for you to go get Med Surg experience to work in Psych.

You graduated 34 years ago - it would take a lot to learn all the new Med Surg things AND get the experience - and for what? To use a miniscule amount when you work Psych?

I think the refresher course was great idea, combined with general medical knowledge, and common sense and you should be able to function. I think you need to get in a hospital that does have heavy medical patients. Study up on Diabetes, siezures, allergic reactions, basic first aide and you should be fine. If you find you need more - THEN go back. GOOD LUCK.

normj · May 8, 2004

I graduated from nursing school in 1970. I worked as a school nurse for two years from 1970-1972. The rest of my career has been as an elementary school teacher. I recently took a refresher nursing course. Do you think I have to work as a med surg nurse before getting a job as a psychiatric nurse??? Thanks for any advice you can give me.

i am choosing to work med-surg for a year or 2 before I go into psych, general opinion among all I ask is about 2:1 in favor of doing that versus going right into psychiatry ...

chris_at_lucas_RN, RN · May 8, 2004

Maybe I should change my handle to "dim bulb," but would somebody please tell me why this is wrong?

...who brought a patient to the nurses' station for VS, checked the board and saw that the doctor had ordered BPs "sitting and standing" (I guess they couldn't deal with the term "orthostatic"), and said to the patient, "Well, since you're already standing, I'll do that one first ..."

The only thing I can think of is that the BP might be a wee bit lower if the pt were allowed to sit a bit for the sitting BP, but then they have to stand up again anyway.

Sorry to be so dense..... I just don't get this...

lucianne · May 8, 2004

Chris, you're going to be embarassed....

Orthostatic hypotension occurs when a person moves from either lying to sitting, lying to standing, or sitting to standing positions. Sitting to standing is most convenient, but not as accurate. Therefore, you need the sitting pressure first and then you have to measure the blood pressure again when the patient moves to a standing position. The patient should be sitting or lying for 5 minutes before the first measurement is taken and the second measurement should be taken withing 1 to 2 minutes of standing. If the second systolic measurement is 20mm Hg lower or the second diastolic is 10mm Hg lower, or the heart rate rises 20 beats or more, the patient is considered to have orthostatic hypotension. Measuring the standing blood pressure first isn't going to tell you anything.

chris_at_lucas_RN, RN · May 9, 2004

Hi, there--if I was embarassed every time I didn't know something I'd never been taught, I'd be in big trouble! But then, wouldn't we all?

So, no, I'm not embarassed at all!:)

Your explanation is excellent. It's is true that we get our education all the time, from everywhere, even the professional stuff. It's a constant process.

When this comes up on my CPNE, I'll have you to personally thank for it!

(I hope you taught that other nurse as well as you taught me....)

lucianne · May 10, 2004

Chris, I didn't mean to imply that you should be embarassed. Actually, I never came across orthostatic blood pressure measurements until I started working on the inpatient unit and had to do them on patients with anorexia.

Glad you liked the explanation--and it WILL come up somehow, somewhere. :)

luci