First job interview at a residential treatment center!

Nurse GreenBean, ASN, RN · Jul 18, 2020

3 minutes ago, NursePoopyPants said:
Hi, folks...
I'm a new grad RN and I have my first upcoming interview for a substance abuse recovery nurse position in a residential treatment center. Before you all yell at me for not starting off in med-surg, I have known since before I started my program that I was interested in mental health/addictions. And really this is the only facet of nursing I am super passionate about!
Just wondering if anyone could share their experiences/ typical day/ qualities that made you a excellent substance abuse recovery nurse. Any tips or tricks to the trade to make sure I'm giving this vulnerable population of individuals the best care I can while also maintaining my own mental well-being??
Thanks! ?

I also knew I wanted only to work in psych when I graduated, so I went straight into my specialty as my first nursing job.
What I learned beyond a doubt is that there literally is no replacement for the things you learn your first year as a nurse, and if you skip med surg, you’re missing a lot of the foundations of being a nurse, even in psych.

In my first year as a psych nurse, here are some of the things I needed to know, but had zero experience in:

rapid responses and dealing with the crash cart. Psych meds can have profound effects on cardiac function. If you can’t tell whether someone is having a cardiac response to some commonly administered psych meds, you can’t help your patients. If you haven’t been around a lot of rapid responses (and called for quite a few), you’re likely to hesitate. That can do real harm to patients.

Psychotic appearing behaviors that have a mental health origin vs those that have medical origins. My first year, I absolutely couldn’t tell the difference. Neither could the nurses I was working with that had never done Med surg. Once I did leave to get my medical experience, suddenly I could MUCH more easily spot the difference between bizarre behavior due to psychosis vs poor response to psychotropics vs AMS due to infection or AKI. After going back and getting my year on medical, I literally was able to get quite a few patients life saving medical treatment that had been chalked of by several shifts before me. “So-and-so has been acting up and has needed several ETOs for aggression in the last two days” but that patient was literally was fully blocked due to high dose meds that cause constipation without concurrent use of laxatives. Patient needed emergency resection by the time I got the patient). “So-and-so has been getting increasingly isolative and irritable. I’m be been letting them stay in their room, but encourage them to participate in meals and groups as much as possible” was actually full in sepsis that had gone unnoticed for 3 shifts. Straight to ICU, do not pass Go. Patient arrives on unit, medically stable but with healing burns over torso and neck that needs dressing changes with no wound care nurse willing to come to the unit for assessment and orders. Thankfully that happened after I did my medical. Had I come across that before, I would have botched those dressing changes. My geriatric patient who was sent to us for AMS and sensory hallucinations (by their own Dr!) was admitted 16 hours earlier to the unit in full kidney failure, was no longer eating or drinking and had been hallucinating -at least in part - because “nothing tastes right”. Again, straight to ICU. The nurses before me who didn’t catch these things were INCREDIBLE psych nurses. But they had zero medical training, and these patients could have died because of it.

Now, in a way I’m glad I did my beloved psych first, because I cried on my way to every medical shift for the entire year I did it, I was so stressed and so unhappy. If that had been my first experience as a nurse, I may not have made it to my second year. But in my specialty, I wanted to be a really GOOD nurse. And the longer I was in my specialty without understanding basic medical nursing, the more I realized honestly that was never going to happen. I was missing huge chunks of information that my patients needed me to have down pat.

When I was making my move to Medical nursing and looking for jobs in that area, I was again aware of how little I knew. The problem was that I had been a nurse for a year at that point: too long for any units or hospitals to want to train me But with no experience, I knew I would be unsafe to work with patients without some kind of “new nurse” training. Heck, I didn’t even know how to insert an IV beyond the rate times I got to try in nursing school!

I was stuck. I ended up getting “lucky” and found a hospital unit that was desperate enough for nurses that they were willing to give me 12 weeks with a preceptor, which was the only way I was able to do it. Of course, I also found out that they did this because this unit was the most avoided unit in the hospital with very high turnover (this the crying during my commute).

I don’t know how I would do it if I had to do it again: medical first or psych first then medical then back to psych. Both had real pitfalls, and both ended up having advantages for me (but then, I did get lucky enough to be trained in medical despite being an experienced nurse).

What I would never do is avoid gaining the medical experience altogether. You’re going to be giving medications that profoundly impact cardiac functioning and the CNS. You’re going to be giving ETO injections based on your assessments of someone’s behaviors and physical status. If you don’t know that someone is not making sense because they are heading towards septic shock, or that a nonverbal patient is acting out because their intestines are near rupturing from meds you’re giving that you didn’t know should be given with stool softeners and laxatives, those patients could die or become profoundly harmed by that lack of information.

Sorry about the lecture. I work with long time psych nurses with no medical experience, and I find their assessments pretty troubling in what glaring medical issues they completely miss. That should never happen.

amoLucia · Aug 1, 2020

Nurse GreenBean - kudos to you for your professional commitment to excellent care for patients.

Nurse GreenBean, ASN, RN · Aug 2, 2020

4 hours ago, amoLucia said:
Nurse GreenBean - kudos to you for your professional commitment to excellent care for patients.

Thank you very much. I appreciate your kind words.

it was hard...very hard...leaving a unit that I had cut my nursing teeth in, where I adored the patient population, and where I was on track for leadership roles. But I knew that without medical, I wasn’t providing the care that my patients deserved. And once I got the medical, I realized even more how much I had been missing without it.

I really did hate it though. That was not a fun year for me. But I would do it again in a heartbeat for the experience and skill set I walked away with.

SElliott87, ADN, BSN · Aug 3, 2020

I knew from day one med/surg and floor nursing were not for me. My first job right out school was in a fast-paced urban Emergency Room and I thrived off the adrenaline, and somewhere along the line became the go-to person for any psych emergency, combative patient or mental health/overdose client that came through our squad doors. Fast forward ten years later and I work as a Nursing Supervisor for a small, for-profit mental health and addiction treatment center utilizing MAT. I love my job, and though I tried some other specialties out inbetween the ER and now (travel ER, home care, oncology, hematology), this type of nursing is my niche and passion. Also currently 2 classes in to my PMH-NP Program.

CONGRATS on being a new grad, and the best piece of advice I can give you is to remind your patients that having a mental illness or an addiction does not make you less of a person, or less deserving of a chance, and that there is no straight line from addiction to sobriety!