For New Grads -YES you can do psych.

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I wanted to post this for new grads who are perhaps in the same position that I was in about 6 months ago. I did nursing as a second degree, my first love was always mental health. I've always been very passionate about protecting the mentally ill. As I was nearing the end of nursing school, I couldn't stop thinking about how much I wanted to be a psych nurse... I could feel it in my BONES but it seemed like every time I had a thought about psych nursing as a new grad, I had another thought of "well... maybe I should do some med surg first. Just to be safe. Just in case." Because that's what everyone had told me to do.

Just to be safe from WHAT? I hated med surg during my clinical rotations. I learned a ton and I respected the process of healing on a med surg floor.... but I hated it. So why should I have done med surg nursing "just in case" when I knew I was never going to do med surg? But... that didn't stop those "just in case..." thoughts from invading my head as I was choosing my future.

I met with a nursing instructor/mentor before graduation to talk about my dilemma. To this day I am so grateful for her pushing me to do psych. She told me quite bluntly to just follow my gut. She told me that in her opinion, nurses on med-surg floors should get mental health nursing experience before walking onto a med-surg floor because mental illness hits everyone, everywhere. She gave me that "push" to do what I know I'm meant to be doing. She told me that psych is the future.... more and more people are carrying the weight of a mental illness.

I have been lucky to begin working as a new grad on a unit with an incredibly supportive team, a phenomenal nursing manager who coaches me and mentors me and supports me, and a very steady, consistent orientation in a hospital where therapeutic communication and milieu safety are of up top most importance. On my unit, I have only seen one restraint, and it was absolutely necessary at the time. It's been 3 months. My preceptors are supportive, my manager creates a safe working environment and validates my concerns, a lot of the time my coworkers are laughing and dancing to music hour or zumba group... I can't say enough good things about it. I lucked out.

HOWEVER, with that being said.... I wanted to tell all of you brand new nurses who are about to go out there interviewing TO LISTEN TO YOUR GUT. I was smart. My first interview was on a different unit in a different facility where the nurses looked burnt out, the unit looked run down, the furniture was torn up, the manager offered me the job 5 minutes into the interview..... and I went home from my interview with a bad, sinking feeling in my stomach. Nursing is a small world and I still hear stories about the nurses being miserable and treating each other poorly on that floor. I had a feeling not to accept a position there. I was lucky enough to receive an offer at the same time from the employer I work for now, but I just wanted to say.... if something feels off to you, if the facility seems a little shady, if the nurses look really tired and burnt out... chances are you may burn out quickly too. If your interview lasts an hour and a half and your future manager is asking you so many intense questions that your head is spinning... take it as a good sign. He/She knows what she's doing. If an offer is granted to you within 5 minutes... be wary.

I am so thankful that my nursing mentor pushed me to do psych nursing that I want to pay it forward and inspire those who may be thinking about doing psych nursing right after graduation. I am so happy where I am. There isn't a day when I don't come home satisfied from my job. I think it is a privilege to be a psych nurse, to be there for that patient who is SO vulnerable and SO impacted by their mental illness that they would do anything to release the pain.... it is a privilege to be the person who has opportunity to begin a conversation with that patient, to ask them for their story. I feel like I am where I am supposed to be, and I don't intend on leaving this unit or this hospital or psychiatric nursing until I retire! No, I don't feel like I'm missing any "skills." Yes, we still insert foley catheters. Yes, our patients still require wound changes. Yes, our patients are still in wheel chairs with arm and leg hard casts and require skin care and ROM exercises. Yes, our patients do need immediate medical attention. Yes, I am still learning medical skills! Yes, I am IV certified! Almost all nurses are trained to perform "skills" but how many nurses can sit down with a patient who is hearing derogatory auditory hallucinations, and make him or her feel safe?

If you want to do psych nursing, just DO IT. Follow your gut. But be smart. Keep your eyes open and your mind sharp when you're going in for interviews. Observe the unit, the patients, the environment. Don't settle, unless you absolutely have no choice. I do not regret for a SECOND that I didn't start with med surg or any other unit like that. I hear my friends from nursing school talk about everything they experience on their med surg floors and I just sigh... because I know I would be absolutely miserable there, and I am so thankful I didn't put myself through that "just because."

Do what you love and you will be happy. It's that easy.

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Specializes in Family Nurse Practitioner.

Many congratulations and welcome to psych. :) Your repeated mentions of being passionate, protective, making patients feel safe etc. would have me caution you to consider counter transference, watch your personal investment in the process and remember boundaries. No biggie just something that can bite a newbie in the butt.

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Specializes in Psych (25 years), Medical (15 years).

I say "AMEN!" to your entire post, Psych_Nurse89!

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Specializes in Prior military RN/current ICU RN..

I would disagree with the idea that doing med surg is "just because". I did two years med surg when I got my BSN before switching to psych long term. I am telling you what I learned in med/surg stays with me to this day. For one..confidence. My assessment skills are top notch. I do not get nervous during medical emergencies. I went through endless code blues and I honed my skills. I learned how to give IM injections. I learned how to understand lab values. I learned how to place IVs. PCA pumps, NG tubes.

Now many of those things may not seem important working psych, but it made my confidence level skyrocket.

It isn't "just because" that many of us did med/surg first. Many do it to create a strong foundation to build off. I don't care what others do. That is their business. However I don't like the notion that people who work med surg for a year or two are "settling" or "have no choice". I made a decision based on what I felt would provide me the best skills for the long term.

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Specializes in Psych (25 years), Medical (15 years).

Good points, windsurfer8. Nurses with some medical background are an integral asset to any Psych unit!

I have found that competent new Nurses straight into Psych often avail themselves for medical learning opportunities and ask a multitude of questions.

Other new Nurses seem to be satisfied in knowing Psych nursing well.

Still others are content being warm bodies with RN/LPN behind their names.

It takes all kinds...

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@Jules A - thank you for that tip! Because I am a brand new grad I am actually trying very consciously to avoid countertransference (though I know it's a subconscious process) but in general being careful about my investment in the patients, etc. By "keeping them safe" I mean ensuring them that they're safe on the unit and safe around staff, etc. Thank you though :)

@windsurfer8 power to you!! I have ALL the respect for nurses who thrive in med surg and master it. My point was, I knew myself well enough to know that I would personally be miserable on a med surg floor. I didn't want to be taking care of patients when I myself was feeling miserable only because a few people had told me to "do my time" there... that's not fair to the patients. I simply had no interest in it and knew I wouldn't be happy in it (I wasn't happy in the clinicals there, but thrived in psych clinical). I don't feel in any way disadvantaged on my unit now, and I am lucky to have experienced nurses by my side as I learn and ask questions and observe. I know I am NEVER alone on the unit and am lucky to be in a place where we all work together as a team and help each other out. I know this topic is THE debate in psych nursing, but that is just my perspective :)

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Specializes in psych/dementia.

Another new grad who went straight to psych nursing. While it's only been 3 months, I don't see myself regretting my decision. I WOULD have regretted my decision to do med/surg! That's just not me. It's never been me. I've ALWAYS been a "psych" person. No regrets!

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I feel like you wrote this post to me personally! Thank you so much for taking the time to write this. I'm on track to graduate from an accelerated BSN program this December as my second degree as well. I minored in psych in college and it has always been the one thing I have always enjoyed learning about and have been interested in. I've had many nurses and many of my teachers give me the same advice about working on a med surg unit for at least a year. Reading your post made me feel much better about just going for it and "following my gut" like you said! Do you mind telling where you work/how it's going so far? I'm currently in Louisiana but thinking about moving to Texas, TN or NC possibly after graduation for a few years! I eventually want to go back to school to become a PMHNP and Louisiana doesn't offer many opportunities for that right now.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.
I would disagree with the idea that doing med surg is "just because". I did two years med surg when I got my BSN before switching to psych long term. I am telling you what I learned in med/surg stays with me to this day. For one..confidence. My assessment skills are top notch. I do not get nervous during medical emergencies. I went through endless code blues and I honed my skills. I learned how to give IM injections. I learned how to understand lab values. I learned how to place IVs. PCA pumps, NG tubes.

I wish that I had been able to do med-surg first. My first job offer out of nursing school was in mental health. Five years later, when I found myself working in a freestanding mental health facility that was being closed by the parent company, I found a lot of doors closed because I had been pigeonholed into mental health and it was assumed that I couldn't do anything else. I went from making a solid salary to drawing unemployment compensation for three months, during a time when hospitals were running full page ads for RNs. I couldn't buy an interview. The facility I worked at was the largest mental health provider in my area, and the nursing job market simply could not absorb that many people thrown out of work at once in mental health.

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Psych_Nurse89,

Could you please send me a private message? Your post was just what I was looking for and didn't even know it. I have some questions for you and would like to chat privately, if at all possible. Thanks in advance for your time.

-Pr0spectiveRN

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Great Post,

I am a second degree student. I have over 15 years experience working in mental/behavioral health and just accepted a psych nurse job at the VA. While I am excited, I was also nervous that I would lose skills. My argument to my husband was about learning IVs...and then I read your post. You made me feel so much more confident in my decision. Thanks for this!

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Specializes in Psych.
I would disagree with the idea that doing med surg is "just because". I did two years med surg when I got my BSN before switching to psych long term. I am telling you what I learned in med/surg stays with me to this day. For one..confidence. My assessment skills are top notch. I do not get nervous during medical emergencies. I went through endless code blues and I honed my skills. I learned how to give IM injections. I learned how to understand lab values. I learned how to place IVs. PCA pumps, NG tubes.

Now many of those things may not seem important working psych, but it made my confidence level skyrocket.

It isn't "just because" that many of us did med/surg first. Many do it to create a strong foundation to build off. I don't care what others do. That is their business. However I don't like the notion that people who work med surg for a year or two are "settling" or "have no choice". I made a decision based on what I felt would provide me the best skills for the long term.

Sorry, gotta disagree with ya on this one. I went into psych straight out of nursing school. In my experience, I never STOPPED looking at and understanding lab values, doing physical assessments, inserting catheters (mostly just straight cath though). My first job in a community mental health agency was more medical than psych. We had social workers and therapists to deal with much of the psych stuff. We were in charge of keeping the clients healthy. I learned more about health promotion and prevention at that job than any other jib I have ever head.

Psych patients get sick too. On average, the severely mentally ill die 25 years sooner than non-mentally ill folk. When I worked at the free standing psych hospital, we had no medical floor to send patients to, no ICU, no IMC. We had to be able to assess to a pretty good degree whether that chest pain or SOB was because of anxiety or because there was some cardiac problem going on. If it was the latter, we were SOL until EMS showed up.

I work on a psych unit in a general hospital now. We take pretty medically sick patients as well. We also take alcohol detox. Those patients get VERY sick quickly. I manage IV fluids, hang IV meds, do wound care, etc. About the only med-sug tasks I don't do are IV starts or NG tubes. Its actually nice we have respiratory to do neb treatments. I did them myself at the free standing. I think your physical assessment skills have to be pretty on point in psych because to get a doc to take you seriously you 1) have to prove to the doctor you know what you are talking about because most doctors think psych nurses dont know what we're talking about 2) Be able to have real, solid evidence something is going on because most doctors dont take the patients seriously either. Its always "just in their head".

Did I mention we do TONS of IM's? In my first job I ran an injection clinic where all the Pts on long term antipsychotics came to get their IM's every other week or every month depending on the med. You learn confidence in psych, at least I have. I have learned how to keep my cool in a crisis. I have learned how to be confident in my assessments. I have learned to manage my time. Having an assignment of 5 actively detoxing alcoholics can be pretty time consuming :)

Ive learned a lot of skills I wouldnt have learned in med surg. In my facility, 2 members of our team are required to respond to any code greens (combative person) in the hospital. I have foiund it very interesting how a lot of med surg nurses (we have a LOT of code greens on the medical floors) are just not able to de-escalate patients or even calm them down. From dementia patients climbing OOB to schizophrenics admitted for medical reasons. Half the time I show up and they are standing there like a deer in headlights. For example. we just went to a code last week wherein an actively hallucinating high fall risk schizophrenic was trying to get OOB and swinging at the air. We were able to get the situation under control quite quickly, and the house supervisor at night relies pretty heavily on us during any behavior in the hospital.

Dont get me wrong, I have much respect for med surg nurses. Their work is often thankless, and unsafe due to high ratios, but really if what you want is psych, I say go for it. When I went into school, I was pretty surprised that I immediately felt "home" during psych clinical LOL. I too felt like I needed a year of med surg, and believe you me, I tried. This was 2011 though and it was quite difficult for new grads to land that first job. It just so happens the position I was offered after umpteem interviews and resumes sent was with a community agency.

And if you really feel like you might want to branch out someday, I would advise anyone to work on a psych unit in a general hospital. Units are much more likely to put in the time to train internal transfers :)

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