GeneralJinjur

Doubtful in this case, since they have been unconscious for most of their ICU stay, but I agree that balancing mental and physical health is always a concern. As have I. My go-to response is to find a way to make something work. There was no safe workaround for this patient. I remain impressed with the ICU nurse for acknowledging that we share a common goal for this patient and not being hostile about it. It was an unusual response and I am allowed to celebrate 2 nurses successfully advocating for the best interests of this patient. My expectation is that this patient will be safe to transfer within a day or three. I will accept them and they will get the mental health treatment they clearly need. They will be more alert and able to focus when they join my unit, which means they will be better able to absorb what is happening in groups and therapy. This was the right move for this patient.

In the middle of nurse to nurse, I had to stop a transfer to my unit today because pt was unable to ambulate independently. I was so impressed with the ICU nurse on the other end who listened to my reasons for shutting it down and said, "That's okay. I just want this kid to be safe." Me too, which is why I had to stop the admission. A kid who can't ambulate won't be safe on my unit. I think that's the first time a discharging nurse hasn't thrown a fit or demanded that I take an inappropriate patient. It was a real highlight of my day.

I agree that psych nursing can be very emotionally draining. I have done both kinds of shifts for at least 3 years on each type. Personally, I prefer 12s, since working five 8 hour shifts feels like I am always on the unit. Working 32 hours a week is a good middle ground.

3 years on a waitlist...

You all make good points -- I think the irritation comes from this being seen as only a nurse's problem for not reminding the doctor of necessary orders that should be obvious, given the patient's condition. No doubt docs are being reminded about this, but it's very likely you aren't going to see it happen. Their culture is so very different from nursing's.

Exactly! I know my patients well and no longer have to hope that I met their needs. My job satisfaction is through the roof because I have the tools to take great care of all my patients.

I would document it in my discharge note. I can worry about them, but it doesn't help the patient one speck. Recording their behavior as they leave my care can help the next treatment team address this.

My first hospital had 3 nurses to cover 26-32 patients, with the same number of techs. I left there for a better staffed facility, which also happens to pay more. Now I have 5 patients per shift and it's lovely. I feel like I'm on vacation every day.

The manager may be unable to if there is a sudden hiring freeze or some other administrative fun occurs. I am in favor of taking advantage of every job interview, even if all it means is that you have more practice for the next time you job hunt.

I only tell my bad stories to family members who work in law enforcement, because they can commiserate. Everyone else gets to hear the funny/quirky stories.

I love the 3-11 shift. Did that my first year, then moved to days because I wanted to see my children. As soon as the little whippersnappers are out of the house, I will go back to evenings. Yes, you will get the majority of admissions and a fair number of discharges, but I liked the extra time to interact with patients and I despise getting up before the sun.

Oh, I connect just fine and definitely prefer it that way (though I have yet to get a paranoid psychotic patient to connect with me in the first few days -- which doesn't mean I don't try). I also work really hard to find the things that motivate that patient and share it with all the other staff. If there are severe personality disorders, then I am more businesslike so they don't misread the boundaries. They misread them anyway, but it's a little clearer for the other patients that I am not giving the personality disorder folks special privileges. One of my favorite lines when they are attempting to wheedle me into giving them pain meds too soon or some other typical outrageous request is, "No, I like my job and I like my license." Not a one has ever pushed it farther. Livingdeadnurse, I have only been in locked hospital inpatient units. Some patients are brought in by police, a few are walk-ins, and the majority have been medically cleared at an ER after a suicide attempt. There's a lot of anger because "the ER said I would only be here 3 days" and the typical stay is 7-10 days. Sadly, there are a lot of frequent fliers as well, so I don't always have the advantage of being nice and knowing they will go away soon. I do a fair bit of wound care for self-inflicted damage and you would see the typical spread of chronic medical issues, like diabetes and asthma. Lots of substance abuse in my patients. Also, you would be putting patients in restraints and seclusion from time to time. Despite all the weirdness, I really enjoy it. No two days are alike and I get to see marked improvement from admit to discharge. There is a ton of teaching involved and you get to test the upper limits of your patience. Any chance you could stay PRN at your current job and dip your toe in the psych waters?

A free standing psychiatric hospital offered me my first nursing job and thus, a psych nurse was born. I'm in my 4th year of working in psych and I really like it. I can see myself sticking with this specialty until I retire. I did not plan to do this when I was in nursing school. I adored med surg and fully expected to spend a few years at least building my basic nursing skills there. Are there are other areas of nursing that interest you? One of the reasons I wanted to be a nurse was because I could jump around to different areas and it wouldn't be frowned on.

Any chance you can go to one of our rural hospitals? The outlook in the Denver metro area is exceptionally tough for new grads. Channel 7 news did an article within the past year about how there were only something like 10 new grad positions open in the state and we have around 700 new grads in the Denver area. There are hospitals in Grand Junction, Lamar, and Pueblo that have more flexibility than the Denver hospitals. If you are able to move, I would definitely apply in those types of places. I disagree with the thinking that nursing home experience does not count. Many new grads started at my free-standing psych hospital, but continued applying everywhere and left for the first "real hospital" job offer they received. In most cases, the fact that they were working as a nurse helped them get the interview. Please visit the Colorado forum to get more ideas of places to apply. I wish you the best of luck and perseverance!

I am great at teaching laypeople and peers. In school, we called it Patho for Kindergarteners. I also seem to be good at walking in on folks as they are trying to hang themselves. It's a useful skill in Psych. :)