Getting over being nervous

[Little Panda RN]

How do you get over being nervous. I am new to pysch and today I was very nervous. I dont think I showed it, but I sure felt it. How do you deal with those pts who are at the time very psychotic. Of course there is no reasoning with them because of their state of mind.

This type of pt makes me very nervous. They swear, threaten to kill you, spit on things and do things that are completely the other side of normal. I am not sure how to handle it. I dont even want to go near the room, but of course I do.

Is it normal to feel this way? Maybe I am not cut out for psych. I like my job and adore the people I work with. My co-workers are awesome they dont seem to be nervous at all, when something happens they are the first ones in the room. Why do I feel this way. Why cant I be more like them?

Today I felt like I had no backbone. That is just not me. I felt out of my comfort zone. I know I am just babbling here, but it was a very stressful day.

Thanks for listening.

[aloevera]

I don't know that it gets any easier, but you sure do gain knowledge of how to deal with different situations as time passes....

Eventually you will lose that knot in the stomach when facing various crisis,,,,attend all the staff meetings pertaining to "how to deal with borderlines, suicidal pts., etc. Our facility regularly has these in service meetings....Borderlines are very hard to deal with, for me, and I read up on all I could about how to deal with them....

Good Luck, I do love my job !!!!!

[batgirl23]

Hi

I have been a psych nurse for 21 years and I am as passionate about it today as I was when I started out. Most of my career I have worked in a 200 bed specialty mental health facility which treats the most chronically ill and complex patients in our region. I have worked in most sub-specialties in psychiatry and in both in- and out-patient settings. I am currently a clinical educator. The best advice I can give you is:

1) Give yourself a break - you just started!!! :) It will take time for you to get to know yourself and your patients. Psych Nursing is arguably one of the most challenging of the nursing specialty areas - our stock in trade is ourselves (therapeutic use of self) and it takes experience and skill to do it well.

2) When in doubt, just listen. I find many nurses new to psych feel they want to give the patient answers or fix problems and they feel somehow inadequate when they don't have the answers. Sometimes people just need for you to listen to their story and give them time to formulate their own solutions. You may be surprised what people come up with as attainable and realistic personal goals for their recovery.

3) Take care of yourself. The fastest way to burnout is to not take care of yourself. This is hard work mentally and emotionally and you need to renew yourself or you will soon have nothing left to give. Leave work when your shift is done; take up a hobby if you don't already have one; spend time with family & friends (which can be a challenge if you do shiftwork!); sleep enough, eat well, exercise, etc. (all those good things we tell our pts but don't always follow ourselves!:wink2:)

4) Read everything you can get your hands on... then learn what you really need to know from your patients. My best teachers about the experience of mental illness have always been my pts. Who better?

Also, the advice others have given is good: learn by watching your co-workers. You will learn a lot by watching what works (and what doesn't) with your patients.

When you can, take some workshops on things like non-violent crisis intervention and suicide intervention. Having some skills under your belt to help you deal with some of the more frightening aspects of psychiatry may help to increase your sense of competence and improve your self-confidence.

5) Treat all your patients with respect, dignity and courtesy. Patients respond to this the same as anyone else and most will remember your caring and kindness even if they don't really seem to be experiencing the same reality as you right now. Sometimes this can be challenging if a pt's behaviour is frightening or distasteful or perceived as deliberate or manipulative. What helped me in the beginning was to try to imagine this person as they might have been as an innocent infant - it sometimes helped me to find my compassion.

6) Learn how to effectively and consistently set limits and boundaries - many of our patients struggle with this and it's up to us as nurses to make sure no one crosses the line.

I didn't mean for this to be so long but I hope it helps. Hang in there - it will get better!

[Little Panda RN, ASN, RN]

batgirl23, your post is full of so much wonderful advice. I appreciate every bit of it. It is wonderful nurses like you that help us new nurses find our way!!!!

Thank you

[The_Wonderkid]

Hey! Your Nervous thats great! I have always said to people who are new on the ward that use being nervous as a good thing. There is a valid reason why you get nervous in these situations and I believe that even the best nurses with years of experience still get a little jittery when someone comes running at them swearing. Its a natural reaction.

Personally if I feel nervous it makes me more alert. I am aware of what is happening and I become super sensitive to the things around me, including the person being threatening. This ensures you pick up ques (which may be subtle) which if you were calm you wouldn't. Use it to your advantage. One day it will click and you will ease into the situations you are facing. However I always say that the minute you become too relaxed and get complacent thats when you have problems. Its not always a bad thing to be nervous, sometimes you do your job better when the pressure is on... Don't be worrying about it. It'll come and you will chill out!

One last bit of advice. Listen... Listen to everyone around you but most importantly listen to your patient. You shouldn't run into any trouble if you listen to your colleagues but especially if you are listening to the patient (DON'T assume anything!) I found the one thing that caused problems for nurses was they jumped to a conclusion or just plain didn't listen to the patient. If you listen, acknowledge and act on what a patient says to you, you will feel more confident that you are safe and you will begin to build a great relationship with your patients which will make you feel at ease.

[Little Panda RN, ASN, RN]

Thank you wonderkid, I am starting to feel a little better about being nervous. I guess it can be a good thing.

[Mish56, BSN, RN]

ND:

welcome to the wacky world of psych nursing!! I have to agree with some of the posts, if you were NOT nervous I would be worried. I've been a psych nurse for 30 years, there are still patients that can scare the poop out of me! Somehow, I have learned to keep that WAY inside, I've had co-workers say to me "how did you do that? You were SO CALM!!" I make sure the patient doesn't know how I'm feeling, because I'm sure they would feel it if they thought I was scared.

Batgirl gives GREAT advice! Lucky for her students! I have always said my patients have taught me more than any book, but you do need to learn the basics of every dx.

Remember, these are people, someone's mother, sister, and yes brother. I have yet to meet an 8 yr. old who says, "when I grow up I want to be psychotic". They deserve respect (there before the Grace of God go I), and let me tell you society doesn't give it to them. Our psych population has become the "invisible people".

So welcome to the best field of nursing! Hang in there, it does get easier with time and patience (with yourself).

[batgirl23]

I have yet to meet an 8 yr. old who says, "when I grow up I want to be psychotic". They deserve respect (there before the Grace of God go I), and let me tell you society doesn't give it to them. Our psych population has become the "invisible people".

Well said, Mish56! It sometimes surprises me how some people can work in psychiatry and not get that!

[EarthChild1130]

The longer you work with psych patients the more comfortable you will be. It is natural and perfectly normal to be nervous...just keep your game face on! I hope your new job is going well!

[Mish56, BSN, RN]

So nd__mom, how goes the job? Your nerves? Have you run into a pro who will mentor you? Come on, I just got off of 3 days and 40 hours working with some great nurses and some very green mental health workers. Alright; and one old battleax nurse who hates to leave the nurses station and actually check on her patients. But it was a good long weekend. Let's see, had the 38 year old who I've known since he was 18, who once again decided his meds were really poisen and I watched him disintagrate into "a million little pieces" over the weekend (still breaks my heart even tho he frustrated the heck out of me); the real heart breaker-an 18 year old in the midst of his first bipolar break, grandiose,floridly psychotic, trying real hard to appear very threatening (had many convinced), found a soft spot that reminded me he was just a kid and probably terrifed..worked from his threatening to tear up the unit, to begging for 10 more mins. of basketball. Makes it all worth it.

The totally worst of the weekend was a newspaper death notice for a college kid we had briefly over a year ago, whose mom reported he had "died peacefully in his sleep". 21 years old. I know mental illness has a very real mortality rate...but those that slip past us, isn't there something we could have done? Was the suffering that bad? Oh, sorry to be rambling about my weekend, when I really was hoping to see how YOU were doing!! My intent was to demonstrate the ups and downs, successes and failures of pysch nursing.

Sorry bout the spelling, gotta figure out the spell check here!

[Little Panda RN, ASN, RN]

Mish56 the job itself is going good. I am feeling a little more comftorable interacting with the pts, but of course we have not had anyone with a high acuity lately, mostly depression on the adult side. The adol side is another story. Lets say we have some holes in the wall in low stim. Anyways I am learning to deal with the escalations. We have been short staffed and that is a challenge.