this is getting old

PMHNP-1 · Jan 4, 2015

Psych nsg is actually one of the more difficult specialties....what is more complex than disorders of the brain, with neuro, cognitive, and behavioral symptoms and signs?

If someone wants to have a real holistic practice, based on evidence, psych nursing can be that practice. What other type of nursing is there, where we need to do not just physiological and psych assessment, but a full psychosocial and neuro, as well? And then all the psych testing, AIMs and the rest. Add the serious med reactions we're looking out for, and it's actually quite a good challenge.

Now, I don't know the reason that other people's comments are getting to you. But it may have to do with a couple of things: you've been in the specialty just under 2 years, and with that timing, it could be that in these 1.5 years you learned to do the job, and are having trouble getting beyond the adequate stage?

Which, if that's the case, would be because of factor 2: the workplace. If the unit you work on isn't set up for continuous learning for employees, for premium evidence-based care, for continuous review (team) of best practices, and full of good examples (the senior psych nursing staff and techs, and the PMHNPs, Psychiatrists, Social Workers, etc), you may not feel like you're learning a lot, or even doing a lot. I was lucky, early in my practice, to work in a unit where 2 of the psychiatrists LOVED teaching nurses about the meds and about how to do psych evaluations. We provided excellent care there and everyone was constantly learning and keeping up to date.

A bad environment, one where staff tell the patients to "stop asking that over and over! I TOLD YOU!!", units where there are a lot of behavioral events, units where restraints have to be used once a week or more.....A unit where people who actually interact with the patients are shunned by the rest of the staff "for setting a bad example", where EVERY patient is labeled "border" by the nurses and techs.....where patients are treated more like they are in prison.........It will never seem like you're providing much good care if you're working in such an environment. In that case, it would not be unusual to feel defensive about one's choice of specialty, since it wouldn't feel very "special".

A bad environment makes it difficult for a new psych nurse to learn, and to practice providing good care (when no one else is).

If this is what's going on, I hope there are other psych hospitals/units nearby that are better managed and run, so you can have the opportunity to practice providing psych care at its best.

PMHNP-1 · Jan 4, 2015

Hey ICURN3020 - don't be so hard on yourself! In the psych unit we are all trained and the unit is specifically designed (the space, the look, the activities - everything) for a psych unit. We couldn't care for a telemetry patient there, let alone an ICU patient.

MountainRN53 · Jan 5, 2015

Psych nursing is extremely challenging and I commend anyone who can do it. I work with several high functioning dementia patients and even they get on my nerves from time to time. I agree with windsurfer8, those who are saying these things are jealous or ignorant. Sticks and stones...

Gooselady, BSN, RN · Jan 5, 2015

When I went to medical oncology after 17 or so years in psych, I didn't hear comments or judgments as the OP said.

In the interview for the oncology position, I was surprised when the DON commented that my 'psych skills' will be especially useful on the floor. I didn't take her that seriously, as in my experience, the OPINIONS of non-psych nurses more glorified 'psych skills' than put them down as 'not real nursing'. Turns out my previous experience as a psych nurse almost made me a super star in acute care!

The 'awe' and respect I got for how I handled 'difficult' patients was almost shocking. The skills I did gather while working psych were not so obvious IN psych, but were very noticeable outside of psych. I gained a ton more respect for psych nurses after I was no longer one myself. The chatter about psych nursing was never negative, it was mostly a kind of incredulous respect, followed by "I could NEVER do that kind of nursing".

I could calm just about anybody down, including a grandmother who wanted to hit me with her umbrella. She gave me a hug on the way out, the old bat. "How do you do it?" asked my co-workers. Good question! "How do you stay so CALM??" Not sure!

We were plagued by a professional borderline personality, red-flagged in that nation wide 'patient to watch out for' list, I forget what it's called. We were told we'd probably have her on our floor for a year, and this was acute care. Her paraplegia made her inappropriate for a psych bed. I wrote a formal email to my manager and cc'd the DON about my concerns for the staff, that we were going to need a lot of extra support to cope with this patient. They took me seriously, and eased up on the staffing, got a mental health professional involved, and helped us reinforce a strict yet humane behavior contract for her based upon the ones other hospitals plagued by her used. Some nurses simply could NOT be assigned to her. Others were terrified but ended up being 'pros' handling her. Psych nursing is a knack, not something taught. You've 'got it' or you don't. It's a kind of talent.

Therefore it's been more respected than not, at least wherever I've worked. And the transition of 17 years of psych into acute care (via a 5 wk residency) was seriously no big deal. Most of nursing is like riding a bike. Psych nurses ARE nurses, they do NURSING care whether or not they are wrestling two triple pumps and a BiPAP or observing a patient in restraints.

So how a psych nurse can be considered 'not a real nurse' just makes no sense, and maybe my environs have been fortunate.

**NickiLaughs, ADN, BSN, RN** · Jan 5, 2015

Tell them if it's so easy then why does every other department of the hospital try to get rid of them as quickly as possible? Seriously, some psych patient's aren't bad, but others can make you suicidal and feel like you should be in a room just like them.

The manic ones that just brutalize with their statements and there's no ability to reason with them because they're just crazy.

Reorientation my ***. I start to believe there really is a demon in the corner with some of them.

Makes me :wacky:

Thank you for doing what I can't.

TakeTwoAspirin, MSN, RN, APRN · Jan 5, 2015

It's not just psych nursing. If it's any consolation, I worked most of my nursing career in the OR and PACU. I would be very wealthy indeed if I had a dollar for every nurse who said, "OR nursing isn't REAL nursing". 100% of these people had never stepped into an OR. Ignorant people probably think you sit around chatting all day and holding hands. They think I sat all day "playing on the computer". Let them think what they want. Do what you do and know your own value to your patients.

lasair · Jan 5, 2015

Is psych nursing easier than general nursing???? A lot of general nurses would not be able to handle the stuff we do and some are even to caught up to take advise from us when they have a difficult patient. I just get on with it, really, whatever to them. Haters gonna hate, just don't return the hate. Have appreciation for each others jobs, they are different jobs. You are a nurse that works in psychiatry - you are no greater or less than any other nurse.

Mandychelle79, ASN, RN · Jan 6, 2015

Because I am a smart alek I would just shoot back then why the heck do you guys kick the patients you cant handle to us ( usually without being medically stable)