Hello Psych Nurses & Future Psych Nurses, Please Read

lpnflorida · Mar 31, 2009

I loved working Psych for the multitude of years I did it. I also during that time was thankful for the numberous times of being pulled to the medical units as it helped to keep my clinical skills up which I did not use in Psych. I finally left and have no regrets for the years I spent on a nonmedical floor. I will always be able to use the skills I learned on Psych.

Psych is not for the faint of heart either, it is not an easy job by any means. There is just as much stress there as on a medical floor . It is simply different. Separating your emotional needs/adjustments to what is needed for your patients might be the most difficult for you. I have witnessed many excellent Psych nurses who had various problems such as chronic depression, dysfunctional homes etc. I recall one new grad who ended up having a complete psychotic breakdown while in her first year of being a Psych nurse. It might have happened to her no matter where she worked, but again working among a population who's issue are the same as ones own are not necessarily healthy for either the nurse or the patient.

I think talking to your councilor who knows you best will give you some answers as to will it be a good fit for you. It can be a very rewarding career, it can also be heartbreaking on so many levels.

Good luck, in what ever field you decide to land in. As to Psych nurses being looked down upon. Yes, I found that to be true, yet I would not have traded the many many things I learned, the many patients I helped in their times of need.

GooeyRN, ADN, BSN, CNA, LPN, RN · Mar 31, 2009

I worked psych for a year after nursing school. Then I married and moved, no local psych hospitals. So, I had no choice but to do med/surg. It was rough starting out, but I was able to transition. Now I am looking to go back to psych. I really think you should suffer out 6 months-year of med/surg first. That way, if you get burnt out of psych, you will have more options. You never know what life will bring, where you will be, what jobs will be available. I hate to see you pigeon holed early in your career. Med/surg is rough, but you do get used to it. I really don't mind it much after 2 years. I just prefer psych.

aniutka · Apr 1, 2009

I am working since december in Psych unit, Jun 2008 graduate.

what I find problematic is not the patients but often staff, not working together, using a lot of force, not being therapeutic at all, just medicating patients to be free of their annoying behaviors. One must develop very thick skin to work in such environment. I see very little understanding, willingness to help, lack of empathy and patience. Words heard most often are: limit setting, let me offer some medication to help you come down, staff splitting, I see a lot of violence, not enough therapy, lots of politics and no direction/education for staff. what matters is your RN license, you as a human being, nurse, don't matter, everyone is just looking to cover their a#$%^& and do as little as possible as patient call it " hiding in the buble" ( nursing stations are plexiglassed for safety)

I think it takes special type of a nurse to work in psych and very often people who work at psych units do it only for $ and lack of bodily fluids on the job.

Am I working in such bad place? Please tell me that not all psych units are like mine.

Whispera, MSN, RN · Apr 1, 2009

I've worked in two psych hospitals and neither of them were negative environments for patients or staff. I think you work in a lemon!

goettin98 · Apr 1, 2009

I'm not sure what your psych unit there is like, but ours is probably just as med-surg as the actual medical floors. We do the same things- Foleys, IV fluids and antibiotics several times a day, extensive dressing changes, G-tubes and NGs, wound vacs, external orthopedic fixators, oxygen, PICCs, Infuse-a-Ports, etc. We do lots of showers/baths, toileting, turning people in bed, and wiping butts. I work in a teaching hospital and I seriously think we see the Internal Med residents more often than the Psych ones. I've come to the conclusion that on my floor, we are not there to service the patients, we are there to service the physicians. They come in, see the pt for 5 minutes at most, then write a page of orders and leave. Multiply this by however many pts you have, and let the frustration begin. A lot of days we don't have a clerk, so it takes time to properly enter the orders in the computer, then you spend a lot of time coordinating lab draws, EKG personnel, consulting other MDs, calling family, getting consents signed and faxed, talking with CT/MRI/Xray, dealing with respiratory therapy, etc. If anyone has to have an off-floor procedure done, then we have to figure out which staff member can take them because they have to stay with them. A lot of times these procedure have to wait until the next shift or next day d/t staffing, which the doctors hate. It got to the point where the MDs just started coming to the floor to do lumbar punctures because they're so time consuming when done in radiology. Then, there are certain doctors who want you to call them with lab results or VS, or they call wanting these numbers. Not to mention how many times you end up calling pharmacy and central supply to get the pt's items to the floor. Top this off with (on my floor) 4.5 hours each evening during the week for visitors and 9.5 hrs each weekend day, and you are hard-pressed a lot of times to even get to leave the desk. Only the clerks and techs can ever take lunches and breaks, if the nurses get to run to the cafeteria for 10 minutes to grab food and then spend the next 3 hours eating it between calls, MDs, visitors, and pt "needs," then it's a good night.

Hopefully, the unit you are thinking of has structure. Mine doesn't. The counselors do about 1 group a day, combined. Not kidding. And of course, the counselors and the recreation therapist don't work evenings or weekends. The pts run around the unit, ordering the staff around ("get me this, order me that"), order outlandish meals, demand constant medicine, and then get to sit around in the lap of luxury watching DVDs and playing Wii, mostly on the taxpayers dime. The counselors decided years ago that RNs don't have the proper training to lead groups, so we don't. Not that we would have time anyway. Plus, I don't feel like it's my job to do groups- I don't expect the counselors to pass meds, call MDs, or wipe butts.

Also realize that some, if not most, of your patients may not truly want help. They will brag about going right back to drugs as soon as they're discharged. It's rare that we get pts who want to be there for the right reasons. Most of ours are involuntary or just come in for "rest and relaxation" (yes, I've heard that from pts). And we have many, many "frequent fliers." They like having someone come in every day and clean their room. They like ordering unlimited food room service. They enjoy having someone (staff) at their beck and call 24 hours a day for medicine, sodas, snacks, etc. Don't get me wrong, the ones who are truly sick and do their part in taking responsibility for recovery/treatment are rewarding, I just don't want to give you the false pretense that all pts are like that.

Many of the nurses on my floor are pts of our various psychiatrists. I can't tell you how many of them are on psych meds, mostly related to work stress.

I won't even get INTO the management issues on our floor.

I know you said you'd rather talk to families about psych issues rather than cardiac disease, HTN, or kidney functions, but again, it all depends on your unit. We probably spend more time discussing medical issues and CT/MRI/Xray/lumbar puncture etc. results with pts and families than psych problems.

At my hospital, we are paid the same amount as any other nurse with same/similar years of experience.

I don't mean to give you a negative view, but this is my reality. I went into psych nursing thinking it would be so personally rewarding helping people, the unit would just be full of meaningful conversations, breakthroughs, and hugs, and 99% of the time it's nothing like that. I've only been out of RN school 2 years, but I remember thinking about a lot of things, oh I don't need to know that, I'm going to work psych, I don't need to pay attention to reading EKG strips, Penrose drains, or suprapubic caths! I was very wrong. Some days, I actually ENVY the med-surg nurses. For the most part, their pts are in bed (not standing at the desk 5-deep), and they only have to deal with the medical issues. The minute any psych symptoms come up, they're shipped to my floor. We have to do the psych part AND the med-surg part, so our work feels doubled.

Best wishes to you, whatever you decide.

stephva1008 · Apr 2, 2009

I agree, you should do a few months on med-surg, just to get your feet wet.

I've done med-surg, adult psych, child residential on a sex offenders unit, ICU/ED/Trauma, telephone triage, and now inpatient child and adolescent psych. I've always loved psych but spent so much time in ICU just to make sure I kinda had a feeling for everything. Actually, I just wanted to see if I could actually do the blood and guts and codes. And I could, it just didn't "do it" for me most days.

I worked adult psych in the Navy which was awesome. I can't imagine the previous posters experience- it sounds wretched and terribly unorganized.

I love child and adolescent! I just got certified too and I'm here to stay.

The biggest misconception with psych nurses is that they are lazy and crazy. But if you like it, who cares what people think?

Do some time on med-surg, esp since adult psych has so many co-existing medical issues to deal with. Or just go right into adult psych and get experience there.

You'll never be out of a job being a psych nurse. I wouldn't worry about that. Good luck!

Mr Ian · Apr 2, 2009

i have been a mental health nurse for many years and it did not do me no harm. incidentally i am typing this with my nose for no reason

aniutka · Apr 2, 2009

interesting.....

jmking · Apr 3, 2009

I've been a psych nurse for over a year and half. I am currently trying to find other things to occupy my time. I personally would do med-surg, you just don't get enough time during clinicals to understand and practise all the nesssary procedures.

goettin98 · Apr 6, 2009

Another option (if your hospital has one) is to work as a float/registry nurse for a while. Our registry is set up so that you pick an area, like Women & Children (where you work antenatal, OB, pedi, etc.), Med-Surg (where you work psych, general med, neuro, ortho, etc.), or Acute (working in ER, ICU, etc.) and when you check in for work every day they tell you where you're needed. That way, you could get experience in a lot of areas, keep your skills up, and it could help you decide where you're the most comfortable and where your talents are strongest. Just a thought. . .

wonderbee, BSN, RN · Apr 7, 2009

I've been in psych for over a year now and now it is not by choice. I'm looking to get out and thank my lucky stars that I have solid med-surg experience.

Either I'm a medication nurse or in charge. As a med nurse the responsibilities of my job include meds and charting with frequent prns. This takes up the majority of my 8 hour shift with up to 15 patients. There are treatments too like dressings/skin care, nebulizer treatments, etc. I have little time for therapeutic communication. Additionally, there are a lot of Axis IIs to deal with. Many of them are more appropriate for a jail cell than a bed in a mental hospital.

Psych hospitals are traditionally underfunded and are the poor step children of the medical system. We often work without a clerk. We are still paper charting and there's a lot of fear and ignorance of having to perform medical tasks by nurses who have been in psych and nothing but psych for years and years.

Yes, you can get assaulted. It can be dangerous. Don't look for your facility to be supportive or workers comp to be generous to you if it happens. I really feel I'd be safer working in a jail where security is always present.

Geripsych floors are different. They are more like med/surg or LTC. You are more likely to be medically proficient and use those skills than on say a mood disorders unit.