How do nurses view psychologists?

[PsychNewbie]

Hi everyone!

I began working as a psychologist on an inpatient acute ward about 6 months ago. We have the usual team of psychiatric nurses and students, techs, OTs, psychiatrists, doctors, etc. I work as part of a 4 person psychology team. I'm having a difficult time dealing with some of the nurses attitudes toward me and my job. I'm not sure if this is limited to the nurses I work with, or if this represents a general view.

My work involves doing various psychological assessments and seeing patients for short term therapy (as it's an acute ward, we try not to keep them longer than necessary.) I also see patients in the community, but I spend the majority of my time on the ward because of how demanding it can be.

I always make myself available to see patients, establish relationships, provide assessments and interventions when asked. I attend all the staff meetings and give input. The nurses have been saying they're very stressed out and are really struggling to deal with some of the tougher patients - some don't have much experience in terms of eating disorders, or mixed personality disorders, and have voiced concern. I offered to do staff supervision and presentations if anyone was interested - just a quick overview for any staff who felt they needed some help, which they seemed happy about and many turned up. I was also asked to be available for 1:1 sessions with nurses to offer my thoughts or another perspective on a patient, which I was happy to do.

I realize this can come across as me thinking I know better and I certainly don't - I just offered to maybe do drop-in informal sessions for anyone who felt like they needed it. I've been very careful to try and not come across that way.

I feel like I really am trying my best to fit in and help the team,but the attitude of most of the nurses toward psychology in general is disappointing. I've seen rolling eyes when I come to do an assessment ("why bother? Those pieces of paper can't tell you anything.") I've been met with sarcasm and disdain when talking about therapy options ("must be nice being a psychologist and not having to do actual work" or "they're just a PD patient, they aren't mentally ill, you wont be able to do anything.")

its discouraging, they are otherwise nice people but it's getting to me. I'm friendly, I work hard and have worked very hard to get where I am, Im here to help just like they are and I feel that I'm not taken seriously - all of the psychology team feels this way. Sort of like everyone thinks we're overpaid and that psychology is a bunch of BS really. That we sit on our asses all day typing reports, when in reality I work 12 hours per day on the ward seeing patients, attending tribunals, and even getting involved in altercations (I'm trained the same as the nurses are in restraint/breakaway techniques so I always help when there's a problem).

What gets me is that I was happy working in community, but we were literally begged to work on the ward, and now we're here and nobody wants us! They request assessments and treatment, but make fun of us in the next breath. I'm trying not to let it get to me, but after 6 months of feeling this way it's wearing me down.

is this a general consensus among all psych nurses? I've seen the same attitude leveled toward the doctors, but only behind their backs. It's a shame because I really value their input and would like to work as a team, but feel very unwanted. Is there anything I can do?

[marshmallowstar, BSN, RN]

That's great that your unit has psychologists doing assessments and therapy, a lot of hospitals have cut it out sadly. The unit I worked on has an incredibly tight treatment team that all rely on each other's input and work. Concerns that some PsyDs/PhDs have had to adjust to when coming inpatient with us is staff splitting, because we are so tight and work with an extremely difficult population (trauma/dissociative disorders) It wasn't uncommon for a therapist new to our unit to "let someone off the hook" for something that the remainder of the team was taking very seriously. SO they may be worried you will do that, even if you won't. If having the psych/therapy team is new to the unit the nursing staff may not know how to utilize you or ways that you can be helpful to them. Something I always appreciated during team meetings when discussing a patient that was difficult for nursing staff was when the therapist would ask, "How can I be helpful? Are there specific things that I can help hold the pt accountable for or help them process that would make your (nursing) work with them better/easier)" I think sometimes nursing staff feels like we take the brunt of the "bad guy" wrap, we're the ones constantly redirecting, setting limits and boundaries, if they see you're willing to do that difficult work too it will help gain their respect. I HATED when therapists would come in and try to be friends with the patients to build rapport, it set up such a bad dynamic. I think the education you're doing with the staff can be really helpful too. Psych nursing is not stressed in a lot of nursing programs, there is a rotation but depending on the 1 instructor and 1 clinical setting you're assigned the learning opportunities can be fantastic or horrible. Also boundaries in other forms of nursing are EXTREMELY different, it is not uncommon to touch patients, to talk about what you did over the weekend or if you're married/have kids, some nurses have a hard time keeping it so client focused when they move to psych, which you know can make working with PD patients even more difficult once you've already revealed personal information and then try to back pedal. Also for newer or burned out nurses and techs (who often are still in undergrad studies) they be so focused on behaviors (understandably so) that they don't realize the motivations and internal processes that are causing the behaviors. I know understanding the internal struggle helped me manage the patients' behaviors more effectively so stressing that in the education piece of how the theoretical understanding of their illness and their assessment results can help direct their behavioral care in these concrete ways.

Sorry I rambled, I love psych, and I miss my unit dearly (I left for work/life balance, scheduling reasons) Feel free to direct message me if you have questions about specific ways our team supported each other.

[nickfitz1969]

Maybe you could ask for constructive feedback from your colleagues about your interpersonal: what you do well, what you could do better and what they would like to see you continue to do. When I was an academic tutor at university, I asked the nursing students these questions and was surprised by some of the feedback, although the feedback was anonymous.

From the information that you provided, you might be seen to be a bit too keen in wanting to help out. Or, you might tell your colleagues that you are available if they require any support. You haven't mentioned how long you have been a psychologist, so if you are new some clinician's might feel threatened by your enthusiasm and knowledge. Normally, nurses are the dominant profession on the ward, so they can often be reluctant to consider or try out new ideas. However, nurses who have been around for a long time will have seen a lot of what you have to offer in terms of skills and knowledge all before, and express negative attitudes.

Having been a mental health nurse for 15 years and worked in 3 countries in a variety of clinical settings, I have worked with many psychologists; some good and some a pain in the orifice (ass)! Try and be genuine and be prepared for criticism. Be a little understated in your approach and don't try and criticize your colleagues believing that you know best! Good Luck, Nick.

[chevyv, BSN, RN]

I've worked with really good psychologists. I wonder if the water gets a bit muddy for some nurses regarding what your role is exactly on the team. I like to know you can talk with an agitated or depressed pt while I get the rest of my pts settled. It sounds like you make yourself available to the nurses and pts, but something is amiss.

It sounds like staff is trying to figure out what your role is exactly. Community is different than inpt. Do you hold groups?

Lastly, nurses rarely have input regarding newer staff. Some may feel like your invading their territory. They might take awhile to warm up to you and your ways. If there are one or two your comfortable talking with, ask them for some feedback. I'd be thrilled to have you! Good luck.

[nickfitz1969]

It's an interesting phenomena when clinicians feel threatened or mistrustful by other disciplines, yet nurses especially have the expectation that patients and their carers should engage in the therapeutic process and trust the nurse within a short period of time!

As a nurse myself, often the nursing profession let's itself down by this type of negative behavior!!

[2mint]

"Sort of like everyone thinks...psychology is a bunch of BS really."

Myself and my clinical group thought the DSM-IV (now is 5 right?) is pretty BS-ie.

But since I might be going into psych, I realize that psych in general does not produce results or that the results take so long to materialize, therefore what you felt about others' view of psychology is not without merit.

However, we did enjoy seeing detox and practicing redirection--whenever they tried to get info of us, we would answer generally and then redirect the talk to focus back on them, which was kind of fun.

[nickfitz1969]

"Sort of like everyone thinks...psychology is a bunch of BS really."

Myself and my clinical group thought the DSM-IV (now is 5 right?) is pretty BS-ie.

But since I might be going into psych, I realize that psych in general does not produce results or that the results take so long to materialize, therefore what you felt about others' view of psychology is not without merit.

However, we did enjoy seeing detox and practicing redirection--whenever they tried to get info of us, we would answer generally and then redirect the talk to focus back on them, which was kind of fun.

Your right about the DSM-5. It's a shame that the psychology profession has moved away from its origins and now believes that a set, or part of a set of behaviors, is evidence of a brain disease (which of course it is not, as there is no evidence to support the claim!). Psychologist's have their place in the workforce, but should focus on their core skills. Dr. Phil doesn't help their cause!!

[Davey Do]

Psychnewbie, I truly appreciate your plight and endeavor to deal with this situation.

I'm sure you know that people with personalities are ... just that: people with personalities. We are motivated by forces we do not understand, there's a pecking order, and some will put others down just feel better about themselves.

My thoughts on why they treat you as they do: Your position is superfluous. Thus, so are you. You're outer trappings, necessary by bureaucratic standards only. We Nurses are necessary evils and, bigod, everyone's going to know that!

How'd I do?

[nickfitz1969]

Psychnewbie, I truly appreciate your plight and endeavor to deal with this situation.

I'm sure you know that people with personalities are ... just that: people with personalities. We are motivated by forces we do not understand, there's a pecking order, and some will put others down just feel better about themselves.

My thoughts on why they treat you as they do: Your position is superfluous. Thus, so are you. You're outer trappings, necessary by bureaucratic standards only. We Nurses are necessary evils and, bigod, everyone's going to know that!

How'd I do?

Davey Do, Your critique is rather superfluous also!

[2mint]

Maybe you could ask for constructive feedback from your colleagues about your interpersonal: what you do well, what you could do better and what they would like to see you continue to do.

A harmless advice in the Ivy Tower world, but a social suicide in the real world...imagine Caesar saying such nonsense.

[marshmallowstar, BSN, RN]

Davey, I've been waiting for you to chime in and you never disappoint :) :) :)

[nickfitz1969]

A harmless advice in the Ivy Tower world, but a social suicide in the real world...imagine Caesar saying such nonsense.

Brilliant! It's just as well I live in the real world unlike nonsense about Caesar and that "Rockstar" rubbish!