I liked Psych as a CNA, and have a deep passion for mental health, but I hate being a Psych nurse. I've been at my facility a couple months, and I've already seen the same patients- malingers, gangbangers, and med-seekers over and over again. I.e. I just d/c'd someone who didn't want to leave for weeks (registered sex offender who was extremely grabby and inappropriate to female staff), he went back to the ED the same day voicing suicidal ideations, came back to our unit, and treats the place like a hotel.
I love the genuine psych patients that I've had the honor of working with. When they get better, I feel like I've made a difference. Nevertheless, I provide non-judgmental care to all, and my nurse manager says patients commend me quite often when he does surveys (before you say they can smell my dislike and dislike me too). The nurses on the floor are all bitter and cynical, and most are leaving because they say it's not rewarding anymore.
Is Psych like that everywhere?
General Q- Have you ever been in an area you didn't love? What did you do?
This isn't a direct answer, but I can see how/why you don't like psych nursing any more. I took several psych classes (as electives) in my first degree, then many years later when I did 'this crazy nursing thing' (got a BSN in nursing in middle age), when taking psych nursing and doing a few clinical days at a local psych hospital, I thought oh yeah, I might be into psych nursing.
Had a hard time finding that first job, ended up totally by accident at a nursing home, and believe me, I have *more than enough* daily experiences with psych nursing, without ALL of my residents being 'psych patients'. I've come close to yelling/cussing out one guy at least twice, and I'm more patient than most. (And believe me, he drives everyone crazy, not just me). No point in describing specific examples, but my 'psych patients', at least in my unit, are tempered by those few who are 'with it' mentally and I can actually interact normally with.
Couldn't agree more I work with behavioral adolescents. I actually love where I work. The only problem is I feel like I'm losing a little bit of knowledge every day :/. That's the one reason I'm job searching. However, if you love psyche peds may be the best thing you can do in the psyche field. The big thing with peds is there is no secondary gain for pediatric psyche cases.
OP - I feel the same way. I work inpatient adult psych. When I have a legit psych patient and watch them get better, that is so rewarding. Unfortunately that's the exception and not the rule on our unit. Most of our patients are repeat frequent flyers who are homeless and need a place to crash until their next check. Many come in because they've got a hot urine and have a court date or probation visit coming up. I'm not just saying that, I've actually had people tell me that their reason for admission is "I need a place to stay" or "I have court tomorrow." We've had people return in less than 24 hours. It gets very frustrating and I guess it happens everywhere.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
Again, I don't get this "legit" psych patient stuff.
Humor me, and please explain the difference between a homeless guy with a hot urine and a court date as opposed to a "legit" psych patient.
Far, as a former school nurse, this may help...
You know the difference between the student who comes to you for a headache because they were cutting class and want a note to avoid an unexcused late/absent and a student who has 103 fever and is upset that he is being sent home?
So I think that it is similar to the frustration we feel when a patient knows the magic words to be admitted in order to avoid being arrested or even a fight at home.
I think that both can be seen in psych/mental illness. The difference is that inpatient psych admission is really for acute stabilization and safety. If someone has a need for treatment, I'm all for IOP/outpatient/group therapy/job coaching/ACT team etc. However, these patients are being admitted to psych because they say the magic S word even though all we can do for them is 3 hits and a cot.
You know the difference between the student who comes to you for a headache because they were cutting class and want a note to avoid an unexcused late/absent and a student who has 103 fever and is upset that he is being sent home?
So I think that it is similar to the frustration we feel when a patient knows the magic words to be admitted in order to avoid being arrested or even a fight at home.
I think that both can be seen in psych/mental illness. The difference is that inpatient psych admission is really for acute stabilization and safety. If someone has a need for treatment, I'm all for IOP/outpatient/group therapy/job coaching/ACT team etc. However, these patients are being admitted to psych because they say the magic S word even though all we can do for them is 3 hits and a cot.
Just so you know...some people who "get a note claiming they're bipolar so they can get disability", really are disabled to the point of needing it. And not all of us are malingerers.
Agreed. That's why we have a multitude of tests to determine the people in need of care and actually provide notes for them. That being said, those tests have been know to weed out many malingerers.
The big thing with peds is there is no secondary gain for pediatric psyche cases.
Sorry gotta disagree there. Sometimes there is MORE secondary gain with adolescents. Sooooooo much attention seeking behavior. Whats a better way to get attention from a distant, hninvolved parent than to keep yourself in hospital after hospital?
Anyway, not to jack this thread.........yep, psych is like that. There is a very high burnout rate. Tis the season for frequent flyers on my unit and I just tell myself, "Terp, obviously there is a major problem with this persons functioning if they would rather be stuck in a psych ward rather than out in the world". Yes even the homeless person with hot urine. I think sooooo many hospitalizations could be avoided if a lot of these pts had stable housing but who am I lol. Maybe those state hospitals werent such a bad thing after all.
The big thing with peds is there is no secondary gain for pediatric psyche cases.
Not true. In addition to the attention-seeking adolescents TerpGal noted, I've worked with lots of kids whose parents were trying to get them on disability (for psychiatric issues), or had already been successful in doing so. A lot of time, the kids' disability payments were the primary financial support of the family (since, Lord knows, the parents aren't working ...), and the parents are reeeeeaaallllly invested in making sure that nothing upsets that applecart. So the state is requiring that the kids be in treatment, and an assortment of mental health professionals are doing all they can to help the kid, but the message the kid is getting from the family is "we need you to stay sick."
Or, the kid is the healthiest member of the family (but the "weak link in the chain," the family member who crumbles under the pressure of the family problems), but it's easy for the parents to blame the kid for the family dysfunction and keep insisting that all the family problems are the result of the child's problems, and use that as an excuse to avoid taking any responsibility or getting any help for their own issues.
V. sad for the kids who are stuck in the middle of those scenarios.
Re-reading this, I'm a little embarrassed that I sound like the nurses whose attitudes I frown upon. I have nothing against the "3 hots and a cot" thing, that just shows a major flaw in the structure of society, but the frustrating part is when we get calls for actively suicidal people (there is a major shortage of Psych beds everywhere), but we never have beds available because they're occupied by someone who wants to skip jail for a few days longer. It's frustrating. I think maybe I'll choose another area, I'd hate to have my attitude affect my care.
Specializes in Mental Health, Burn ICU, SICU, Hospice.
There is no area of nursing where you won't find patients with the same game, different setting. Psych patients, who truly need assistance, may not be the majority, but they need the assistance of knowledgeable and compassionate psychiatric nurses. I like psych, just like I liked burns -- it takes a little extra something to care for patients who have a lot going against them and I want them to know that someone cares in a sometimes very uncaring, painful and dismissive world. Takes no more effort to smile and listen than it does to smile and empty a bed pan -- just has to be something you want to do. Hope you find your place, where your talents and strengths will shine!
So I'm on my third psych job, in 3 different states. My travel job in New York city was like you described; I had 7-10 patients, some were very gangsta-like, gamey, etc. I had so many patients that it was really hard to do more than give pills and chart if they were suicidal or not. I was very stressed and chose not to renew my contract, though they paid well. I'm now in a facility with a max of 4 patients, and the whole culture is much more high level that I can really give better care. But it is my nature to kind of help people on the psych level, I know people that the thought of doing psych just scares them.
djh123
1,101 Posts
This isn't a direct answer, but I can see how/why you don't like psych nursing any more. I took several psych classes (as electives) in my first degree, then many years later when I did 'this crazy nursing thing' (got a BSN in nursing in middle age), when taking psych nursing and doing a few clinical days at a local psych hospital, I thought oh yeah, I might be into psych nursing.
Had a hard time finding that first job, ended up totally by accident at a nursing home, and believe me, I have *more than enough* daily experiences with psych nursing, without ALL of my residents being 'psych patients'. I've come close to yelling/cussing out one guy at least twice, and I'm more patient than most. (And believe me, he drives everyone crazy, not just me). No point in describing specific examples, but my 'psych patients', at least in my unit, are tempered by those few who are 'with it' mentally and I can actually interact normally with.