I Hate Psych

Scarlettz, BSN, RN · Feb 15, 2016

I just started a psych job recently and it is different from what I expected. I think I am more annoyed by my job duties and the facility than I am the patients, though. It is completely paper charting, which I sort of hate. I am spending my whole shift doing unnecessary paper work that could be done in 2 hours with a computerized system. I'd rather have more time to interact with my patients and get to know them on a different level. I am mainly a medication nurse so I feel like the "bad guy" at times. I enjoy teaching about the meds, but I find there is hardly any time to do that thoroughly as a night nurse handing outs meds to 25-30 pts. There are a number of med seekers here. I also work PRN as a med-surg nurse, and you will find many med-seekers there are as well.

I like psych, for the most part, but there are some things I need to work on and that is the med seekers and the very aggressive/rude patients. I come from a med surg background. They are very customer service oriented at my first job so I am finding it hard to be nice/respectful but firm at the same time in psych. I will tell you one thing, so far my psych job has taught me that it is okay to be firm with patients and set limits. It is rewarding to see my patients get better - no matter why they are there. I just wish I had less patients and more interactions with them. I had a really agitated woman, who is normally nice enough to me, get really frustrated with me because I would not give her ALL the meds she could possibly get. I was annoyed by her outburst, of course, but then I thought about why she was there and her background. She had a daughter who committed suicide. I thought about being in her shoes and how she must feel. Medication might be her way to "escape." If I am not mistaken, her daughter OD'd on drugs and maybe she wants to do the same to be with her. Of course I won't allow her to do it, but I can emphasize with her. The best I can do is to be honest with her, be respectful, and be firm in the rules.

I can totally understand your frustration, but maybe if you think about why/how they became that way, you might be less stressed and annoyed by these patients. You will find the good and bad in all nursing specialties. You will find med seekers in all specialties. When I was in my early 20s, I dabbled with some alcohol issues, although I was highly functional. While I do find med-seekers annoying, I realize that I

was once that person - in a lesser degree. I, thankfully, overcame those issues but these people might not be there yet. Now I can see why my family was so pissed/annoyed by my behavior. These people need care, too.

We have a bunch of bitter people at my work, too. Screw them. Don't become that. I have quite a few patients say they were happy to see me on my day back, that I was the best med nurse, that I was one of the few who told them what their meds were (which is preposterous!), and that they were even scared to ask some other nurses for meds. Revel in the appreciation you receive from these patients. Many others are probably appreciative of you, too, but can't put it into words.

Bitter folks are everywhere. BE better and maybe it will rub off on them. And if it doesn't, at least you will feel better.

RN543 · Feb 18, 2016

I have to chime in here. I've worked in psych for 6 years now and it's my passion. But psych isn't for everyone. If you don't love psych nursing, then you aren't doing yourself or your patients any favors by continuing in the specialty. When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started. It's a wonderful thing to pursue this career because you want to make a difference. If that's you then it shows you are a caring person with a desire to help people. The problem is that some people have not accepted the fact that we aren't going to save or cure EVERYONE. It's likely that only a small percentage of our patients will improve and go on to lead productive lives. But I'm not going to stop trying. We need to remember that first of all, we don't always hear or see the success stories (b/c our successful pts may avoid readmission and we might never see them again)... So it's hard not to focus on the negative things we see and hear. But also remember that even the little things u do make a difference to that patient... Even if you're not a miracle worker...

For example, a new patient comes in (depressed and suicidal) that is scared, embarrassed, ashamed... But you show compassion... You listen to them without judgment... You offer a meal to that patient that hasn't eaten in days. U put them at ease and make them feel a little better about what they are going through. You praise them for the choice they made by seeking help. So maybe this patient doesn't make a miraculous recovery... But it doesn't mean u didn't make a difference. Maybe a year from now when they are standing on that bridge about to end it all... They will remember you and how you made them feel about seeking help. Maybe you will be the reason they won't feel too ashamed to ask for help. You may have saved someone's life and never even know it.

I just try not to judge. Someone who has BPD may be a little annoying but I won't let that show... And they are just as deserving of my time and my compassion. And at least in my area, the majority of my patients also have addiction issues. There is no easy fix for mental health disorders and addiction. And then you throw in external factors like homelessness, unemployment, legal issues, relationship/family problems... And the odds are hard for anyone to beat. The truth is we don't have the community resources (at least in my area) for these people to get back on their feet. Even when our facility's case manager finds a halfway house or other placement for one of my patients, they typically don't have the money to afford it. When I have a patient that is readmitted... Of course it saddens me that they are not doing well and had to return... But the only other negative thought I have is how we as a facility failed that patient. Was the patient discharged too soon? Did we not plan appropriately for their discharge? Is their something we can learn from this rather than being negative and judgmental toward the patient? Why would I get annoyed that my admission was a patient that was just here a month ago? Because he's abusing the system? Because he's taking a bed from someone else that really needs it? Oh please! Who are we to decide who is more deserving or who needs our help more than others? Sometimes it's nice to have the same patient again because I already know them... Maybe my assessment will be quicker... I may already have a good rapport with them, etc. And maybe they don't quite "get it" the 1st time, the 2nd time, or even the 20th time. But maybe on the 21st time you admit that patient they will come with a new perspective and insight and will follow up with their aftercare plans. You just never know. I learned my best lessons not from lectures... But from my own screw-ups. Sometimes our patients need to fall before they can pick themselves back up.

In my opinion, there is a lot of discrimination and a lack of compassion for mental health and addiction. But how is this issue (non-compliance, readmissions, etc.) any different than any other nursing specialty? What if you take care of a patient that had a massive MI and goes back to eating cheeseburgers and has a 2nd heart attack within a few months? Or you have a diabetic patient that refuses to follow their recommended diet or take their medications consistently? Would you feel the same disdain for them? Are they just abusing the system too?

Listen... I look at nurses that work in ICU or nursing homes or oncology or just about any other specialty... And I think how do the do it? But I'm sure a lot of them look at psych nursing and think the same. If it's not your thing then it's all good. But even if u think ur negativity is not being noticed by ur patients or co-workers... You're probably wrong. I decide what kind of day I'm going to have each day by my own attitude I walk in with. If you're attitude is negative, your negativity will likely be contagious.

You would be surprised at how much of a difference it makes to carry a smile and a positive attitude... Your positivity will be contagious too. And pretty soon you will be impressed with the difference you are making around you.

Davey Do · Feb 18, 2016

I say "AMEN" to these two points, RN543!

When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started.
I just try not to judge.

elkpark · Feb 18, 2016

I have to chime in here. I've worked in psych for 6 years now and it's my passion. But psych isn't for everyone. If you don't love psych nursing, then you aren't doing yourself or your patients any favors by continuing in the specialty. When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started. It's a wonderful thing to pursue this career because you want to make a difference. If that's you then it shows you are a caring person with a desire to help people. The problem is that some people have not accepted the fact that we aren't going to save or cure EVERYONE. It's likely that only a small percentage of our patients will improve and go on to lead productive lives. But I'm not going to stop trying. We need to remember that first of all, we don't always hear or see the success stories (b/c our successful pts may avoid readmission and we might never see them again)... So it's hard not to focus on the negative things we see and hear. But also remember that even the little things u do make a difference to that patient... Even if you're not a miracle worker...
For example, a new patient comes in (depressed and suicidal) that is scared, embarrassed, ashamed... But you show compassion... You listen to them without judgment... You offer a meal to that patient that hasn't eaten in days. U put them at ease and make them feel a little better about what they are going through. You praise them for the choice they made by seeking help. So maybe this patient doesn't make a miraculous recovery... But it doesn't mean u didn't make a difference. Maybe a year from now when they are standing on that bridge about to end it all... They will remember you and how you made them feel about seeking help. Maybe you will be the reason they won't feel too ashamed to ask for help. You may have saved someone's life and never even know it.
I just try not to judge. Someone who has BPD may be a little annoying but I won't let that show... And they are just as deserving of my time and my compassion. And at least in my area, the majority of my patients also have addiction issues. There is no easy fix for mental health disorders and addiction. And then you throw in external factors like homelessness, unemployment, legal issues, relationship/family problems... And the odds are hard for anyone to beat. The truth is we don't have the community resources (at least in my area) for these people to get back on their feet. Even when our facility's case manager finds a halfway house or other placement for one of my patients, they typically don't have the money to afford it. When I have a patient that is readmitted... Of course it saddens me that they are not doing well and had to return... But the only other negative thought I have is how we as a facility failed that patient. Was the patient discharged too soon? Did we not plan appropriately for their discharge? Is their something we can learn from this rather than being negative and judgmental toward the patient? Why would I get annoyed that my admission was a patient that was just here a month ago? Because he's abusing the system? Because he's taking a bed from someone else that really needs it? Oh please! Who are we to decide who is more deserving or who needs our help more than others? Sometimes it's nice to have the same patient again because I already know them... Maybe my assessment will be quicker... I may already have a good rapport with them, etc. And maybe they don't quite "get it" the 1st time, the 2nd time, or even the 20th time. But maybe on the 21st time you admit that patient they will come with a new perspective and insight and will follow up with their aftercare plans. You just never know. I learned my best lessons not from lectures... But from my own screw-ups. Sometimes our patients need to fall before they can pick themselves back up.
In my opinion, there is a lot of discrimination and a lack of compassion for mental health and addiction. But how is this issue (non-compliance, readmissions, etc.) any different than any other nursing specialty? What if you take care of a patient that had a massive MI and goes back to eating cheeseburgers and has a 2nd heart attack within a few months? Or you have a diabetic patient that refuses to follow their recommended diet or take their medications consistently? Would you feel the same disdain for them? Are they just abusing the system too?
Listen... I look at nurses that work in ICU or nursing homes or oncology or just about any other specialty... And I think how do the do it? But I'm sure a lot of them look at psych nursing and think the same. If it's not your thing then it's all good. But even if u think ur negativity is not being noticed by ur patients or co-workers... You're probably wrong. I decide what kind of day I'm going to have each day by my own attitude I walk in with. If you're attitude is negative, your negativity will likely be contagious.
You would be surprised at how much of a difference it makes to carry a smile and a positive attitude... Your positivity will be contagious too. And pretty soon you will be impressed with the difference you are making around you.

I can't "like" this post enough. Well said!

A&Ox6, MSN, RN · Feb 18, 2016

I have to chime in here. I've worked in psych for 6 years now and it's my passion. But psych isn't for everyone. If you don't love psych nursing, then you aren't doing yourself or your patients any favors by continuing in the specialty. When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started. It's a wonderful thing to pursue this career because you want to make a difference. If that's you then it shows you are a caring person with a desire to help people. The problem is that some people have not accepted the fact that we aren't going to save or cure EVERYONE. It's likely that only a small percentage of our patients will improve and go on to lead productive lives. But I'm not going to stop trying. We need to remember that first of all, we don't always hear or see the success stories (b/c our successful pts may avoid readmission and we might never see them again)... So it's hard not to focus on the negative things we see and hear. But also remember that even the little things u do make a difference to that patient... Even if you're not a miracle worker...
For example, a new patient comes in (depressed and suicidal) that is scared, embarrassed, ashamed... But you show compassion... You listen to them without judgment... You offer a meal to that patient that hasn't eaten in days. U put them at ease and make them feel a little better about what they are going through. You praise them for the choice they made by seeking help. So maybe this patient doesn't make a miraculous recovery... But it doesn't mean u didn't make a difference. Maybe a year from now when they are standing on that bridge about to end it all... They will remember you and how you made them feel about seeking help. Maybe you will be the reason they won't feel too ashamed to ask for help. You may have saved someone's life and never even know it.
I just try not to judge. Someone who has BPD may be a little annoying but I won't let that show... And they are just as deserving of my time and my compassion. And at least in my area, the majority of my patients also have addiction issues. There is no easy fix for mental health disorders and addiction. And then you throw in external factors like homelessness, unemployment, legal issues, relationship/family problems... And the odds are hard for anyone to beat. The truth is we don't have the community resources (at least in my area) for these people to get back on their feet. Even when our facility's case manager finds a halfway house or other placement for one of my patients, they typically don't have the money to afford it. When I have a patient that is readmitted... Of course it saddens me that they are not doing well and had to return... But the only other negative thought I have is how we as a facility failed that patient. Was the patient discharged too soon? Did we not plan appropriately for their discharge? Is their something we can learn from this rather than being negative and judgmental toward the patient? Why would I get annoyed that my admission was a patient that was just here a month ago? Because he's abusing the system? Because he's taking a bed from someone else that really needs it? Oh please! Who are we to decide who is more deserving or who needs our help more than others? Sometimes it's nice to have the same patient again because I already know them... Maybe my assessment will be quicker... I may already have a good rapport with them, etc. And maybe they don't quite "get it" the 1st time, the 2nd time, or even the 20th time. But maybe on the 21st time you admit that patient they will come with a new perspective and insight and will follow up with their aftercare plans. You just never know. I learned my best lessons not from lectures... But from my own screw-ups. Sometimes our patients need to fall before they can pick themselves back up.
In my opinion, there is a lot of discrimination and a lack of compassion for mental health and addiction. But how is this issue (non-compliance, readmissions, etc.) any different than any other nursing specialty? What if you take care of a patient that had a massive MI and goes back to eating cheeseburgers and has a 2nd heart attack within a few months? Or you have a diabetic patient that refuses to follow their recommended diet or take their medications consistently? Would you feel the same disdain for them? Are they just abusing the system too?
Listen... I look at nurses that work in ICU or nursing homes or oncology or just about any other specialty... And I think how do the do it? But I'm sure a lot of them look at psych nursing and think the same. If it's not your thing then it's all good. But even if u think ur negativity is not being noticed by ur patients or co-workers... You're probably wrong. I decide what kind of day I'm going to have each day by my own attitude I walk in with. If you're attitude is negative, your negativity will likely be contagious.
You would be surprised at how much of a difference it makes to carry a smile and a positive attitude... Your positivity will be contagious too. And pretty soon you will be impressed with the difference you are making around you.

You make some great points, and I agree overall with what you say. However, some hospitals are so desperate to stay full that they admit individuals who will be much better served seeing a therapist or psychiatrist on an outpatient basis.

Just because an individual is competent to sign for a voluntary admission, doesn't mean that inpatient treatment is appropriate.

PG2018 · Feb 19, 2016

I hated the two months I was on an inpatient unit as a RN as well. There was too much charting and other minutae on top of supervising the patients. I felt like I had too much busy work, too little autonomy, and no authority.

I am totally enthralled with outpatient work as a psych NP. It's the only reason I entered the nurse field.

Tommo446 · Jun 29, 2016

Let me rephrase my previous comment. "A lot less secondary gain." probably would have been the better way of saying it.

Jusween · Jul 2, 2016

You are differentiating between your axis one and two patients. Axis one patients have discernible mental illness such as hallucinations, delusions etc. Axis Two patients are character disordered. Their personality is warped in such a way that they can't function well in society. They are every bit as damaged, it is just more subtle. I would suggest you study trauma informed care. It will help you to put these people in a different perspective so you don't experience so much counter transference. I always try to think about the tragedy of being so obnoxious and manipulative when you are feeling so scared and out of control internally. Would you want to live in a psychiatric hospital? How crazy do you have to be that this becomes your only option? Trauma informed care helps me look at their behavior more objectively and empathize more. You can set limits and maintain your boundaries in a professional way while still communicating your humanity. It takes practice but it will help you in the real world as well. Everyone has a cross and some carry it poorly...

3peas · Aug 7, 2016

I quit and I didn't wait a year. I'm now in psych and I'm really happy. It's called a job for a reason not vacation-I don't love everything about it, but I'm happy there.

Ingythenurse · May 28, 2020

I empathize with you. I have worked with psych patients and it could get difficult. I honestly think that if you really hate your job, you might want to just leave. you say you love helping "legit" psych patients and you say you provide non-judgemental treatment but I just feel like your post was a tad bit judgemental and a bit bitter. psych nurses work with all types of patients including criminals and unfortunately that comes with the job title. These patients watch your every move and you can try all you want to hide how you really feel about them but eventually you could slip up and when you do, they will sense the judgement which will interfere with treatment and progress. you just seem unfulfilled with your current situation so you should consider taking a leap of faith and maybe choose another specialty.

allnurses Guide · Jul 2, 2020

On 2/6/2016 at 2:55 PM, Tommo446 said:
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.

Peds and adolescents get plenty of secondary gain for their behavior. In fact it is at these ages that they develop challenging behavior as a way to satisfy their need for emotional safety - But the parents are something else altogether!

Hppy

The0Walrus, BSN, RN · Jul 6, 2020

I know what you mean. I have been a psych nurse for a year now. I'm pretty good now in psych. I work in the locked unit where we see those med seekers, gangbangers, etc. I don't like those patients I have to admit. I don't care how it sounds. I keep the job simply because I've gotten good at it and now I'm going to school for my WOCN certificate just to keep learning.

To answer your question better, there are different psych units to work at. I've worked at a few that weren't substance abuse clinics. At the VA you'll see more patients with PTSD or depression and maybe schizophrenia. There are many avenues you can go as a psych nurse.