Interview this week in Acute Adult Psychiatric Unit!

Specialties Psychiatric

Published

Good day Nurses!

I am a new graduate unhappily working in med/surg. The unit is not that bad, I just know it's not where I want to be and where I plan on continuing my career. Fortunately, I was offered the opportunity to come in for an interview in adult psych this week and I am so excited. Mental health has always been a HUGE passion of mine and I am so happy that I get this opportunity. Growing up with a mental illness was very tough but allowed me to be empathetic to people who are suffering from mental illnesses. The only issue that I am having is that I used to be a psychiatric support technician in an acute adult unit and let's just say...it didn't go so well.

I loved it when I started, I loved the patients and I loved the environment. Unfortunately, I wasn't properly trained and there was a predicament where I was thrown a cup of water on my face and was called some very bad things from one of the patients and I did not know how to react. I ended up quitting eventually because I was in shock and wasn't prepared, I regretted it weeks and months after that.

I want to be prepared this time, I want to thrive in the field of mental health because I know it is where I see myself forever to be honest. I want to be more prepared to handle insults and manipulation from patients and what to do when patients are rude and tend to be aggressive. I want to care for this vulnerable population and be the best possible nurse I can be. Any advice to help a new grad become a successful psych nurse will help! I've read numerous posts from the psych nursing board and love reading everything. I am very excited about this opportunity. Thank you guys!

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I'll definitely look into that book, it seems like something that I really need to read! That has always been my issue, I take things personally sometimes and it will stay in my mind for days and I hate that. I definitely need to work on that.

Is GeroPsych like another med/surg since you're dealing with many medical co-morbidities?

I will be sure to bring up safety because even though sometimes it's inevitable, I want to avoid any assaults. Maybe that's not likely..

Take NOTHING personally. No matter whom it's from and even if it was meant personally. These people are trying to function with broken brains. Information does not get processed properly and what comes out is often not appropriate to the situation.

In other instances, people have a very poor interpersonal tool chest. They don't know how to handle frustration and whoever is standing in front of them becomes the target.

Your interview should allow you to ask questions about the working conditions. What kinds of safety measures are in place? What's the protocol when patients become physically combative? This one might be hard to assess in an interview, but what's the unit culture? You'll want to get a sense of it during your probation period. Is everyone trying to be tough? Are they trying to be the patients' friends and be more popular that the other nurses? Are they split (and easy to split by patients)?

In your interview, when your previous job history comes up, emphasize how poorly-equipped you were to handle the situation, how much time you spent thinking about it, how much you've learned in nursing school and how receptive you are to continued learning and growth. Good luck!

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Welcome to psych. The biggest pieces of advice I can give you is never engage in a power struggle with a patient - Once that happens you have already lost the battle. 2nd don't take anything a patient says or does to you seriously. Let it slide off your back like water off a duck. Finally be prepared to take care of a lot of patients. In my state there are no mandated staffing ratios for psych and I frequently have 10 to 20 patients to look after chart on etc......Oh and buy a good pair of running shoes.

Hppy

I understand, thank you. I have to realize that they are ill and some of them don't have much control of the things that they say. So if a patient is coming towards me with insults and many rude comments, what should my approach be?

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
I am hoping for your sake that your interview isn't at an UHS-owned facility. If it is, RUN!

I recently spent seven months working at an UHS-owned facility and when I left, I contacted the State to report unsafe conditions.

For what is it worth, I agree with another poster who stated that you should never engage in a power struggle with patients. They will hurl insults at you (sometimes for two hours, forcing a code to called), lie to your face, dismantle furniture, etc.

On the Geriatric unit, you can expect to be slapped and punched by patients with dementia.

My orientation consisted of FIVE eight-hour shifts. Shortly thereafter, I was frequently made charge nurse. That was at a point when I still had no clue as to what I was doing.

My hope for you is that you will be working at a decent facility and actually provides orientation.

Good luck!

I actually was called for an interview from a UHS facility but I have seen NUMEROUS posts on this board stating to avoid UHS facilities, the current one I have an interview for isn't UHS facility.

Working in Geropsych, does hitting, slapping, punching happen often? Or is that something that could happen but doesn't happen often?

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Med-surg is useful in a psych setting as many of the patients have medical issues tbh. Where I work we turn-over staff every 4-6 months. When I started working at this place at-least 5 people left. It isn't easy work and it can be dangerous.

Yeah, it is definitely a good learning experience. I just know I am definitely not happy and know my heart is in psych. I definitely would like to keep up with some outside skills just so I can still be competent if anything was to happen.

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Take NOTHING personally. No matter whom it's from and even if it was meant personally. These people are trying to function with broken brains. Information does not get processed properly and what comes out is often not appropriate to the situation.

In other instances, people have a very poor interpersonal tool chest. They don't know how to handle frustration and whoever is standing in front of them becomes the target.

Your interview should allow you to ask questions about the working conditions. What kinds of safety measures are in place? What's the protocol when patients become physically combative? This one might be hard to assess in an interview, but what's the unit culture? You'll want to get a sense of it during your probation period. Is everyone trying to be tough? Are they trying to be the patients' friends and be more popular that the other nurses? Are they split (and easy to split by patients)?

In your interview, when your previous job history comes up, emphasize how poorly-equipped you were to handle the situation, how much time you spent thinking about it, how much you've learned in nursing school and how receptive you are to continued learning and growth. Good luck!

In a predicament where a patient came at you with insults and rude comments consistently, what would you have done in that situation?

Thank you so much! The interview is today, I will definitely keep all that information in mind. I want to be able to get a good feel of the unit so I can make sure I am making the right decision between adult psych and geriatric psych.

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Whew! I am so glad that your interview isn't with an UHS facility! Hooray.

My home unit was adult, which consisted of SI, depression, psychotic, etc. However, UHS likes to float nurses and techs to other units (without training). So I spent several nights working on the geriatric unit. Some patients have dementia so bad, that they cry, scream, hit with their cane and hit other patients. Some are in their own world and turn around and punch for no reason.

These things certainly didn't happen everyday, but they do happen frequently. One patient hit staff on a regular basis. She never hit me. I don't know why. But I was ready to move away from her very quickly. I also didn't let me guard down around her.

If a patient is hurling insults at you, there isn't much you can do. You set a boundary, but most likely, the patient won't respect the boundary. That happened to myself and another nurse. The patient yelled, screamed hurled insults at both of us, and her mother for two hours. We had to call two codes. The other patients were highly distressed by the situation.

This was a BPD patient with Bipolar disorder, too. She wasn't going to stop. It was horrible. Again, not every night was like that.

Most of the day-to-day stuff is manipulation and staff splitting.

I now work in med-surge, and I don't miss the psychiatric facility at all. And yes, I thought I wanted to do psych when I graduated. But if the state of mental health care is what I witnessed, I want no part of it.

Hopefully, the facility where you are interviewing provides quality care in a staff environment for staff and patients.

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A good facility will train you on how to de escalate and handle those situations. What I've found with Geri psych population is that a lot of them don't like it when it's time for cares. They'll bite, scream, hit, scratch, etc. one guy had a colostomy and would tear it out and play with it or dig at his stoma and smear feces. Another lady with a urostomy would purposely take it off when mad and hurl it at techs and nurses and even doctors alike.

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
A good facility will train you on how to de escalate and handle those situations. What I've found with Geri psych population is that a lot of them don't like it when it's time for cares. They'll bite, scream, hit, scratch, etc. one guy had a colostomy and would tear it out and play with it or dig at his stoma and smear feces. Another lady with a urostomy would purposely take it off when mad and hurl it at techs and nurses and even doctors alike.

The manager of the unit told me that orientation is about 4-6 weeks but may be able to start getting patients in week 2-3. So is working in geropsych pretty much like working in med/surg just with mental illnesses? What was the role of the nurse and the tech in geropsych?

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Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.

I had the interview today for geriatric psychiatry. It's a 13 bed unit in a major hospital in my state. The nurses seemed very nice and it didn't seem too bad at all. They did tell me that there are antibiotics, Blood transfusions, and a lot of other medical ailments to deal with. I didn't get to stay too long because renovations were being done in the unit. It had a nursing home look to it which isn't a bad thing. The manager told me that he thinks I would be very good fit. I think I have a good chance of getting the job. Tomorrow is the interview for adult psych.

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If it were me, I would take adult pysch over geriatric. As the poster above stated, geriatric psychiatric patients with medical issues can be a handful. I find it difficult to deal with them in med-surge, and I don't have them as patients on a daily basis.

It's good that you'll get five weeks orientation. If you take the job, don't let them push you out on your own before you are ready.

I would also ask to shadow a shift. That will give you a real feel for the job. I did that with my current med-surge position. It gave me a chance to see the work flow and how nurses interacted with one another.

Just something to think about.

Good luck, and let us know what you decide.

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Oh, at the facility where I worked, the techs helped with feeding and toileting patients. But nurses would have with those tasks too depending on the acuity of the unit.

On adult psych, the techs actually ran group. Nurses handled admissions, discharges, problems and passing medications.

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The manager of the unit told me that orientation is about 4-6 weeks but may be able to start getting patients in week 2-3. So is working in geropsych pretty much like working in med/surg just with mental illnesses? What was the role of the nurse and the tech in geropsych?

I feel like it's like working a nursing home but with extremely aggressive patients. My facility takes the worse of the worst that no other place can or will handle. I'm a float, you couldn't pay me enough to work that unit full time. God bless my coworker's who can though.

In my facility, the techs on that unit are responsible for cares primarily--CNA type stuff. They're also responsible for going hands on if needed, such as if a patient needs to be secluded for their own safety and the safety of others on the unit. The nurse's job is to do assessments, give meds, treatments, give IMs if needed, obtain orders, review orders, and oversee things. I'm a noc RN, and our geripsych unit is an admission unit so we get admits at all hours of the day or night. There's usually 2 RNs on, sometimes 3. Techs can range from 4-6 or more, depending if we have any 1:1s and suicidal precaution people. We have 17 beds. This unit is more physical than any other, and that should tell you something considering our population is forensics.

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