Is Psych Nursing Easy?

barlowjb · Dec 13, 2009

Hi I am a new med surg nurse one day out of orientation. Anyway, I genuinely like psych nursing and I had my preceptorship in psych nursing.

The easy part is that it doesn't get as technical (skills wise) as med surg, however now more than ever there are medical patients on Psych floors. For example, I've had psych patients receiving IV fluids (such as anorexic pts), some with PICC lines, and some needing ostomy and wound care etc. So as a med surg nurse transferring to psych, you will have an edge in caring for these pts.

The part which may be harder, is the mental part of psych nursing. You may have suicidal pts that you have to monitor, not to mention people who suffer from bipolar disorder who may be in the manic phase of their illness while on the floor. I once had a pt (schizophrenia) who suffered a panic attack right before discharge and who became very threatening. You may deal with pts with dementia, developmental disabilities, alcoholics, drug addicts etc - talking to them, constantly reinforcing positive behaviors and attitudes, trying to help them reframe their destructive thinking etc. Other aspects of psych nursing include leading group sessions, dealing with new admissions and discharges.

For me med surg nursing is more stressfull than psych nursing in more ways than one, but psych nursing like I said is heavy on the nurse mentally. Additionally you have a lot of documentation to do, lots of medications to give throughout the day and I am yet to see a psych nurse just sitting with nothing to do. They still do a lot, and just like med surg nurses they too complain of not having enough time to do all they are expected to do.

As far as being pigeoned holed, I think you have an edge because you would be leaving med surg to do psych and not the other way around. Although I loved psych my preceptor and others advised me to get some experience in med surg nursing first then move on to psych, which is what Im doing now.

Furthermore I actually know someone who was a psych nurse for 6 years before she decided to try med surg. She said the only issue for her with becoming a med surg nurse was that she had to take a pay cut because they viewed her as "new" to the world of med surg.

I have a lot of respect for mental health nursing and while it may not be as hectic as med surg in a lot of ways, I just wanted to make sure that you are not so disillusioned that you believe "its so easy even a caveman could do it:)". Not everyone is cut out for psych nursing. The edge that I have due to my genuine liking for the specialty, is that now that I am a med surg nurse I don't get flustered easily by difficult or abnoxious pts, because I already have a knack for attending to their mental needs (which makes my job easier).

Would I encourage you to go ahead and try it? yes, but only if you are doing it for the right reasons. If you are genuinely tired of med surg nursing regardless of your pregnancy - by all means go ahead. If you want to switch just because of your pregnancy, you should put some thought into it. You could also call the psych floor speak with a manager and ask for permission to shadow a psych nurse on a few of your days off to get a feel of it before you make that decision.

I hope I helped

pandora44 · Dec 14, 2009

I think the question depends on what your strengths and weakness are and what you are looking for in a job. Psych is different from med-surg. It is slower. It may be easier for you.

I did a year of med-surg just out of school. I HATED it. It was too busy, too physical, with too little real contact with my patients. I thought I might like psych and I was right. Actually, I love it.

The pace is much different, slower. Even with admits and discharges, I have never missed a meal, I get to go to the bathroom whenever I need to, and I have yet to cry on the floor out of sheer frustration at the number of things I need to do and lack of time in which to do them.

It is less physical, although this depends on the unit. I work adult, low acuity. All of my patients can ambulate independently, take care of their own toileting needs (no more wiping bottoms), make their own beds, feed themselves, etc. There are considerably less body fluids involved. Much less rolling, lifting, turning, or lugging of patients.

I see much more respect from the medical staff, although this also depends on the unit, and more autonomy for the nursing staff. The psychiatrists I work with really do depend on the nursing staff for help planning patient care. Psych nurses have much more control over their patients than med-surg nurses. We are responsible for their entire environment. Every unit has rules to help maintain the milieu, but it is up the nursing staff to decided when to enforce and when to bend those rules. This is one of the most challenging areas of psych nursing.

I have more to say on this but I'll have to do it later. I love the med-surg vs. psych debate.

Meraki · Dec 14, 2009

I too find the med-surg / psych debate interesting.

I think it is really hard to lump all psych wards together. There are crisis units, assessment units, treatment units, long term care units etc... each of which have a different pace and range of duties.

You would also have to look at the scope of the nursing role for a particular job. Does the nurse primarily just do med passes and orders or are they an integral part of the daily program and spent most of their time with patients.

I spent a brief period of time working on a long term unit for adults (mostly in their 40's - 70's) with chronic mental illness. Most of the patients spent their days pacing the halls, smoking in the lounge, sleeping or playing checkers. There were moments of 'action' but it was very low key and slow paced and most of my duties were med/order related as well as chatting with patients during down time. I was bored there and didn't last long. Other nurses had worked there for years and loved it.

Then I worked on an acute care crisis unit for adolescents and bored, quiet, easy and low key it was NOT! There were many shifts when we didn't get breaks, had to eat on the go and did bathroom dashes. The acuity was just really high and the patients had to be supervised at all times. Nurses were the direct care givers there - we did everything, ran groups, 1:1, meds, orders, case coordinating, emotional support, goal planning, meal supervision, recreational activities...there were days I left this job completely physically exhausted, but I loved it.

As an earlier poster mentioned there is also the mental emotional exhaustion from dealing with this patient population. You can't underestimate the toll this can have on your overall health and wellbeing.

One quick example. We were understaffed one night so a med surg nurse came down to help us out. She joked about how they had drawn straws and she was the lucky one - 'getting the night off' by coming to psych. The first few hours ended up being pretty quiet and she made a lot of (all in good fun) comments about how easy our job was, 'you call this nursing' and 'gotta love being paid to do nothing', 'you call this busy, you needed me for what' type things. It was quite maddening as the way the night was going (quiet) reinforced all the beliefs and attitudes she had about psych nursing. Then cue our psychotic patient who we had been worried about. For the next 4 hours she and I 2:1'd her which involved non stop redirection and managing of very active behavior related to delusional and hallucinations. By the end of the shift the med-surg nurse had a totally different perspective and attitude! She realized that she had really had no idea of what psych nursing actually looked like in practice and at one point about 3 hours in she conceded that this was one of the hardest shifts she had worked in a along time!

I have close friends who work med surg - they run themselves ragged many days and they also at times have quieter nights. In summary - Not harder, not easier, just different!

Also if you are pregnant - I would consider the population and acuity of the unit. Is there aggressive behavior? How unpredictable are the patients? Are you going to feel safe? Pregnancy and psych can go hand in hand but I've also seen pregnant psych nurses switch to other units because they are worried about the risk factors.

Jules A, MSN · Dec 15, 2009

It might be easy for the few that don't get off their lazy bums and come out of the nurses station. Not so easy for those of us dodging chairs and attempting to break up fist fights. I'm kind of offended that this line of thinking is still being passed around. If its so easy I'd like to know why medsurg floors can't wait to get rid of our patients? I am horrified at the physical condition of some of the postop and trauma patients they try to shove off on us because they are sick of dealing with their psych issues. I have worked with very few pregnant nurses. One was fussed over by the kids we worked with the other had her unborn baby's life threatened. I wonder how easy that was?

elkpark · Dec 15, 2009

I second (third?) the "It's not easier, it's not harder, it's different" idea. I have taught several psych clinical rotations, in different facilities, over the years and, invariably, the students start out thinking, after the expectations of the rotation are discussed with them, that this is going to be a lot "easier" than their med-surg rotations. Also invariably, by the end of the rotation, some or all of them say to me (individually), "Wow, I thought at the beginning that this rotation was going to be easy, but this is really hard -- you have to think all the time in psych!" I think that's a pretty fair description ...

b_segal_b_segal · Dec 15, 2009

In my ward I deal with hostile behavior on a regular basis. One day the patient is kind, the next day he is in punch-kick mode. As a nurse you need to address anxiety, de-escalate, set limits, put out a fire, break-up fights between patients. A few patients are nasty: they just seem to know what to say to get in your nerves, as they try to ruin your day. It is all part of mental illness. Others are depressed and need encouragement with meals, not to mention suicide precautions. And of course, there's the patient that will ask you a question or make a request, and keep asking you the same thing something like 12x in the last 15 minutes. Many patients develop physical illness and can't tell you much less describe what they're feeling. Then there are a number of mental patients that have physical concerns too: diabetes, skin disease, prostate issues, lung CA, COPD, HIV, h1n1, epilepsy, dysphagia, constipation, hypothyroidism, incontinence, UTI, CHF, and others. And there's the patient that is sexually inappropriate.

You will use physical and chemical restraints. Judgment call by the nurse.

All of the above requires skill and knowledge. You will still need to read through lab reports, ekg, biopsy reports. You will need to touch base with the doctor and auxiliary staff, advocate for the patient.

iwanna · Dec 15, 2009

I never thought that psych nursing was easy. I liked it, though. I worked the geri-unit, adults, adolescents and children's. You most likely will have episodes where someone is going off and needs restraints. There were frequent fights. As LPN, we did quite a bit. We helped the techs with groups and passed meds. The RNs did admissions, rounds with the drs. and were quite busy. I would never say that it was easy, but I did like it.

delphiniumRN · Dec 16, 2009

I worked Geri Psych one day it was worse than a pulmonary floor. If you equate Geri to fragile and then add on all of the peculiar labs as well as the slew of medical meds and psych meds and their possible interactions. There is a great challenge in that. I think I agree with the other nurses psych can exhaust you emotionally and mentally quicker. It can be physically demanding when there is a psych code.

It is like comparing oranges to apples. The only similarity is that they are round fruits..

rpw4031 · Dec 17, 2009

If you are not uncomfortable (afraid) around psych patients and you stick to adults and not peds or geri then yes, psych is easier.

maxthecat · Dec 18, 2009

I agree that psych nursing is different and that how easy it is for a particular nurse probably depends on that nurse's strengths and weaknesses.

I will say that I admire the ER, med surg, ICU nurses who work with patients who have mental health problems AT THE SAME TIME that they are acutely physically ill. In my opinion those nurses have a much harder job than I do when the patients are medically stabilized and admitted to my psych unit. I have much better ratios than they do (ICU excepted) and I am not dealing with two crises at the same time (acute medical, acute psych). I also have much better ratios than the long term care nurses who are dealing with geri-psych patients. So in that way, yes, I would say Psych nursing is easier.

However, if you are uncomfortable dealing with people who respond differently than the "norm," and having to think on your feet as you adapt how you deal with these people, psych may seem overwhelming and therefore harder.

As far as technical skills--anybody can become proficient at IV's, telemetry, etc. So I don't feel bad that these skills have deteriorated since I've been in Psych, because I know I have the knowledge base and could easily relearn them if I had to.

The other type of knowledge base, the ability to interpret complex physiological data, can be learned. Some nurses are better than others at this. Most probably are in ICU, but not all.

I'm not too stupid to be a "real" nurse. I've been there and done that. I prefer Psych because I'm fascinated by people and their behaviors and because I seem to have a natural "flair" for dealing with the mentally ill population. So, yes, Psych is easier for me, but not because I'm too lazy or stupid to do a different type of nursing. I think it's the possible assumption that Psych nursing is for the nurse who is lazy or stupid that makes some of us get our backs up when nurses from other specialties talk about the easiness of psych nursing and/or pigeon hole us into not being able to do anything else.

Neseret · Dec 18, 2009

I would agree that psych. nursing is more laid back. Depending on what type of unit you work on it can be emotionally and mentally demanding. I work on an acute care psych. unit, and at times it can be quiet chaotic and emotionally taxing. However I love what I do and am fascinated by human psychology. I find there is always something to laugh about. At the same time we deal with pretty serious problems that people face in their lives. You have to be open and willing to discuss those issues and have a level of compassion in working with people in those stressful situations. ie: suicide, depression, living with psychosis, family issues etc. I believe each area of nursing has its pros and cons. It all depends what you interests you and what you love. As far as your question about once a psych. nurse always a psych nurse...most of the nurse I work with have either practiced psych nursing all their careers and some have switched from other areas. I've never seen a nurse that went back to other fields though once they started practicing psych nursing:)...