Is this really what psych nursing is like?

[Nickytoto]

I've just had two week of hospital clinical experience at a subacute mental health ward (shizophrenic, depressed, BAD, drug-induced psychosis patients etc). Prior to my experience, all the mental health education I had was a three hour tutorial class, which primary discussed mental state examination and the class asessment. We didn't cover communication in class, but I wasn't too concerned because I figured it would be like my children's nursing prac where I would see lots of interactions between clients and staff.

For the entire two weeks I barely saw the staff interacting with the patients... The main interaction seemed to come when it was time for meds. It seemed like everytime somebody was upset, nurses dished out the diazepam (Valium) and other PRN meds like it was lollies. At lunchtime there would be no RNs on the floor, both RNs took their break at the same time so I would get labile, anxious or delusional pts asking for their meds. As I hadn't seen anybody de-escalating the patients before I had no idea what to do and the patients would just get worse and worse until the RNs got to the floor. I found that time always made me feel frustrated, as I felt like I couldn't do anything. I've discussed this with my facilitator and she admitted this wasn't the best facility to have students. I'm concerned about working in mental health later to find the same sort of situation.

I guess I could just be an idealist, but I had hoped meds would be a last resort and that there would be more talking to create a therapeutic environment. Is this what psych nursing is really like at most hospitals?

[Thunderwolf, MSN, RN]

Well...a nice debate.

Like insatiable...I have a Masters in Counseling too.

Treatment groups....hmmm...level of education...where do we start?

MHT...level of education when hired depends upon the facility...no education expected...some education expected....a bachelor degree in a related field expected. It all depends upon the facility and the level of competence of MHT's. In saying that....can a MHT lead or provide groups?....uh, depends. Exercise, sleep hygiene, relaxation groups (or something similar)....yep, safe groups should be fine. Treatment groups...discussing diagnosis, symptoms, meds, group process, insight group, focus groups on mental health, et cetera....a very big NO. If the MHT has a bachelors in a related field....sort of changes things a bit....where leading groups on stress management and in improving general coping and learning some improved coping strategies and skills....along with safe groups previously mentioned...should be fine. Generic nursing training should also be able to function at this level....in addition to educational groups...like medications, illness education and management of symptoms. However, "treatment" groups beyond educational....where it is reaching into providing therapy or counseling within the group truly needs additional education. This additional education should consist of graduate level classes in group theory, group process, how to actually do genuine group therapy within a group, additional course work in abnormal psych, et cetera. At this level, I firmly believe the education needs to be at some Graduate level. To provide counseling or therapy as the focus in group, you have to know what you are doing...because if you don't...you may actually be more harmful to your patients than good to them...simply out of ignorance. If a MHT is expected to function at this level at your facility or even a generic nurse...you are asking for trouble.

Ok...let the debate continue.

[inthesky]

i barely talked to one patient today (excluding mass discharges and admits) paperwork paperwork paperwork.. i nearly passed out tonight when i got home because I barely ate. I don't remember going to nursing school to be an overworked, pressured secretary. sorry..just a vent. =(. It is pretty ridiculous that I probably spent and entire hour + stickering and putting together charts. I'm so tired, im not even sure what I did today. I hope tomorrow will be a better day.

[aloevera]

it was one of those days, for sure....been there, done that, too....

I hate all that putting stickers on the papers....and it is really fun to drop a chart and have to re=put the entire thing together again !!!

Yes, yes, too much paperwork, I agree...but someone has to do it..I wish we had a unit sec, to answer that phone and put those charts together....

[inthesky]

Today was a much better day. You never know what you are going to get when you walk in that door or even in the next hour. I actually made my way into the milieu without a specific purpose. One patient even said "omg I've never seen you outside". I interviewed a few patients in depth outside of admitting.. today i was an actual psych nurse.

[aloevera]

inthesky----yes, that is what makes psych nursing so exciting....like that box of chocolates that Forrest's mother talked about, for sure

[wonderbee, BSN, RN]

Thanks for sharing your experience RNKittykat. It does seem like some places work that way. That's a shame for nurses who would prefer to more involved with the patients.

I can see where employing a minimally trained milieu therapist would be of concern. I imagine too many facilities use underqualified staff.

However, with proper training, I'd imagine a non-nurse could provide an effective quality of therapeutic interaction for otherwise medically stable psych patients. It's not as if RNs get all that much training in the specific skills for working in a therapeutic milieu. One term of coursework and clinical would be what most students will have had exposure to in nursing school in addition perhaps to a pre-req psych and/or abnormal psych course. The rest will be learned on the job and isn't really related to the rest of world of clinical nursing. Someone with an AA or BA psych degree would seem like just as good a candidate to work as a milieu therapist as an RN. What do you think?

I absolute agree with that assessment. We do have some MTs who posses those degrees and who are where they want to be for the time being. We also have some MTs who walked off their jobs from some fast-food place who were just looking for a job. With education and training, they too have done a pretty decent job. Many of our MTs are nursing students. There are a few though who don't belong there.

We also have nurses who prefer not to go out into the milieu any longer than they have to, especially when the milieu is particularly tenuous.

[sikeNP]

All units are different, I wouldn't make a judgement based on one unit and the group of nurses that happened to be working that day. There are many psych nurses who love what they do and it is reflected in their work...and that is not demonstrated only by med administration.

[aloevera]

Back to the debate.....our MHT's do not have any psych training except CPI....hmmmmm

our nurses seem to have mostly "on the job training"...we have hired some new ones with NO psych experience...hmmmmmm

It doesn't seem to be the best environment for our patients, I know but the buzz going around is that the new co. that bought our hospital is stripping down to make everything...."cost effective", I think the term is...hmmmmm kinda scares me...will have to wait and see what emerges....The ideal would be to have properly trained staff, but then again, those properly trained staff would not be "cost effective"...Anyone work for a State Hospital?? I would be anxious to hear if the staffing is better and training required is different than the private hospital I work for...