Just started Psych Nursing... help!

stylishgurl · Sep 4, 2013

I just quit my mental health job.I was working in substance abuse unit I am having compassion fatigue I feel like life is futile for those people who just choose to be chemically dependent.I am very compassionate and non judgmental but it came to a point where I am not treated so right anymore no matter how nice and respectful I am patients will still get ugly violent and rude just to get what they want.Everyday is chaotic I fee like working in a jungle!Cursing is way too much F and S words all they can say.Ifeel like I am slave for these violent people.All I can say is you need a lot of patience don't take anything personally most of these people are irritable and irrational.They can be nasty and its unbelievable how I see and hear dirty acts from them.

twinkerrs · Sep 4, 2013

Setting clear concise limits is paramount in psych nursing. As far as assessment goes you are still going to be doing a normal nursing assessment generally problem focused because if you are working with grown ups they usually have tons of co-morbidities. Also you will be monitoring and documenting behaviors. Brush up on the correct terminology for different symptoms especially those for bipolar. Document accurately and non judgmental which sometimes can be really difficult.

Reignred · Sep 5, 2013

I never thought I would get into mental health nursing. The stigma of patients and stories of staff working in psych facilities initially deter me to accept a placement for my clinical. While working with people who are mentally challeged, it gave me a deeper understanding and empathy for people who are affected. It gave me greater respect for nurses who work together with these patients . I have learned that being sincere with patients is key to have a good working relationship with them. Objective and firm limit-setting,as well as low- key approach will also be appropriate to set boundaries. Remember to keep yourself safe at all times as well as the patients.

microserf · Sep 5, 2013

Hi!

I just finished my first year of mental health nursing in nearby Hamilton! At the first facility I worked at we used the Broset Violence Checklist (BVC) to assess for potential violence. After assessing, we usually intervened with supportive statements, limit setting, non-pharmacological interventions (distraction, offering to take client to a more relaxing, low-stim environment, etc.), then pharmacological interventions (offering PRN meds). If at any point, safety to others was an imminent issue we would usually call for help (security, other staff) and use the seclusion room. I found the Broset online here:

http://pshsa.ca/wp-content/uploads/2013/02/VAACEtoo_-instruction.pdf.pdf

There is also a great model (ABC Model) for dealing with crises, which can result in violence if not addressed:

http://pda.rnao.ca/content/abc-model-crises-intervention

Remember! Almost everything in psych nursing is dependent on your therapeutic alliance! Coping is another huge concept in psych. Try to look up some DBT-informed coping skills if your clients are having a hard time.

Assessment takes a lot of practice! Remember all the terms and although doing an MSE is great, try not to forget the bigger picture (why is the patient here? what is the treatment/care plan?).

Some good resources I used to help with my assessment skills were: Mental Status Exam Explained by Robinson and Psychiatric Clinical Skills by Goldbloom (very practical, has a great section on admission assessments).

Hope that helps! Welcome to psych nursing!

illcleff · Sep 7, 2013

I have been a psychiatric nurse for over 3 years. The key is communication techniques that are used. Some patients need a calm approach to manage their anxiety and agitation while others need strict limit setting. My advice is not to be afraid because the patients can sense it and some will take advantage of it. Be confident and non-judgemental. Psychiatric nursing is not for everyone because it can be emotionally draining on the nurse but it will help give you a different perspective about live in general. Take a nice deep breath because there is so much to learn.

MrChicagoRN, RN · Sep 7, 2013

The best way to deal with violent patients is to know your patients, and to intervene quickly.

There are some free videos and ebooks on crisisprevention.com

Or google CPI or patient see ablation on YouTube

MrChicagoRN, RN · Sep 8, 2013

Dang word correction...

Look up patient deescalation, or CPI

Kay28 · Sep 8, 2013

Yes, CPI is awesome, its a requirement on my unit

mollyj91 · Sep 8, 2013

I recently started a job earlier this year on an acute women's treatment unit in a county mental health facility. The facility houses the county's most and severely mentally ill. 95% of the patients have a history or current behavior checks for attacking other patients or staff. It is my first nursing job, and the first time I stepped onto my unit, I had no idea what I got myself into. I never thought I would ever work in a mental health setting, let alone THIS facility. I am FT as well, and I have learned that being FT is very beneficial. It provides stability to the patients (at least at my facility, each FT nurse has a permanent designated "mod" of patients). The most important thing is to build a relationship with the patients and get to know them and their triggers. I have been threatened to have my "head blown off", I have had dinner plates thrown at me, and someone jump over the nurses station desk at me. It may take a few days (or a week) of restraints and IM's, but eventually there is a light at the end of the tunnel and the patients somewhat come around once they begin their medication regimen (if they don't cheek meds). Redirection is key. If you have a trusting relationship with a patient who is threatening and hostile, take them away from what is triggering them and try to sit down with them and encourage them that behavior like this will not get them discharged any sooner and try to do deep breathing or something to re-direct them. Sometimes it doesn't work and sometimes it does. You will eventually know which patients are easily re-directable and which ones to have the PRN's ready. Do NOT show that you are scared. They can sense if you are scared of them and will use it to their advantage and manipulate you. I am by no means experienced at all, but I have learned so much since I started working where I work and I can honestly say I love working with the patient population that I work with. One piece of advice a mentor had given me: "Never let a patient get in the way of you and your escape route and always be the last when going into a room with a patient". It is all a learning experience and it is not for everyone. Best of luck to you!

TCASII, ADN · Oct 9, 2013

The DSM is not going to help you in psych, nor are many textbooks. Sure, some books help you understand things and give decent examples, but dealing with the people is totally different. So many of them know what they should expect from you too so they will look for that reaction. It's almost a setup for failure when they know what you're gonna do. To be honest, I work in a crisis facility. We receive the worst patients, most from police. We get those who are at other psych hospitals, even critical care units, and I don't find it all that difficult dealing with them. Nothing about the patients is hard IMO. The hard part is the acuity ratio and paperwork for me. I will probably go against the grain here, but I've noticed the more controlling nurses/BHTs actually have more problems with patient behavior than those who are more calm and "hands off". For example, I had a manic with psychosis the other day screaming like no other at my techs. They could not calm her down. They were really stern with her and laying down the law. I simply went over and calmly asked her what was wrong and how could we fix it. I took a cocktail of meds and politely asked her to take the meds because she appeared upset and that we wanted to help. She took the meds and starting calming down before the meds kicked in. Well, I walked into the med room for 2 minutes and she was riled up by a tech all over again. I went back out and calmly approached her to see what was going on. She calmed after that and eventually went to bed after I got her some food. Another one threw water on a doctor and refused meds. I talked that one into taking meds without a problem because I was super friendly with her. I know people think I'm rewarding bad behavior or that I'm not setting limits. At times with mania and psychosis that simply won't work. A personality D/O, yes, but manics and other just don't react well to retorts. The job really isn't hard. You do need to be careful and watch your back, but I've never been concerned.