Leaving cardiac for adolescent psych...?

[michigan94]

Hello all, I asked for advice on here last week but am looking for more. I’m a newer nurse and I’ve been working days on a cardiac stepdown unit since January and it’s been rough. My unit is very overwhelming- high patient turnover, very unstable patients, constant phone calls... And just a lack of passion for the area I’m working in. I truly dread my work days. I just don’t think bedside nursing is my thing or will ever be and I’ve been struggling to figure out why I even went into nursing. I recently was offered a position on nights at an inpatient behavioral health facility. The facility has an adult and adolescent unit, I told them I preferred adolescent mainly because I’m very small, other than that I don’t have much knowledge on which area would be better for me (input on both is appreciated). I applied because mental health has always been a passion of mine, and advocating and helping patients to have a better life is something that seems very rewarding. I’m truly not looking for an “easy” route here, and know I’ll have to deal with a lot of tough things in psych, I just want to find my niche in nursing and be able to say I love what I do, and cardiac/bedside is not it, I’ve grown to hate it. I’m just anxious because I’ve never worked in this area, and I don’t want to get into another job I don’t like. Can anyone out there who’s worked as a psych nurse, specifically with adolescents give me some advice? Thank you ?

[dream'n, BSN, RN]

I've worked in a couple top level, lock-down, adolescent residential behavior facilities in the past. When I worked nights I was the only nurse in the facility, therefore I couldn't take a break or a lunch as a RN had to be on duty at all times. I had between 50 to 110 patients. Thankfully the facilities didn't take patients that were physically unhealthy so the ratio was manageable. Be sure to find out if the facility takes in physically ill patients as that would require much smaller ratios. I also didn't have any prescribed medications to be given at night which was very helpful. I had psych techs on the actual units monitoring the patients sleeping, behaviors and they would notify me of any issues.

My medical skills had to be on point since I was alone and because a small percentage of my patients were Munchhausen or had Fictitious disorder. I also had some patients that would feign or cause injury to themselves to be sent out to the ER so they could AWOL.

I found generally that the boys were easier to handle than the girls. A large portion of the patients in adolescent facilities have Oppositional-defiant disorder and issues with the law. Almost all also had extreme trauma in their childhoods. Lots of depression and suicidal ideation with self harm behaviors.

If a medication is given to a patient, the nurse must be very watchful and check their mouths afterwards. The patient's would, at times, try to 'cheek' their medications to give to other patients, save up to get high or for a suicide attempt. Nurses must be very mindful of what they have on their person as patient's will grab and use ice, salt, pens, paperclips, erasers, staples, etc to injury themselves.

I hope this helps, PM me if you have any questions. I'd be happy to help you.

[chinurse1901]

I currently work on an adolescent inpatient unit and absolutely love it. We can have up to 31 patients at any given time, and often do have that many during the school year. Our census drops quite a bit during the summer (we're at 9 now), presumably because of the lack of school avoidance/stress/anxiety.

I would say about 80% of the patients we see struggle with depression, anxiety and suicidal ideation. 15% would be behavioral, and the remaining 5% would be psychosis (particularly drug induced). As an adolescent psych nurse, I spend a lot of my shift trying to connect to the kids and talk through what they're going through. I practice skills with them, help them set and work towards treatment goals, and administer medications. A huge component of my job is assessing suicide risk and using critical thinking to determine how to best keep the patient safe (take away their shower curtain, put them on finger foods only, not allow them to use pencils, etc.) We do have patients that we need to put in mechanical restraints, and administer IM medications in order to keep patients and staff safe, but that's something you try to avoid by using verbal de-escalation. Every day is different, and you'll never be bored, ESPECIALLY with adolescents. The things they say and do will have you in tears laughing at times. There's nothing easy about it, but at the end of the day, it is extremely rewarding.

[Zookeeper44, RN]

I was a psych nurse on an adolescent unit...kind of hoping I can go back to it ? I agree with and echo what the other posters said. Pros and cons of working nights: Pros...they are teenagers, they will sleep for the most part, and no administration to deal with ? BUT, the Con...the unit I was on tended to get a lot of admissions at night which is hard if you are the only nurse. It's not "easy" but medically...it is. We had a few diabetics, lice and scabies, wounds from suicide attempts, eating disorders...but mostly they were medically pretty healthy. I say give it a try...you will know pretty quickly that you either absolutely love or hate it.

[Zookeeper44, RN]

On 6/9/2019 at 8:32 AM, dream'n said:

I had between 50 to 110 patients.

??? That's a lotta kids ?