what is it like to be a psych nurse ?

Heylove, BSN, RN, EMT-B · Mar 22, 2018

What is it like to be a psych nurse , what are the psych nurses responsibilities , what is a typical day in the life of a psych nurse ?. Tell me the good the bad .

I speak from a nurses perspective working in psychiatric acute care. I don't know how it differs from outpatient psych nursing because I haven't worked outpatient. Also, adult and senior units are usually different than how my unit is ran.

The number one responsibility is to keep patients SAFE. They have to meet certain criteria to be hospitalized where they are threatening to harm themselves or someone else, or, in some cases "unable to care for themselves." This last one does not usually apply to my patient population of 12-18 year olds, who have adults who are responsible for their care. We make sure that they do not have access to anything that can be used to harm themselves. No strings, scissors, knives, etc, and they usually are not allowed in their rooms during the day. They are encouraged to attend groups, and not allowed to sleep all day.

A typical day starts with 30 minutes of report. All nurses in my unit are present for report from the previous shift's charge nurse to hear report on all patients, which is anywhere from 12-18 patients. The oncoming charge nurse determines assignments which include who will pass medications, who will lead groups, which mental health techs will be assigned on any one-to-ones and patient assignments. Charge nurse usually starts the admissions and discharges, but all of us contribute to both admissions and discharges. There is a lot to do, including patient intake assessment, notifying the doctors, verifying home medications, putting in orders, vitals, documentation of personal property, unit orientation, etc.

The morning usually entails waking the patients up, encouraging ADLs, breakfast, and medications. Groups fill up most of the morning, lunch, and then more groups. During all of these activities, vitals are done, doctors (in our case a pediatrician and our psychiatrist,) and the social workers/case workers pull each of the patients out to talk to them individually. Patient assessments are done by the nurses, usually in the morning, and we document in the computer between activities. It is a very highly-organized and chaotic dance, actually.

We answer phone calls from parents, call parents when a patient wants to call their parents, manage visitations, and patient outbursts/breakdowns/whatever. Crying, screaming, attitudes and vomiting are all common. Oh, and we have to lock patients out of their rooms for one hour after meals if they are known to purge.

We do room checks every shift to make sure there is no contraband.

Basically, we are busy the entire shift. And I love it.

Wannabenurseneko · Mar 23, 2018

I speak from a nurses perspective working in psychiatric acute care. I don't know how it differs from outpatient psych nursing because I haven't worked outpatient. Also, adult and senior units are usually different than how my unit is ran.
The number one responsibility is to keep patients SAFE. They have to meet certain criteria to be hospitalized where they are threatening to harm themselves or someone else, or, in some cases "unable to care for themselves." This last one does not usually apply to my patient population of 12-18 year olds, who have adults who are responsible for their care. We make sure that they do not have access to anything that can be used to harm themselves. No strings, scissors, knives, etc, and they usually are not allowed in their rooms during the day. They are encouraged to attend groups, and not allowed to sleep all day.
A typical day starts with 30 minutes of report. All nurses in my unit are present for report from the previous shift's charge nurse to hear report on all patients, which is anywhere from 12-18 patients. The oncoming charge nurse determines assignments which include who will pass medications, who will lead groups, which mental health techs will be assigned on any one-to-ones and patient assignments. Charge nurse usually starts the admissions and discharges, but all of us contribute to both admissions and discharges. There is a lot to do, including patient intake assessment, notifying the doctors, verifying home medications, putting in orders, vitals, documentation of personal property, unit orientation, etc.
The morning usually entails waking the patients up, encouraging ADLs, breakfast, and medications. Groups fill up most of the morning, lunch, and then more groups. During all of these activities, vitals are done, doctors (in our case a pediatrician and our psychiatrist,) and the social workers/case workers pull each of the patients out to talk to them individually. Patient assessments are done by the nurses, usually in the morning, and we document in the computer between activities. It is a very highly-organized and chaotic dance, actually.
We answer phone calls from parents, call parents when a patient wants to call their parents, manage visitations, and patient outbursts/breakdowns/whatever. Crying, screaming, attitudes and vomiting are all common. Oh, and we have to lock patients out of their rooms for one hour after meals if they are known to purge.
We do room checks every shift to make sure there is no contraband.
Basically, we are busy the entire shift. And I love it.

Thank you so much for sharing the info with me , I had no idea it there was an out patient Psychiatric Nurses as well . You are a very strong person to be able to handle this and love it , I hope when I become a nurse that I can be this strong .

gladboutit · Mar 24, 2018

One of the main goals of inpatient psych is to keep the patient safe, particularly since most patients are admitted due to a risk of harming themselves or someone else. As for outpatient, it can consist of community-based clinics for medication management and also substance abuse clinics. Good luck.

hrnurse · Mar 28, 2018

There's many roles and environments for psych nurses . That's the beauty of it . You'll learn different skills in different locations . Different age groups and populations pose various challenges .

pixierose, BSN, RN · Mar 28, 2018

There's many roles and environments for psych nurses . That's the beauty of it . You'll learn different skills in different locations . Different age groups and populations pose various challenges .

^^ This.

I used to work inpatient Geri psych. There was a lot of medical, as there were a lot of comorbidities. Wound care, subQ/IM for both insulin and psych meds, PICC lines, TPN, J/G tubes, etc.

Now I work (a lot of) per diem in a pediatric psych ED. It's a completely different world than the inpatient psych unit that I was on. It's "go go go!" as we often get children and adolescents coming in every few minutes. We need to get them wanded and get them through a clothing change process ASAP, as quite a few of them have been bringing in items that have been dangerous to their own safety (and ours), such as lighters and razor blades hidden in their bras or underwear. We have them shake their underitems while we hold a sheet for privacy in front of them; it's amazing what has dropped out ... it's heartbreaking.

Then we interview them, assess for safety (all the time ... this never stops). Get them medically cleared so they can eat .. and then they wait to speak to a clinician. There has been a lot of restraints lately; that's been rough. And we've had a lot of patients coming in with threats of violence to their schools; that's been horrific.

I think the one common theme you'll see: safety. Whether it's q15 or 1:1 ... safety is number 1.

GeminiNurse29 · Mar 29, 2018

I worked in patient on the night shift.

Rounds...q hourly and whoemever was deemed in need of q15 min checks.

PRNs...for anxiety, insomnia, headaches, etc.

Geriatric psych, they're up at all hours and some never sleep. They also need help with ADLs. Think of the craziest nursing home you've seen and multiply it by 10. That's what we had. Those patients were let go by their facilities or families due to aggression and safety issues.

Assessments to determine if a patient was showing symptoms of actual medical conditions or if they were just "faking it" for lack of better terms.

Sometimes, you'd need to go hands on and physically restrain someone (techs did this) and give IM shots or seclude someone.

Some patients require a 1:1 sitter and/or camera monitoring. You literally have someone watching them while they sleep.

Lots of room searches.

I could go on and on. Fascinating and interesting and challenging in its own ways.

oceanblue52 · Mar 30, 2018

^^ This.
I used to work inpatient Geri psych. There was a lot of medical, as there were a lot of comorbidities. Wound care, subQ/IM for both insulin and psych meds, PICC lines, TPN, J/G tubes, etc.
Now I work (a lot of) per diem in a pediatric psych ED. It's a completely different world than the inpatient psych unit that I was on. It's "go go go!" as we often get children and adolescents coming in every few minutes. We need to get them wanded and get them through a clothing change process ASAP, as quite a few of them have been bringing in items that have been dangerous to their own safety (and ours), such as lighters and razor blades hidden in their bras or underwear. We have them shake their underitems while we hold a sheet for privacy in front of them; it's amazing what has dropped out ... it's heartbreaking.
Then we interview them, assess for safety (all the time ... this never stops). Get them medically cleared so they can eat .. and then they wait to speak to a clinician. There has been a lot of restraints lately; that's been rough. And we've had a lot of patients coming in with threats of violence to their schools; that's been horrific.
I think the one common theme you'll see: safety. Whether it's q15 or 1:1 ... safety is number 1.

Very good summation. Would like to add my own anecdote with strip searching a patient, came in looking pretty put together. A colleague of mine had her remove her underwear and hundreds (literally) of pills came tumbling out, mostly benzos. She was a voluntary patient and still don't quite understand her rationale for coming in.

The lesson being...never assume a patient is not hiding something. They are crafty. Have a few other stories but will save them for another time.