Losing your skills in psych?

[Jedi of Zen]

Student here - I have heard it said that nurses who work in psych tend to lose some of their nursing skills (due to not having to use them as much). Have any psych nurses out there found this to be true? And if so, do you ever 'moonlight' in another department to keep fresh on your skills?

Thanks for your time.

[StuPer]

Over the years on this forum I have seen repeated stories from students saying their lecturers have advised them to do med/surg for a year or two before going into psych. Invariably the reasoning offered is losing of skills, being unemployable if they go straight into psych and then dont like it.

I have always been very annoyed at hearing this, as to be honest it appears to be at best an ill advised attempt to 'steer' a 'misguided' student down the 'right' path.

If you have had psych experience and loved it, or if you have always wanted to do it..... then do it! Psych has probably the hardest time recruiting staff partly due to the above scenario and also because of misinformation and predjudice about the patients/diagnosis, so anyone is passionate about it should be encouraged.

Skills..... well as a few others have said, I wouldnt dream of functioning in a general ward capacity after all these years in psych, but I can still do the basics. I do however have a whole gamut of skills associated with my field which general nurses do not have. What you may lose, you regain in new skills.

Ultimately its up to you, if you are certain psych is for you go for it, ignore the naysayers, if your unsure however, it maybe wise to hedge your bets.

StuPer

[rotary]

ANY nursing skill can be re-learned. The majority of our time as students was spent in the class room, not working full time in heavy medical units becoming expert nurses in everything, so I really don't understand the worry that new grads have regarding this (and I'm a new grad myself).

If you go to psych and decide to switch off to something with more physical skills required down the road, you'll have absolutely no problems getting back into the swing of things. It might take a bit longer for you to be independent, but it's nothing to worry about.

[behensley]

Just to add my thoughts on the subject...

I have worked in the psych department/ward in the hospital that I work for a year now. I sometimes get pulled to other parts of the hospital and that is where I get the assurance that I won't have to worry about loosing any skills because I use them regularly, (starting IVs, hanging blood, ATBs, NGTs, foleys, etc.)

I agree that when we work on the mental health side of nursing, we have to be sharp with all of our skill, especially the knowledge of medication side effects, lab work, and discerning whether the pts psychosis or out side influences are at work throughout the day.

If you like this line of nursing, by all means do it -- it can be very rewarding! I Love it!!! :wink2:

[ritaPHIL]

i would say that somehow you might tend to forget some nursing skills but on the other hand, being a psych nurse is not that easy.you tend to deal with personality and behaviors of different patients... in my opinion, i guess when you decide to shift to med-serg all you need to do is attend trainings and seminars just to polish your ideas...

no regrets that i become a psychiatric nurse now. it is challenging and it test your patience when dealing with mental illness]

peace

[MrChicagoRN, RN]

Student here - I have heard it said that nurses who work in psych tend to lose some of their nursing skills (due to not having to use them as much). Have any psych nurses out there found this to be true? And if so, do you ever 'moonlight' in another department to keep fresh on your skills?

Thanks for your time.

Anytime you enter any specialty you will use some skills more than others. What do you define as skills vs non skills? Being theraputic is definitely a skill.

You don't need to "lose" anything unless you want to.

Plenty of patients leading unhealthy lifestyles: obesity, smoking, HTN, DM, hi-cholesterol, COPD, etc Plenty of opportunity for assessment and teaching opportunities.

[Iowa_I_Care]

i was reading this thread and thought i would put in my 2 cents. i have been a psych nurse for over 20 years with absolutely no regrets. i heard the same thing about "losing skills" when i trained and i still think it's a bogus idea. if anything my assessment skills have to be sharp to tease out an emerging medical problem (ie delerium, drug toxicity, infections, etc.) from psychiatric "behaviours" or delusional thinking, for example. and what about the people who cut and burn themselves? more than enough dressings here sometimes. what about the results of suicidal behaviours? what about the huge numbers of psych patients with very serious, yet often undiagnosed endocrine problems like type 2 diabetes and all the associated medical risks? what about serious psychiatric medical conditions such as neuroleptic malignant syndrome? what about foot care problems? what about the incidence of hep b & c, tb, ca-mrsa and all the other infection issues in a population that is often homeless and/or living in sub-standard housing, etc. we may not do a lot of the "sexy" stuff with high-tech gizmos or do a lot of ivs, catheterizations, central lines, etc. but we do need really good basic nursing skills.

for all you students and new grads thinking about psych as a career... do it!! a wise faculty advisor told me in my final year that the technical skills / technology can be learned or re-learned at any time - the skills you learn in psych nursing are invaluable and will always be relevant wherever you go in nursing or in life. i have never forgotten that and i have found it to be true.

i am a new rn grad who has worked in our psych department as an lpn several times this past year. i now have an opportunity to work there full time as an rn, but i, like many people had that same mentality that i should be doing all the "sexy" stuff as a new grad. psych is where i am most comfortable and i am told that i have outstanding therapeautic communication skills. i have decided that this is where i want to be and the heck with anyone or their opinions. i truly believe that more can be done with talk than medicine in some cases. thank you for making my decision feel as if it is the right one!!

[batgirl23]

I am a new RN grad who has worked in our Psych department as an LPN several times this past year. I now have an opportunity to work there full time as an RN, but I, like many people had that same mentality that I should be doing all the "sexy" stuff as a new grad. Psych is where I am most comfortable and I am told that I have outstanding therapeautic communication skills. I have decided that this is where I want to be and the heck with anyone or their opinions. I truly believe that more can be done with talk than medicine in some cases. Thank you for making my decision feel as if it is the right one!!

Good for you! All the best!

[Jedi of Zen]

Just wanted to say thanks to all who have responded to this thread. Everyone's comments here have definitely given me some good food for thought. My first psych clinical is in about a month, so maybe I'll come back and give an "update" on my own interest if anyone would care to read. Thanks again! :)

[seabiscuitRN]

I worked as an LPN in psych for a year before graduating as an RN. Then I worked med/tele. I learned a lot, got really good at IV starts, piggybacks, blood tx, hep drips, etc. But I missed psych, so I came back. I'm glad I had that expereince in tele; I feel like it gave me a background -sort of a little boost- to be a better psych nurse. It's nice to know that if one of my pts crashes, I know what to assess and how to manage a medically-unstable pt.

But that's what worked for me, not what should work for somebody else.

I work with some awesome psych nurses who (by their own admission) don't have any medical skills. Some of them are happy, some of them gripe about it.

We had a pt with a PICC and nobody heparinized it after IVPB abx because in their 20 years of nursing, they'd never worked with a PICC. We had a pt who needed blood and the nurses didn't know they were supposed to be doing anything different than a normal IV fluid and so the pt ID/blood band didn't get checked at the bedside and nobody did frequent vs. We had a pt get IV mag and nobody did any kind of cardiac assessment, muchless tele or an EKG. But things like that don't happen because of a lack of medical experience, it happened because the nurses pracitced outside of their knowledge/skill base.

If you work psych for a few (or many) years and then go medical, you can re-learn your skills. You can re-learn the medical knowledge like labs and heart caths or hip bolsters. You can figure out how to manage a load of medical pts.

But keep in mind that some facilites require medical experience prior to working psych.

Most importantly, do what you feel is best for you and your career, and try not to base your choice on what worked well for somebody else.

[aloevera]

I don't want to do all the med-surg stuff anymore !!!!! I love psych and am still using our basic skills plus some added psych skills as well...sure, we still do draws, EKG's, wound care, foleys, etc. but I wouldn't and couldn't go back to a med-surg setting ever !!!

[seabiscuitRN]

One of the RNs I work with told me that after a few years of working psych, I'll be "worthless as a nurse." Um, no.

I don't totally understand why psych nurses are so often worried about losing their medical skills. Shouldn't we be more focused on honing our psych skills?

[sarmedic70]

Hey everybody..........great input................I have been sitting here doing a lot of thinking about this myself. I, too, am a psych nurse..........and also a medic and worked med-surg, labor/delivery (limited), post partum, et al. The reality check of it is this: Nursing is a multi-faceted profession with vast skills throughout in all of the areas a nurse can possiblyl get into............you are going to loose something in the way of skills somewhere along the line period. Even in Med-Surg where you get the full gambit of nearly everything........but not all M/S RNs get ALL of what M/S entails in the first place...............You are always going to be learning new skills in nursing......and with that you could lose what you have learned when you make a career change within nursing. What does NOT change are the basic assessment skills and having a really good eye/"gut feel" for when there are changes in a patient's condition. I think (no, I know!!!) in psych nursing, one has to be even more on top of things than nearly anybody else in nursing................you are dealing with psych issues primarily; however these patients have all sorts of many other medical issues as well (some related to the medications they are taking, some due to just not taking care of themselves related to their mental illneses, et al)......so you will be up on your skills for the most part...................if you work a geriatric psych section, you have not only the psych issues but also the other medical issues: foley's, et al. There are times you will have to do IVs and NGs (on one of our adult units, we have a patient who sticks stuff up the arm under the skin (and not small stuff either),and as a result IV's have to be started on this individual. Another individual, on the same unit (and these are not geriatric patients either) has an NG tube related to eating disorders. As a psych nurse, you really have to be in tune in that so many patients will have somatoform "illnesses" thereby the "Cry Wolf" Syndrome (and nurses do and can get jaded as a result), but if still not in tune with the patient's condition and really recognizing basic changes in S/Sx and being observant of patients, that "Cry Wolf" patient can actually have something serious that one time. And it could mean life or death for them. That has happened..............a patient in a psych facility passed away as a result of strangulated and thereby obstructed bowel, but because this patient was always complaining about something and yet when checked out would essentially have nothing.........except this time.............because staff was "jaded" some key things were apparently missed in this patient, and this patient subsequently died.

I guess what I am trying to say (and probably doing a very poor job of it) is that there is no way any RN can have all the skills in nursing regardless. It's an ever evolving profession for one with so many pathways in the medical arena/specialties. What does not change are the basic skills: Assessment, vitals, et al.......................and those are always required regardless of where an RN works. Anything outside of those basic skills, hospitals do their own in-services and annual skills testing appropriate for that facility. Change to a different area in nursing, you will go through that facility' orientation and skills training/assessment. If you don't know something, you will learn it......................or in some cases, re-learn it if you had it once before but just out of practice...................

I do strongly feel, though, that before going into something like Psych Nursing that a newly graduated RN spend a minimum of 6 mo-1 year in Med-Surg just to gain the confidence and skills of good assessments and basic nursing foundation before going any place else.............there have been discussions along this line in another thread in this Psych Nursing forum that has been great.................and I believe most are pretty much in the same line of thinking as I just stated...................Other than that.................Skills not used for a period of time truly do come back..........most of the time it is the lack of confidence in ourselves that is the issue once we feel that we have lost our skills.................but it is just the same as riding a bike...........once you get back on, it comes back to you...................no worries.......................and do what you truly joy doing in nursing. You won't TRULY lose your skills............................

I would not worry about "losing" skills if you get into psych nursing. In fact, I think in a lot of ways, they get stronger because you have to be more in tune with the changes of the patient not only with psych issues but recognizing that they will also have (if they don't already) medical issues, and those medical issues will oft be masked by psych issues.

Psych nurses are REAL nurses.......and don't let anybody tell you otherwise...................I dare THEM, who say that, work in our job for even one day and see what they think after that............can they put up with the constant getting hit, bitten, scratched, poo thrown at them, being threatened, et al......................I dare them to work on MY unit at the state facility where I work.....................I AM a REAL NURSE...........I am an RN (of which is first and foremost).............and my specialty area is PSYCH...........and I love it..........always the challenge and never ever a dull moment! :chuckle

Cheers

C