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LPN student First day of psych rotation, HELP!

by vern234 vern234 (New) New

:imbar Today was my first day of a three week rotation in psych, I left the floor feeling stressed out,& emotionally tired. I am normally very good at communicating with my patients, but today I just froze, any advice would be greatly appreciated.

Hi vern234,

If this is your first experience of psych then it is not unusual to feel this way, however I would have hoped your mentor, or colleagues would have been supportive enough to help you, is there anyone you can talk to on the ward?. The other thing that will help decypher what is going on is to 'model' on some of the most senior experienced clinicians... watch what they watch, ask them why they do what they do.. this should give you a reference point to be able to get a feel for the ward and the patients.

I remember my first day on a psych ward... I had just finished a surgical ward placement where having time to scratch your forehead was a luxury. I must have looked like I was on speed to the regular staff... "what do I do, what do I do... whats next!!!" They simply told me to grab a cup of coffee and go and sit down with the patients watching TV... I thought WHAT!!!... is'nt there anything I can do. It took sometime for me to realise that you can be theraputic by simply being there and accessible to the clients. After I qualified I distinctly remember seeing the first batch of student nurses on placement come on the ward... sure enough they were wound up like the Duracell bunny... and I told them the same thing I had been told... within a few shifts they were into the swing of things and getting used to learning at a different pace.

Don't know if any of this waffle is useful, but I hope it helps you realise that psych can initially appear daunting and scarey, but this soon fades and you see the big picture.

regards StuPer

I think you may be right, I am not used to the slower pace and need to feel alittle more at ease. The thing that really got to me was a verbal attack on all the students by a patient, He "Didn't give his permission to have students watching him all day, writing stuff about him....." he then encited all the others at group to voice the same thought, the charge nurse had to end group. I'm sure it happens often, but it was alittle frightening on our 1st day. We have become very secure in the knowledge that most patients just love the extra care and attention we shower on them & the thought that we may not be as accepted on the psych ward really deflated me.

hmmmm......I remember feeling absolutely terrified on my first day of clinical.

Then I thought - hey - these are just fellow human beings with a bit different perspective on life.

I did not really put it all together until I was scheduled to work on the psych ward as a PCT for the first time. I was thankful for all I had learned at school.

We had a schizo patient who kept looking at me like she wanted to stick a knife into me. When we took them out for their smoke break - she came up to me and asked if she could talk to me. Of course I said sure.

She totally opened up to me - I don't know why. She told me about how her family was against her and why, that the doctors were not listening to her and keep her from her family. She hated make up. Thought it was the devils work. I was thankful I had not worn any makeup that night.

Anyway, the teaching they give you in school on therapeutic communication really works. Just go with the flow and remember what you have been taught.

With my new critical thinking skills, I was able to realize she was just sizing me up. To see if I would be receptive to her, now I don't think she wanted to stick a knife in me at all. She just wanted someone to talk to.

No, I did not solve any of her problems, but if I was able to give her some relief for a few minutes, then I feel I was a success.

Bottom line - remember psych patients are human - not monsters (most of them).

Always make sure you feel comfortable. Follow your instincts.



Has 18 years experience.

We spent time in the group. Then we were each assigned a client on the unit. I think the instructor tried to match us up by age. I tried but the patient I had, you just had to fight the urge to tell him "wake up and smell the coffee, life isn't fair".

I enjoyed working in group situations, but the one on one was hard. Depression, I couldn't deal with in the context my case study exhibited. Post-partum client was no problem, OCD was great.

I knew I wasn't a Psych type. It's a rotation to get through, get the credit for, and if its not you, file it away to experience.

And remember, ur a nurse in training and nobody likes or gets on with everybody they'll ever meet.

remember these people in your after you get out in the real world, or even in your next rotation these are as was said just people...just like looking in fun house mirror...and these people have surgery, show up in ob-gyn. learn everything you can and you will be a better nurse for the rest of your life

There is an old expression "there but for the grace of god go I"... and it served me very well on placement.. there are so many reasons why people end up mentally unwell. I have thought numerous times, what would I have been like if I had had to go through this set of events... its quite sobering to realise in many cases you would'nt necessarily fare much better than your 'patients'.

Another thing to bare in mind is that when admitted to a psych ward many people feel very vulnerable, and have difficulty accepting the need for help from psych staff. Add to that the student nurse and some clients will see themselves as being in a 'fish bowl' hence the defensive attack on you guys. Sometimes apologising if you unintentionally upset a client can be an ice-breaker... of course he may also be aware of the vulnerabilities of being a student nurse and thought "Ill show 'em".

regards StuPer


Has 7 years experience.

[Hey you just described how I feel EVERY day! :uhoh3:

Seriously, take a deep breath and relax. Its not unusual to feel that way at first. Psych is unlike all your other rotations. In med surge you either changed the dressing, cleaned the trach, etc or you didnt. In psych its much more subtle. Not as concrete. You probably did better then you think, most patients are very happy just to have someone listen to them. Also keep in mind your not there to solve all the patients ills, just lend an ear, be supportive and learn what you can. Good luck..

You will find psych in all areas of nursing and it is in most of the questions on state boards,I understand. (It's been too many years since I took them to know whats in them now). In any case,always ask patients if there is anything you can do for them. I learned that from a nephrologist when I worked in dialysis. it demonstrates caring. This can be very important to someone who is depressed or having trouble thinking straight.

Spazzy Nurse, RN

Specializes in Mental Health, MI/CD, Neurology. Has 9 years experience.

OMG, my first day of psych. clinical was one of the scariest days of my life. I think every other student agreed with me. We were petrified, since all we knew about psych was what we saw in the movies. It didn't take us long at all to see that life is not like the movies. In this rotation we got to sit down with the clients and listen to how these illnesses really made them feel. Some of the clients made total sense, some of them didn't at all--- which was even more facinating to us. :) As other people have said, the pace can be a lot slower, allowing you to be able to fully take things in. We were amazed at the stories that we heard from people who at one time were living lives much like ours. It was a fantastic 2 weeks, and we left there feeling the complete opposite of what we felt like when we got there. That rotation opened up our minds like no other rotation did.

Plus remember that many people with a psych. dx like to push buttons. Hang in there. :)

Nurse Ratched, RN

Specializes in Geriatrics/Oncology/Psych/College Health.

I left the floor feeling stressed out,& emotionally tired.

That's nursing for you ;).

Seriously, I left my psych rotation thinking that was the LAST place I wanted to work (altho the prof really liked me and I fared pretty well.) Go figure - a year later, there I was :).

It's one of the most fascinating areas to work. I don't necesarily recommend it for a new grad, as I do think it's important to get your feet under you as a nurse first, and dealing with the complexities of constant psych interaction next.

As another poster stated, tho, you will see it on every floor. It will get better. The switch from med surg to psych in clinicals can be extremely disorienting. Most people in my class grew to love the change of pace. It wasn't easier, just different.

did you do your selfawareness before the exposure? that would help.


Specializes in Psych, DOU.

a pt during my rotation told me once, "this is not like a medical floor, u cant see improvement in pts in days. Its Long Term treatment. Nad he wsa right. DOnt feel like u can "Help" them right away. But know that the limits and structure u provide them helps them in the long run

hello to all!! i missed writing here huh?

this time i need your stories on how your anxiety was on the first day of your psychiatric nursing exposure in the mental institution. i am doing my research studies on this.

if any one of you knows where i should look or what website would i be able to see how the nursing students' anxiety are in their first day of their psychia exposure or minutes and hours before they face their clients in the mental hospital or facility.

please , please anyone...i will be very happy to be a member of this website. :specs:


Specializes in ..

Try to avoid making generalizations about your patients. Not all psychiatric patients like to "push buttons" as one poster commented, but plenty will. However, I think you see enough of those on the medical/surgical floors anyway!

They are people, just like you and me. & more so, they have illnesses that limit their lives, just like all the patients that you're used to on med/surg floors. The difference is the mode of treatment. You can't cure depression with a trachy and you can't improve a psychosis with an round of IV antibiotics. Psych is very intricate and complex, much like the brain, much like life... Treatment is often a long term combination of many, many things: stabilization, management; medication (find the right medication!), therapy (different forms of therapy), exposure, life skills etcetc

Perhaps it would help to take a squizz at some of the pts care plans and treatment goals for their admission/long term to see what their issues are and how the facility are addressing them. That way, you can determine how best to make the little difference you can in the weeks that you are there as a student.

Forever Sunshine, ASN, RN

Specializes in LTC. Has 7 years experience.

I am a LPN student in an 11 month program. I graduate at the end of July. Yay.

This Monday was the first day of our psych rotation. The classes all doing psych had to report to the psychiatric hospital that we are doing our rotation in, and its a big area and FRIGHTENING. I was driving to the assigned building more scared than a 5 year old on the first day of kindergarten. lol We did not see any patients or units, we just received an orientation and introduction on the facility. I felt a little more relieved hearing that we will not be alone with the patient. I felt even more relieved hearing that the patients are heavily medicated. I don't do well with hostility, I tend to back down and compromise and do what needs to be done to make everyone happy.

All this week its theory part of the class and Monday through Friday next week we go to clinical. The teacher this week told us what to expect, some things about the patients, not to walk in looking scared, what we have to do with the patients all the therapeutic communication, etc.

We have to have a conversation with the patients and observe them. What are some topics that the patients just love to talk about and what are some that usually aggravate and upset them? I know every patient is different but I'm really confused as to what to share with a psych patient. In my med-surg rotation towards the end it became alot easier to have a conversation with my patients. This one patient who I enjoyed taking care of and was quite pleasant for the most part I'd spend as much time as I could after I fed her lunch talking with her and we talked about the area she was from and her children and grandchildren and where she likes to go on vacation. It was one of my most memorable parts of clinical and even though I was scurrying at the end of the day to get everything done that I needed to get in to my instructor, I really feel that helped me communicate with the rest of my patients for that rotation.

Can I ask psych patient these same things? Because I know that some don't have good relationships with their families and I don't want to upset any of them.

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