Mental health clinicals are so boring

allnurses Guide · Feb 13, 2013

Oh, it is so very very much different when you are actually working it!

As much as I love Psych, I also found our rotation rather dull.

What you are missing is actually participating in the work day as an employee, which is very interesting and busy busy busy (at least we are!).

There is a whole dynamic to the unit that you can't see unless you are actually in "the game".

I feel bad for the nursing students who come to us just so they can "observe".

I try to pull them into what I am doing-- just to show them it's not just passing pills and "talking to people".

In fact, a few have been surprised by how little talking I actually get to do with my pts.

I also know what I am looking at on my unit.

What I mean is, that while I am observing too, I know what's going to be trouble long before it happens.

I'm "in the game" and so my interest is active, whereas the poor student has no clue what they are really looking at and that can make it feel like they are merely sitting in a waiting room... kind of like "ho-hum... when's this over?".

Especially if the pts aren't putting on a "good show"... and they typically don't if we keep things "cool" like we are supposed to.

And when it comes to interviewing pts, we usually give the student the most "normal" and "boring" pt we've got... because you, as a student, really don't want to be responsible for setting a pt off.

So again, students: miss the interesting stuff, can't see all the planning and thinking going on in our brains (i.e. "crap... how am I going to tell my pt he's lost cafeteria privileges without him going off the deep end?"), how the nurses work together with counselors, PCT's, doctors, therapists, families, etc., the med pass and the judgement call involved with that, AND seeing us address medical issues!

Oh, yeah... paperwork and charting out the butt.

... and there's more!!

That's only part of what you're missing.

You'll just have to trust me... I'm never bored at work.

Cheers.

elkpark · Feb 13, 2013

Like every other clinical experience you will have in school, how much you get out of it will depend heavily on what you put into it. I've taught psych clinical in a number of different settings over the years, and I've had students who just wanted to sit around and wait for it to be over, and complained about how we weren't "doing" anything, and those who really made an effort to work on their communication skills and learn as much as they could about psychiatric illnesses and individual clients' experiences of those illnesses.

You said that you're supposed to sit, observe, and have one conversation with your assigned client. I'm sure there's no rule or anything else preventing you from having more than one conversation, or talking with other clients beside your assigned client (and I've never encountered a student clinical experience, in any setting, where the students were expected to sit :)). In my experience, there are typically quite a few clients who don't have nursing students assigned, who would love to have some company and conversation. Playing card games or board games or working on jigsaw puzzles are often good ways to stimulate worthwhile interaction with clients, more so than just walking up to someone and attempting to engage the individual in conversation because that's what you are supposed to do in clinical. If a few students start up a game or a puzzle, that will often attract the clients over to join in and it's much easier to have a conversation in that kind of "natural" setting (esp. for students, who typically feel pretty anxious and awkward about just sitting down and asking people a lot of personal questions).

I imagine you're welcome to review the charts of your assigned clients and read about their history and current status in detail. Part of what you should be learning in psych clinical is how to do a competent, basic mental status exam and how to talk about the findings of that exam. Reading the reports of the other clinicians who are working with the client is a good way to learn more about that. Are you reviewing the diagnostic criteria of the different common disorders and looking to see which of the symptoms you can observe in the clients with those diagnoses on the unit? Are you asking your client and the attending psychiatrist if you can sit in on the psychiatrist's evaluation, and asking questions of the psychiatrist afterwards?

If it were up to me, nursing programs would have a lot more emphasis on psychiatric nursing than they do. Lots of the stuff you learn in the other kinds of clinical is going to be outdated within a few years of your graduating; depending on where you choose to work as an RN, you can go your entire career without needing to know anything about pediatrics, or OB, or urology, orthopedics, etc. But I guarantee you that anywhere you go in nursing, you will be working with people who are afraid, who are sad, who are angry, and who are in crisis. You will be working with people with varying degrees of mental illness. And therapeutic communication skills will be a necessary part of your daily practice. Everything changes in nursing except people and their emotions. Those don't change. :)

Is your instructor offering any guidance or assistance? (In recent years, I've run into the (IMO) rather disturbing practice of schools having psych clinical (and lecture) taught by instructors who aren't psych nurses. I have a hard time imaging that they have much to offer the students in clinical.)

I hope you'll end up making this a good experience for yourself. Best wishes!

Esme12, ASN, BSN, RN · Feb 13, 2013

You will find that there are areas that you won't gel with......personally, I hated psych nursing. I admire those who work there. Most of mine was on an adolescent unit.....personally, to me, they were nothing but a bunch of mouthy brats. But take this experience to learn skills. Watch the staff interactions from afar. Much of what I learned was VERY useful in the ED/ICU setting where I spent my career.

Just remember this to shall pass.

rubato, ASN, RN · Feb 13, 2013

Thanks for the wonderful information everyone. I will see what I can do tomorrow to get more involved. I am in an adolescent mental health facility, and yes, we are given the most "stable" patients so that we don't do the wrong thing with someone. I do read the chart and I do try to interact with my patient more, but their schedules are just super busy.

One thing I have observed is that the interaction between the entire staff and the patients is just incredible. I cannot imagine knowing exactly what to say to 8 children under the age of 11 who are all dealing with different issues, but the staff is fabulous at it. I just got used to the pace at my first clinical and there seems to be nothing for me to do during this one.

Thanks again.

elkpark · Feb 14, 2013

One thing I have observed is that the interaction between the entire staff and the patients is just incredible. I cannot imagine knowing exactly what to say to 8 children under the age of 11 who are all dealing with different issues, but the staff is fabulous at it. I just got used to the pace at my first clinical and there seems to be nothing for me to do during this one.

Learning as much as you can about this kind of interaction, and working on developing your own skills, is a main goal of your psych clinical rotation. :)

I've observed over the years that many nursing students really struggle with psych clinical because they're so used to being "busy" doing lots of tasks in med-surg, and they initially perceive psych clinical as not "doing" anything. (Or, they expect it to be a sort of "vacation" from their usual busy clinicals, because they initially perceive it as not "doing" anything.) You're doing lots of stuff, it's just not the kind of technical tasks you do in med-surg clinicals. It's more thinking and communicating.

As a few of my students said to me the last time I taught a psych clinical rotation, "Gee, I thought this rotation was going to be easy, but it's really hard -- you have think all the time." Ummm, yeah -- that. :)

Mrs. Sunshine Lily · Feb 16, 2013

I have a question, and I hope that the responses also help you too rubato:

I am also in Psych Clinical Rotation, and I was assigned to a dual-diagnosis crisis center. It is basically a non-profit organization, which houses up to 12 clients, and helps them to rehabilitate into society. They have rotating set of councilors 24 hours a day, and a nurse practitioner which comes in twice a week for about half the day each time. The councilors give the patient their medications, and it is very much a home setting- very relaxed, welcoming, and homey for the most part. As it is a crisis center, the clients can only stay 90 days max, and if they need further assistance, then they are sent to a similar setting for a limited time, until they can regain independence, or be transferred to a board-and-care.

The current set of patients which reside their are patients who have bipolar disorder or schizophrenia (or both), and a substance abuse issue- usually past meth or alcohol addiction. They APPEAR to be stable, and have not done any unusual types of behavior- the most unusual one for me so far is a patient who hears voices at night, and parts of the day. Basically, they appear to be fairly normal people, that had a hard life and trouble with their mental illness, and turned to drugs for one reason or another. Currently, I spend lots of time talking to my patients, and getting to know them on an individual level- where they are from, what is their story, why are they here now, ext. I ask them a lot of questions about themselves, and try to assess their knowledge of things such as dental care, sleep, hydration, and nutrition so that I can educate them on these things.

However, when tragic subjects come up- such as an experience with rape, or being beaten as a child, I have NO idea what to say. What is the most therapeutic response in a situation such as that?

Also, I have difficulty knowing how to assess their mental health issues, as I am a little worried as to how I can make them feel comfortable telling me these things, when I have relatively little experience mental illness- except for bipolar disorder, which after years of having a person in my life with that disorder, I am still having difficulty being therapeutic with them during manic phases as they are extremely aggressive during these episodes.

Aside from therapeutic communication, I would also like to work on nursing interventions with them, as I feel that I currently have more of a role as a councilor, rather than an educated nurse with med-surg and public health knowledge. I do realize that therapeutic communication is the foundation, but I would really like to also bring things to the table that the patients may not be getting from the facility, and that I as a nurse should be doing/focusing on. What do you recommend I be teaching my patients regarding their health? Many of them have lived on the streets for years and years, but I have never been homeless. I can definitely IMAGINE what it must be like, but I as I have not had to live that way, I truly cannot know what it is like. I am not sure what common useful nursing topics may be helpful for them?

I would really like to use my time in clinical to "work" as I would if I were hired as a psych nurse, because the home I am in is very friendly, involved, and allows us to work within our skill set of giving medications with supervision, and talking to patients. I want to take advantage of my time, and get the most that I can out of my limited time in psych.

I love public health nursing, and psych patients are often neglected d/t their mental illness. What skills can I do now, so that when I work in the field I can understand this population, and do my best to assist them?

Please help!

Thank you.

LadyFree28, BSN, LPN, RN · Feb 17, 2013

My clinical rotation, we facilitated activities and helped the therapists. We were able to observe psych admissions/intake, and rotate to the Geri-Psych, which had tube feelings, etc. We were able to go through the charts, plan care/interventions, and if they were on the verge of a crisis or setback, attempt to "therapeutic communicate" an intervention. My interventions helped me deescalate my pt, so it was effective-I guess. :)

We had card games, projects to present to help with health techniques...they were pretty receptive. Those activities helped through the rotation. My rotation was during the holidays, so that was interesting enough...

SC APRN, DNP, APRN, NP · Feb 18, 2013

Mine wasn't boring at all I was on a Forensics unit. We did sit a lot because we attended groups, treatment plan meetings, hearings. I got to speak with psychiatrists and psychologists from that facility and community groups, and the patients individual counselors. I talked to nurses on the unit I was on and other units. I just talked to anyone I could Patient or staff, then I looked at their chart so it all clicked. It was great, I didn't think I would like it but I did. The best part I didn't have to wear my uniform!