need help on psych. nursing

ttmoss · Jun 19, 2001

Hello, just wanted to let you know that I am a Psychiatric Nurse and have been for the past 8 months. I came to my unit, Child and Adolescent, after graduating from a BS program in my city. I didn't have any problems getting a job because I also had a degree in Psych. I am currently 23 years old. I do like my job, I work with 5-18 year olds, run Nursing Groups, Education Groups, CBT or Cognitive Behavioral Therapy and DBT Dialectical " for the borderline population. I thought that my job would be depressing, and it is sometimes but there are other things that we deal with such as Borderline Personality D/O. These are some of the most interesting patients, but also the most draining, they suck you dry. I like to work with the delusional patients, and some of the psychotic patients can be interesting too. We have a 15 bed unit and 1/2 of the patients are violent. This requires training in therapeutic holds and restraints. I only weigh 98lbs and have had to hold children 2 times my own size. I have been kicked, bitten, spit on, punched you name it. My clothes are constantly ruined. It is hard working with the children, it is something that I like but the most important thing that is missing on the unit is teamwork, there is a division between Nurses and Psych Techs, and it makes the place harder to work for. I am currently enrolled to return back to school for my NP in mental health, I can't wait, I want to have my own practice and teach college level Psych Nursing. I hope this gives you an idea of my unit. By the way, I get paid beans too for all the crap we go through. Think about it.. let me know if you have any questions...

Aerolizing · Oct 18, 2001

There are no special classes to take to be a psych nurse. As long as you have a license, you can nurse on a psych floor.

When I was in school, I worked as a nurse tech at an area hospital that had a psych unit and I asked to be based on that floor but the supervisors would not do that. I did get to go to the psych floor about 50% of the time though. That was the best way to learn. Better than clinicals, better than books, better than advice from friends. I had many people try to discourage me from working there (even as a tech) but I loved it. I got to shadow staff and see what psych nursing is really all about.

I would also recommend if possible to work at a large teaching hospital so you see a variety of psych patients and the latest psych meds. People who work there are used to everyone asking questions so you get to learn a lot and the pay is usually better. I have many psych nurse friends who have worked for small for profit hospitals and they have always complained about unsafe staff:patient ratios. Adult psych is my fav. Working with kids is too physical. Kids like to fight. Adults for the most part are aware that there are legal consequences for violence so they are usually not as labile.

In Ohio, psych nursing is not considered a specialty which rates higher pay. I have my certification in mental health/psych nursing and many places will pay higher wages for that. I would check with your school as they will probably have stats on latest pay rates for new grads for your area. It differs greatly from region to region.

Good luck.

jajnurse · Nov 6, 2001

I am currently working in a private psych facility and am interested in knowing what type of restraints other psych facitlities use with their patients. We use only med restraints and I have witnessed almost weekly assaults on staff from some of our most violent patients. Although we advertise that our facility is very open and humane for our patients I am concerned about the safety of our staff. Any responses?

Aerolizing · Nov 9, 2001

Hi Jajnurse,

Adult psych is my area so I can really only address adult psych. It is not safe NOT to have seclusion areas and at least the supplies for leather restraints. When you have a psychotic person banging their heads over and over again, what are you going to do with them? They need to be protected from themselves. Chemical restraints are fine but what do you do til then? Do you have enough staff for everyone to grab a limb til the meds work? You are describing a very unsafe environment. I wonder if your administration encourages you and your fellow staffers to press charges against patients who are assaultive. They do where I work.

I prefer to use meds with seclusion. I think it protects their dignity. If I were psychotic, I would much prefer a med to calm me down from a psychotic episode in the privacy of my own room. It decreases stimulation and gives them protection from others and when you are paranoid, being locked in a room helps to give you a sense of safety. Most times, the door only has to be locked for an hour and the meds have worked and then the door can be unlocked.

I have used leathers but it has been much less in the past few years. Although our patients are more violent, they seem to respond well to meds and a seclusion room. But I know, I always have leathers there if I need them.

I am very concerned for your safety. Even private facilities use leathers and seclusion. Seclusion is only used for those who need it. It would continue to be an open and humane facility. What is humane about letting a person beat their heads into a skull fracture? What is humane about letting people get beat up even when those people are staff? It sounds like a very inhumane place to work. What do you do with sex offenders? Let them lose on vulnerable patients? How do you get manics to sleep when meds have not kicked in yet ( I have seen this take days)? I would talk with other staff memebers and confront administration or if this is not something they tolerate, I would go work someplace where it is safe.

MHN · Feb 25, 2002

jajnurse,we rarely use restraints but tend to use seclusion rooms.

However we are about to under take a trial of an instrument that

predicts violence in psychiatry in the next 24hr period its called

the Broset Violence Checklist .To find out more just do a search in

Google looking for the Broset site.MHN