Need Psych Nurse perspective

B52, ADN, BSN, MSN, RN · Jul 23, 2023

When I did my psych clinical, which was in a hospital, I didn't see any nurses actually interacting with patients. However, I knew psych was my passion. I've worked in a drug rehab facility, on psych floors, in a psych ER, and now as an in-home case manager. Maybe the dynamic is different in a forensic facility, but I've always had the opportunity to spend a lot of time with my patients and create treatment plans tailored to thier individual needs. If you're ambivalent, perhaps you should try med/surge first.

umbdude, MSN, APRN · Jul 24, 2023

I wouldn't judge it based on one experience at one facility. I went into nursing specifically to work in psych. My psych rotation during my BSN was not good, but I already worked in an inpatient psych unit at a research hospital, so I knew that's the specialty for me.

Other nurses not interacting with patients doesn't mean you have to do the same. Being awkward and not knowing what to say is not unusual for people new to the field. It's a skill that can be developed over time.

Try to think about whether being a psych NP is really what you want to do. If it is, get a little work experience as a psych RN then proceed.

MrChicagoRN, RN · Sep 17, 2023

What you saw in your clinical isn't typical of the experience of the inpatient experience. More frequently it will be people from the community experiencing a mental health crisis. Maybe their first, maybe an exacerbation of a chronic illness.

I do recommend a year of med surgery, or similar experience, as it will make you a more well rounded professional. But either way, don't let your first experience be your guide.

Rionoir, ADN, RN · Sep 22, 2023

That's definitely not a typical psych environment. And honestly, as a PMHNP I feel like you're much more likely to be dealing with depressed housewives than criminally insane individuals. The docs get the fun ones. ?

FullGlass, BSN, MSN, NP · Oct 17, 2023

PMHNP here. Unfortunately, it is all too common in mental health hospitals that the RNs have very little patient contact. They seem to spend all their time in the back, doing god knows what. This is not true of all mental health hospitals, fortunately.

My advice to the OP is to look for a job as a psych RN and to do some shadowing before accepting a job offer to make sure it is a good work environment with patient contact.

I have no idea why some people are advising the OP to work in med-surg. If the OP knows they wants to be a PMHNP, then they need an RN job which will provide some psych experience. Other options besides psych RN could be oncology, kidney dialysis, diabetes, as such patients often have psych comorbidities.

Frankly, if OP is sure they want to be a psych NP, then they should go straight through to a PMHNP program. The other option is to become an FNP then get the PMHNP certification. The primary care experience is actually quite valuable to a PMHNP. (That is what I did).

The vast majority of PMHNPs work in outpatient environments. Many PMHNPs can also work remotely.

And before people bombard me with disagreement, the actual evidence indicates there is no advantage for a primary care NP to have worked as an RN. Now that I am a PMHNP, there is nothing I am doing which would have benefited from me having worked as an RN, either.

newsong1, BSN · Oct 31, 2023

Hi Dizzycarrot,

I can tell by what you wrote here that you want to help folks who are working through mental health struggles:

Quote

I went into nursing school really wanting to become a psychiatric registered nurse with the intention of later becoming a psych NP.
I had a lot of experiendes that really led me to want to help people with conditions like schizophrenia, bipolar disorder, depression, and drug addictions. (Though in general I like helping people with their mental health)

I currently work as a psych nurse in an inpatient hospital. For the first 5 years of my nursing profession, I tried other specialties and nothing quite fit. But I feel like I've now found my calling in nursing as a psych nurse. Who knows? Maybe you might start as a med-surg or ER nurse and eventually find your way back to psych nursing again. The great thing about being a nurse is that you switch specialties and find one that fits for you. There are plenty of opportunities to offer psychiatric care (like empathy and active listening) in non-psychiatric healthcare settings.

In my experience, there are different kinds of sub-specialties within the field of psychiatry. I wouldn't let the experience that you had working with long-term facility patients incompetent to stand trial to color your whole experience of psych nursing. Psychiatric care exists on a spectrum and you got to see how it works on the far end.. there's a place for nurses in that sector, but there are lots of other hospital and outpatient settings where you can be a support to people who are wrestling with mental health issues at different stages.

When I first started working in psych I would float to different units from the most acute adult floor on the unit to the adolescents.. now after having about a year into the hospital, I told my bosses that I want that I want to work with adolescents and more voluntary patients on the unit. I want to work with less acute patients because my eventual goal is to become a psych NP working in outpatient settings where the patient will be more stable, and I can help them with ongoing treatment.

Contrary to what other people feel about accelerating towards a psych NP, I think that the experience that I have as an inpatient psych RN has been valuable for my learning. I'm learning how to assess and interact with patients who are in an acute level of crisis.

FullGlass, BSN, MSN, NP · Oct 31, 2023

Matt Huang said:

Contrary to what other people feel about accelerating towards a psych NP, I think that the experience that I have as an inpatient psych RN has been valuable for my learning. I'm learning how to assess and interact with patients who are in an acute level of crisis.

My point is that there is no reason at all to suggest OP do med-surg nursing if they are interested in psych.

During my undergrad clinical rotation at an inpatient psych ward, a locked ward, the RNs were very involved with patients. They dispensed med, assessed patients daily, and also led group sessions. This was also a top hospital.

I also did a rotation in a pediatric day hospital, where the patients came in for the day, then went home at night. The RNs really did everything - assessed pts, helped lead groups and activities, etc. Again, this was also a top hospital.

As I have repeatedly said elsewhere on this forum, the EVIDENCE indicates that RN experience does NOT improve NP quality. The only exception is acute care, because an acute care NP needs to be familiar with the hospital environment. If the OP wants to be a psych NP working in a psych hospital, then psych RN experience could be useful. Otherwise, it is not needed. The vast majority of psych care is provided in primary care and outpatient mental health settings. Working in primary care as an NP would be great experience for treating basic mental health conditions. Then one could earn a PMHNP. Or if completely sure of wanting to be a psych NP, then just go for the PMHNP!

I went straight through from my ABSN to my AGPCNP, starting at age 53. Several doctors told me, and this is confirmed by evidence, that they preferred NPs w/o RN experience, b/c they had too much of a hospital mindset. Once I began working in primary care, and this is anecdotal, the NPs w/RN experience were no better, and in some cases, much worse than NPs w/o RN experience. I am now a PMHNP, and there is nothing in what I do that would have benefited from me having been a psych RN or med surg RN. I am a top performer, too.

NP is not a "promotion" from RN. It is a completely different job. So if someone wants to be an NP, then go straight to NP (unless acute care).

It is also very unfair to hospitals and other RNs who need jobs for someone to take an RN job knowing they are going to be gone soon and have no long-term commitment to being an RN.

NPs function like doctors, and we don't require doctors to work as RNs first.

newsong1, BSN · Nov 6, 2023

Hi @FullGlass,

I think my hesitation to encourage people to fast-track their way to become psych NPs is that there is an under appreciation about the spectrum of mental health and there is little continuity in the mental health system as a whole. I know a lot of folks who are trying to fast-track their bachelors and masters education to become high paying outpatient psych NPs. Nurses already see themselves as distinct from doctors, and there is contention between the professions at times. Could the same thing happen between nurses and nurse practitioners? I think the great thing about being a nurse practitioner is that we can embody the best parts of being a nurse and being a doctor.

I'm curious about the evidence that you cited that RN experience does not improve NP quality. Could you send me a link to the study articles that you are referring to?

I still think that there are things taught in psych floor nursing that can be useful. Things like the emphasis on being with the patient, teaching patients in group settings, and working on a team of nurses, MHWs, social workers, and psychiatrists in practice settings.

dizzycarrot · Nov 6, 2023

Thank you everyone I've been reading all of your posts and appreciate all the perspectives.

Just an update: I accepted a position at a Psychiatric-Med Surg floor ( md surg but all patients have underlying psychiatric conditions, often presenting in their acute stage). I'll try to attend NP school after a year or so. Probably part time initially while still working until I have to do clinicals, at which point I'll stop working and switch to full-time studies.

I encourage everyone to keep commenting and keep providing their perspective and advice though!

FullGlass, BSN, MSN, NP · Nov 6, 2023

Matt Huang said:

I'm curious about the evidence that you cited that RN experience does not improve NP quality. Could you send me a link to the study articles that you are referring to?

I still think that there are things taught in psych floor nursing that can be useful. Things like the emphasis on being with the patient, teaching patients in group settings, and working on a team of nurses, MHWs, social workers, and psychiatrists in practice settings.

I have provided the evidence in previous posts. Sorry, I can't find them, but you can search on my posts as well as using Google.

Psych floor nursing could be useful for a future PMHNP, yes. However, I fail to see how med-surg nursing would be.

While the psych RN work could be useful, it is not a requirement. I did just fine without it. It might be more useful for a PMHNP that wants to work inpatient.

For an outpatient PMHNP, I think primary care is more valuable than RN experience. As a primary care NP, I got a fair amount of experience diagnosing and treating common and simple mental health conditions like depression. That also exposed me to the comorbidities often associated with mental health issues such as diabetes and endocrine conditions. It also helped me to rule out medical issues that can cause mental health symptoms, like anemia.

While working on teams is nice, in outpatient care, that is seldom the case. Unfortunate, but true. Anyway, one does not need to be an RN to learn how to work on a team.

Rionoir, ADN, RN · Nov 21, 2023

dizzycarrot said:

Thank you everyone I've been reading all of your posts and appreciate all the perspectives.

Just an update: I accepted a position at a Psychiatric-Med Surg floor ( md surg but all patients have underlying psychiatric conditions, often presenting in their acute stage). I'll try to attend NP school after a year or so. Probably part time initially while still working until I have to do clinicals, at which point I'll stop working and switch to full-time studies.

I encourage everyone to keep commenting and keep providing their perspective and advice though!

How do you like that unit? I was considering going to a unit like that since I've kind of flip flopped between psych and med surg.