Needing some realistic perspective....


In nursing school, I really enjoyed my psych clinical, but I wonder how much of the 'real' psych world we actually saw. Most of our day was spent out in the milieu, going to activities with patients and sitting in on a few patient/psychiatrist evaluations. I enjoyed it, but Im sure there is a much more expansive view of the psych world that I never saw.

Now, I am working in LTC and we have a few patients who have chronic behavior issues. I have the hardest time dealing with the patients who yell non-stop when they want something. Even if you are in the same room with them, if you are not immediately meeting their need, they keep yelling. These patients are usually on psych meds, but are rarely re-evaluated by the psychiatrist. At any rate, since it is LTC, they will likely not be discharged, so I will be working with them daily until I find a new job or they pass.

I would like to pursue employment at a psych facility, based on my clinical experience.... but I am worried that I will find myself in a situation much more like the current non-stop yelling situation. I wonder if I am seeing the opposite ends of the spectrum? The best case scenario and the worst case scenario?

So I guess my question is...... what is your average patient load really like? Lots of difficult, high needs people, or a mix?

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.

I haven't heard the concern about the yelling thing before so I'm not sure if my unit would be considered similar because with psychosis there definitely is some yelling but I don't ever feel threatened by it and I don't get offended because they are very sick. Acute units don't have the long term patients which might appeal to you. I would give it a try maybe on a per-diem basis to see if it appeals to you. Good luck.

Davey Do

1 Article; 10,290 Posts

Specializes in Psych (25 years), Medical (15 years). Has 44 years experience.
I wonder if I am seeing the opposite ends of the spectrum? The best case scenario and the worst case scenario?

So I guess my question is...... what is your average patient load really like? Lots of difficult, high needs people, or a mix?

Inpatient Behavioral Health Services are usually devided into at least three areas: Child/Adolescent, Adult, and Geriatric. Our Facility's Patient population is divided into at least four groups and varies according to the census or other factors. For example, sometimes the Adolescent and Adult populations are divided by gender.

The type of Patients you described are most likely Geriatric. Due to dementia, health issues, or a decrease in autonomy, this population tends to be the loudest in volume.

Our Geriatric Unit usually has a high number of LTC Facility Patients with behavior problems. Add medical issues to the mix and you have a wide range of issues to deal with.

Personally, Gero-Psych is one of my favorite populations to work with. Besides just liking the population, there is more direct patient care; the so-called "butt wiping". I also get to keep up on some of my basic medical skills.

If you're more into the ebb and flow thing, although there are no guarentees, I would suggest that you go for working with the Adult population. Generally, the Adult population range from the anhedonic Major Depressive Disorders to the psychotic acting-out Schizophrenics.

The Adolescent/Child population are usually a bunch of animated acting-out low tolerance behavior-disordered poor boundaried Patients. Not exactly my cup of tea. But when assigned to those units, I therapeutically deal with them.

Hopefully, RandS, that gives you an idea of what to expect.

The best to you.


Whispera, MSN, RN

3,458 Posts

Specializes in psych, addictions, hospice, education.

The yelling-out patients I've had experience with, were all older patients, usually suffering from dementia. Other patients can have tantrums or talk to themselves, but they don't call for help continuously, like some elders do.

Where I've worked there have been adult units for those not quite so sick, adult psych-ICU units for patients who were the sickest of the sick (ICU refers to their psych issues, not medical issues), geriatric units for elders who had a wide range of psych problems, child/adolescent units (for the 10-18 year old crowd), and units for the mentally retarded/developmentally disabled patients who had psychiatric issues.

My personal favorites are the 1) adult (not ICU) units because the patients are often just needing a boost to get back on their feet, and I can make a difference just by interacting and showing them someone cares, and I can see someone get better with hope of staying better; and 2)child/adolescent units because kids are fascinating to me and I enjoy their personalities--and to see a child smile who hasn't, is a great blessing.

As a side-note, yelling out means something is going on in the patient that is tremendously troubling to him or her. Getting to the bottom of the problem can and should be a mission. It can really make a huge difference in those cases where you can figure out the reason for the yelling.