New Grad Going into Psych Nursing or Leaving Nursing

_firefly, BSN, RN, EMT-B · Feb 11, 2015

I think your view is really way too narrow. There are dozens of other areas outside of med-surge, icu, and psych. Do some research and think about what appeals to you. Don't settle. You don't even have to do clinical nursing.

Jules A, MSN · Feb 11, 2015

My advice would be please only come to psych if you have an interest in working with patients who have mental health and addictions issues. I also had no interest in medical floor nursing and loved working in psych as nurse however make no mistake there were no leisurely lunch breaks and imo if you work in psych any length of time and haven't been assaulted you need to get out of the nurses station and interact with your patients. Ok so that last comment might be a tad bit of an exaggeration but being concerned about getting hit to me is a disqualifying factor for psych. Hopefully others will write in if that hasn't been their experience.

Whispera, MSN, RN · Feb 11, 2015

I think you should remember that people who write here are writing, oftentimes, about their stressors. People write about the negatives more than the positives, sometimes, because the negatives tend to stand out in their minds more intensely. You might not be getting a totally realistic picture from the negatives you read here. The same is true from what you see on the units. People experiencing work stress tend to be more vocal than those that are happy.

A common misconception is that there are never tubes, drains, or body fluids on psych. That isn't true, especially if you work med/psych. Also, believing psych will be a place where you get breaks and lunchtime isn't necessarily an accurate belief. I almost never got a lunch break when I worked psych. I'd eat bites as I flew by the table where my food was sitting, but I seldom got to sit down to eat. I got more lunchbreaks on med/surg than on psych, and that's not saying much because my med/surg experience was very intense and time-consuming too.

I've never been hit by a psych patient. I've had patients show extreme anger, and we worked through it. Most psych patients would much rather hurt themselves than hurt anyone else. I've never been peed or pooped on by one either. They aren't out to get you!

The stress on psych comes from the intense emotions the patients feel, as well as from experiencing their bizarro world, from their point of view, sometimes. It can be emotionally draining. Emotional draining is very physically tiring. I think I came home more tired from a usual day on psych than I would experience during the usual day on med/surg. Then, when a day on psych included managing the extremes, there were times I could hardly make it to my car, I was so exhausted. I'd also worry about the safety of the patients I had left when I went home. Would they ever feel better? Would the world ever decide to provide enough services to mentally ill people so they can get well and stay well?

The good parts:

Psych caregivers often become a well-oiled team that will pitch in to help each other and the patients in any circumstance. They don't even need to be asked to help. They just know what's needed and jump in. They stand up for each other.

You can make a difference. That one patient you spent time with may believe someone cares, or that he or she matters, because you spent time with him. You can see people get very-obviously better.

You can develop an intense belief in the power of the human spirit.

pinkiepieRN · Feb 12, 2015

How did you feel about your psych rotation in nursing school? Was it something you liked or was it just less stressful than med-surg?

MMA12345 · Feb 12, 2015

I do have an interest in helping and treating patients with psychiatric disorders. I really enjoyed my psych rotation and speaking to the patients at an inpatient facility. I feel like I could have an impact on patients with psychiatric issues contrary to med-surg units where patients are there due to years of poor lifestyle habits and don't seem interested in changing their lives. My goal is to work as an RN for several years at a psychiatric unit and go back to school to become a psychiatric nurse practitioner. Getting assaulted is something I do understand will probably happen so that's an issue I can look past. I will probably work for a while in psych and find out for myself if this is something I want to do for a career. Thanks everyone for your responses.

Jules A, MSN · Feb 12, 2015

I do have an interest in helping and treating patients with psychiatric disorders. I really enjoyed my psych rotation and speaking to the patients at an inpatient facility. I feel like I could have an impact on patients with psychiatric issues contrary to med-surg units where patients are there due to years of poor lifestyle habits and don't seem interested in changing their lives. My goal is to work as an RN for several years at a psychiatric unit and go back to school to become a psychiatric nurse practitioner. Getting assaulted is something I do understand will probably happen so that's an issue I can look past. I will probably work for a while in psych and find out for myself if this is something I want to do for a career. Thanks everyone for your responses.

That sounds like an excellent plan. Do keep in mind that our patients often have a plethora of medical problems from "poor lifestyle habits" also. I would guess there is no group who is more likely to be non-compliant than mental health patients. Although I feel pleased when I'm actually able to help someone more often I have to derive my satisfaction from within and if everyone is breathing and no one was assaulted overnight to me that is a successful shift.

Neurotic Student · Feb 15, 2015

Hi, I will share with you my story because it reminds me of my story.

I was a new graduate in 2013. I thought I should start out in med-surge because that's where I thought I should start out, it's the traditional/medical nursing, I would get to see everything in this specialty. I would pay my dues. I would finally gain all the technical nursing skills and it would become second nature. I could do that for a year and from my experience, then decide what I really wanted. These were all things I thought I should do. I sent many applications for med-surge but to no avail. I decided to apply to psych positions. I got responses 2-3 months later from 2 freestanding psych hospitals. Before my psych rotation began during nursing school, I was actually looking forward to it. A lot of my classmates were actually scared. I immediately jumped at the opportunity, and it's not only because I would finally have a RN job and not be unemployed, I was also excited. I wanted to do med-surge first before I do anything else so that I could gain the traditional nursing skills. But it's useless for me to have those skills anyways if I don't want to be in that specialty of nursing.

Every time I stepped in a medical hospital back in nursing school, I had a dreary feeling. Hospitals smells like death to me. Like a dead body decayed there, was removed, then they tried to sterilize and clean the smell away but they could never cover up the death. I hated gowning up for an iso patient, then realizing I had forgotten this and that. Go out to retrieve it, gown up, then remember that I forgot something else. I hated that working in that environment would give me a lot of the antibiotic resistant microorganisms as well. It's like I'm going to become sick by being around the sick. I hated walking in a room to a ventilator patient, with the intermittent ventilator sounds going on. Then you gotta tell some of the patients if you vomit, let me see, if you urinate/take a dump let me see. Yeah, cuz that's what I really want to see. The fun skills were trying to start IV's and injections because when do you get a chance to legally stab someone. I don't miss any of that stuff, I still get to do IM's in psych.

I love the psych job that I have now, but that's because the people I work with are awesome. I don't feel in danger, but that doesn't mean there isn't a risk of getting hurt. I have coworkers who have worked 7+ years there and have never once been assaulted. It's all about assessing the situation and how you present yourself. However, there are some cases where you won't see it coming. Most of my patients are medically stable because it's a freestanding psych facility. There are some days where it's very stressful and you won't get a break but that can be said of most jobs. Sometimes the stress isn't from your patients' behaviors, it's from the hospital being understaffed. This worked out for me, I now have a job and it's a job I like. It has almost been a year for me in psych. In the beginning I would stress out a lot at this job but that was because I felt incompetent at my job due to being inexperienced. After about 5 months was when I started to love my job. Even if you decide to not go into psych, know that you will probably feel incompetent the first few months of your job.

I hope my story will in some way help you. I wish you the best! :)

CynthiaMay · Feb 16, 2015

You are sadly mistaken if you think Psych nursing doesn't involve med surg skills. Psych patients also have medical conditions. Add to that that these psych patients are probably going to want to kill you. They will abuse you verbally and physically. You may be put in physical danger because it's your job to keep patients from assaulting or killing each other. Psych patients are manipulative, most have violent histories and addictions. I am a Psych RN in a state owned hospital and I absolutely LOVE IT. Over 90% of nurses who accept a psych job leave it in less than 6 months. It's really not a job for a new grad, but some places do hire new grads. Good luck in your decision. Mental health does need dedicated RNs and LPNs.

Whispera, MSN, RN · Feb 16, 2015

CynthiaMay, I completely disagree with you about the mental status of psych patients. Sure, there are some who are like those you know, but most all dangerous, assaultive, manipulative, and addicted. I think the environment in which you work might have lots of patients with those characteristics, but that's not the case everywhere.

I've worked in 3 psych facilities. In each we had a psychiatric ICU (intense PSYCH), a psych step-down unit, and a chemical dependency unit. Depending on the facility, there were also geriatric, adolescent, and eating disorder units. While some of the extremely ill patients were psychotic and had no contact with reality, and many wanted to hurt themselves, most wouldn't hurt someone else ever, unless they felt their safety was threatened. They'd much rather hurt themselves. Sure some psych patients are manipulative, but so are some people who aren't patients.

Most of the patients I've cared-for are regular people who are going through a hard time. There but for the grace of God, go I. I feel that the other nurses and caregivers felt the same as I feel. People almost never left their jobs on the units, unless they had life interference that required a change (moving, childbirth, etc.). I only left my jobs on psych units because, 1: staff was released due to budget cuts; 2: I got a career advancement opportunity, and 3: my husband got a job 2 hours away and I wanted to live with him!

All that being said, I'm glad you love your job. It seems you won't be one of the ones leaving, and that's super!

MrChicagoRN, RN · Feb 22, 2015

You are sadly mistaken if you think Psych nursing doesn't involve med surg skills. Psych patients also have medical conditions. Add to that that these psych patients are probably going to want to kill you. They will abuse you verbally and physically. You may be put in physical danger because it's your job to keep patients from assaulting or killing each other. Psych patients are manipulative, most have violent histories and addictions. I am a Psych RN in a state owned hospital and I absolutely LOVE IT. Over 90% of nurses who accept a psych job leave it in less than 6 months. It's really not a job for a new grad, but some places do hire new grads. Good luck in your decision. Mental health does need dedicated RNs and LPNs.

I agree with you in the 1st 2 sentences, and the last one.

The part about them wanting to kill you, way off base. While I have had some threatening violence, medications & CPI can really turn that around.

wingding · Feb 25, 2015

MMA12345 --- Just got to know --- What made you think that as a psych nurse you'd be able to actually get a break to eat, not get slapped or peed/pooped on??? I am the one that cleans vomit on my shifts because it doesn't bother me,,, but I also do the poop, pee clean up room, bedding, pt, as needed --- Slapped???? How about punched, kicked, bit while calling a Dr. Strong & restraining person who is hell bent on hurting you, doctor & anyone else they can get to!! It doesn't happen every day, but it does happen. Need to be up on labs & s/s of withdrawls. If you want your meal breaks, & all the ammenities, try clinic nurse - but even there you have trouble.