New Grad, New Psych Nurse, HELP?

[KayteRN]

I just recently got a job as a psych nurse on a mainly geropsych unit, that I began 3 weeks ago. There are some younger pts as well, but "frail", or vulnerable (as if psych pts aren't). i.e. with more medical problems as well, that may have greater difficulty on another unit with more violent pts who act out a lot.

Anywho. I am feeling very overwhelmed. I have had different preceptors each time I go into work, and it's challenging. There are pros to this, but I don't prefer it overall. I am trying to get tips on what questions to ask for my 1:1 assessment every shift. Some pts are developementally disabled, and therefore can't really answer if they've had a bm lately, or even how they feel, or if they feel safe, etc. It's hard to figure out the questions to ask each pt. I feel like a total moron at frequent intervals. Everyone has been really nice (co-workers), but I just feel so dumb. I've never worked in a hospital (besides nursing clincials), and NEVER worked in THIS type of atmosphere, with very labile people, who snap on the drop of a dime, at times. I feel like I'm dancing around their behavior. I know to set limits, but it's hard when someone is shouting in your face how they are "not going to take that medication" and "you don't know sh**, Bit*#", etc etc. I am trying to pick up some key phrases for redirection and things like that to kind of put in my back pocket and branch out as I become more comfortable. I get different information from nurse to nurse at my job, and I don't know how to proceed really. I just find this whole experience very challenging. I do LIKE it, it's just like I said, I feel stupid. Everyone is very positive and "you'll get it! it took me 6 months at least to feel better about coming to work, there's so much to know!" but I feel like I am progressing too slowly.

Advice please?

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

I'm not a nurse, but I feel for you... I work in DD Services, managing a day habilitation program for adults with DD, low vision/blindness, hearing loss, mental health issues (schizoaffective disorder, autism/asperger's), down's syndrome... etc. etc. etc.! We have a magical mix of behaviours and bodily fluids..!! ;-)

I got completely thrown in at the deep end. I had NO idea, fresh out of uni feeling all grown up and like I knew it all with my psych degree, how to communicate with these guys. How to build relationships/rapports with them - how to deal with the behaviours, how to EXPECT and preempt the behaviors... it wasn't pretty!

It does come with practice, and time/experience. As you get more and more used to this population, you'll fine-tune those skills of knowing exactly what approach is going to work for this individual, and you'll get quicker and quicker getting there.

For the DD folks, I recommend lots of laughing, making things simple and easy to understand without speaking to them like they're 3 (which can be a really fine line sometimes and I've seen every single member of staff here, including myself, struggle with it). Make things a joke/a game... maybe there's a DD patient who gets really anxious with needles and you need to re-do an IV, I'd probably try and make it light-hearted and fun, like "OH my goodness, Ms Lois, not you again! Look at you makin' me run around with all this good medicine to help you feel better... hey, is that your lunch over there? It's GONE, you didn't save me anything?! What am I going to do with you, 'eh?"

(Haha, sorry, I'm rambling - I just genuinely wholeheartedly love this population and have so much fun building those relationships..!).

The redireaction thing is trickier, because it's so hard to know what will work with someone unless you really KNOW them. A huge part of it is being confident in your own skills/abilities/knowledge of the protocols and the sytem, and convincing yourself that even if something did come up, you would know how to handle it. If you're redirecting from something that was initially directed at YOU, I would probably say something like "I'm sorry you feel that way/I can see you're feeling anxious upset about ... BUT I am here to do MY job. I need to (have you take these meds/do this procedure/whatever it is) to make sure you're being taken care of. If you're not okay with that right now, I'll come back in 5 minutes/I'll be happy to talk about whatever it is with you first." Or sometimes even just a "Okay, right now we're in a hospital, and we are all professionals. We don't speak to anyone like that, so please speak respctfully and I'll be respectful of you too."

Sorry if none of that made ANY sense! Let us know how it's going, good luck!!!

[Davey Do]

KayteRN:

Reaching out for understanding in order to progress in life is a healthy trait. The majority of us have been right where you're at and have progressed, in our own ways, from there. It is sometimes a long haul from feeling awkward and incompetent to feeling comfortable and competent.

Listen to your supportive co-workers. You'll get there.

Currently, you seem to be feeling around, trying to get your bearings, learning the best technique that is comfortable with you. It's all a learning process.

You must care about what you're doing. Otherwise, you wouldn't be there. Or here. That, in and of itself, speaks volumes.

My sole advice to you, in dealing with this population, is to incorporate the institutions' principles, policies and procedures into who you are as a nurse. "They're two great tastes that taste together" if you believe in yourself and what you're doing.

So many times, I've witnessed Professionals becoming somebody else (changing their personality) when dealing with Patients who exhibit behavior that is not of the norm. That's a conflict within itself.

So, know thyself and learn thy job.

Good luck to you, Kayte RN.

Dave

[IowafemaleRN]

I promise you, things will get better! I've been a psych nurse for 5 years now, and majority of the time find it a breeze.

However when I first started I felt like a total moron and a fake. I felt like I needed to prove myself right off the bat that I was competent even though I had no clue how to handle situations such as you have given example of. I was very quiet around my preceptor and did not know what questions to ask. It was very stressful.

The first evening I was on my own I picked a group of the hardest patients, I think trying to prove myself. This backfired on me and I became tearful, which other coworkers noticed. I was so embarrassed and totally had doubt in myself. However things got much better as time went on. I watched how other nurses reacted to situations and learned from them and my own trial and error when interacting with patients.

I was told that you don't start feeling like you know what your doing until around 2 years after working which I totally agree with. I truly think being a psych nurse just has to come with experience and isn't something that you can really just learn from a text book and then jump into the skills like med/surge. At the time though I thought I should know it all and thought I was expected to.

For 1:1 assessments do you guys have a set list of questions on a paper to ask? We have a set list of questions we have to ask, each patient, each shift. A few of the questions we ask are if there having any suicidal thoughts, self harm thoughts or thoughts of harming anyone else. How their mood is. Are they oriented to the date and yes whens the last time they have had a BM. When I first started I felt like I had to keep asking the pt the same question over and over until I could get the an answer, but for someone who is too confused and is not able to answer then you would just document exactly how they responded to the questions. So for example if you asked the patient whens the last time they had a BM and the patient answered, "I have three babies." I would asked the question once more just to make sure they weren't just hard of hearing. If they answered nonsensically again then I would document: Pt too confused to answer this question. When asking pt whens the last time they had a BM pt stated, " I have three babies."

When I first started I was scared to ask a dumb question, but now I know that I was foolish to think that because they didn't expect me to know everything. What to do when a pt is angry and refusing their meds would be a great question for you preceptor. I'm not sure if I should answer that quetion for you as I'm not sure if what I would do would be different from your hospital policy or what your manager or the doctor would want you to do.

I truly love working with my patients in psych now that I feel competent. I meant it when I said I felt like a total moron and stressed when I first started.

I hope maybe this helped, let me know if you have any other questions at all.

-PsychRN

[Noah'sRNMom]

When I started working at my facility, I found it helpful to get to know the staff. I'm not sure about where you work, but I work at a state facility, so my patients are here for 6 months at least. We have regualr ward staff and they were able to tell me who I needed to watch out for, who would attack me, who would try and sneak off the ward, who would try to bully me around, etc. They also were able to tell me how to handle different patients. Just always try and observe. See how seasoned RN's and psych aides interact with certain patients and try to do the same, if that makes any sense. As for getting patients to do things they don't want to do, like take meds.. it's different in each situation. At my facility, we have patient levels. When they are a certain level they get to do certain things. I don't automatically say "you are going to lose your level if you don't do this" I usually try to find out why they dont want to take it and see if it's a resonable answer. I work from there and this is where your communication will come in handy. If you cant get them to do it then you have to find their currency. Like I said, where I work it is levels. "You know that you are prescribed this medication and if you don't want to take it, it is your choice, but the consequence of that action will be to decrease your level." Then tell them what they are going to lose by chosing to not take meds. "I know you like to go outside and smoke, and if you lose your level, you won't be able to do that." You will find that the longer you are there the easier it will be to talk to the patients and find out what works for different patients!