New grad psych nurse... need some advice

Specialties Psychiatric

Published

Hello,

I am a new grad, just graduated in May and passed NCLEX in June. I am relocating from California to North Dakota for a job at a psychiatric hospital. I have a couple of questions regarding psych nursing.

First... I decided to become a nurse while working as an aide at a psychiatric facility and I always knew that pysch nursing was what I wanted to do. However, my instructors told me in school that I shouldn't make psych my first job because I will lose my skills. They said I should get a med surge job first. However that is not what I wanted to do. I love psych and it is what I want to specialize in. The problem is that we did not learn to start IV's in school and I am afraid if we get a patient on the unit who needs an IV that I will look stupid and not be able to start it. I am pretty ok with most of my skills, but I worry that I am not IV ready at all. Any thoughts on this?

Second... I did my transition to practice in an acute psych facility and I learned there that writing psych nurses notes is my weakness. I am ok with assessments, patient/staff interactions, meds, etc. But when it comes to writing notes, I never seem to know what to write. I always miss important stuff. Any advice on practicing writing notes would be very helpful.

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I am a new grad too, and really focused on becoming a psych nurse. Like you, I had no idea how to start an iv, and was worried sick about it! I was lucky to be accepted into a graduate nurse program and placed on the psych unit I wanted to be on. The other graduate nurses were placed on med/surg floors, and got inservice trainings on starting iv's and other medical procedures. I was very frustrated that i didn't get to go on those rotations, and got very tired of hearing "you're a psych nurse, you won't need to do that..." However, since I've been on my floor, there have been a couple of medical emergencies. Instead of being the person treating the patient, I've been assisting, because the tech on my floor is an EMT and has more direct skills than me. I am continuing to look for opportunities to gain additional training in crisis/trauma and nursing skills and that my psych background will be instrumental in helping people who are in a true crisis. I have to remember is that I can't be proficient in all areas of nursing all at once. I am hoping to prove myself as a good psych nurse, and an asset to the facility that I work for. Once I have been there for a while I am hoping to be able to go to them and ask for training on med/surg floors to learn the skills. Remember, starting iv's and giving shots are skills that anyone can be taught. Knowing how to care for a person is a gift.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I went straight from school into a mental health job. About five years down the road, when the facility I was working in abruptly closed, I became almost unemployable. I couldn't get interviews despite local hospitals running full page ads looking for RNs. Once you work in psychiatric nursing, many employers assume that you can't do anything else and they won't talk to you. I drew unemployment compensation for 90 days despite having five years experience with most of it being in a charge position.

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Thanks for your responses. I plan to stay in psych nursing as it is what I enjoy. It's what I plan to specialize in. My only concern is making sure I keep my skills up enough to care for any patient I may be presented with. I just hope maybe there will be an experienced nurse at my facility willing to teach me some of the things I did not learn in school, such as IV starts and blood draws, so that I will be prepared for any medical emergency that may arise. Any suggestions on nurses notes?

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Specializes in Psychiatry, Mental Health.

Hello, Gen.

I "did my time" on med-surg right out of school, but only because I was waiting for an opening at the large psychiatric hospital where I wanted to work. I don't think it particularly helped or hindered me.

In all my years on the psych floor I was never once called upon to start an IV. I did do blood draws when the lab techs weren't available, but the hospital's policy was that floor RNs had to take a brief in-service and be certified before they could do that. Now, I realize that this was a very long time ago, but why not just ask your head nurse about it once you get started? Remember that different hospitals and different states have different rules. More importantly, no one expects a new grad to know everything! Far better to ask in advance.

What concerns is this idea that "skills" are not something we use in psychiatric nursing. With time and training, you will develop very refined skills in close observation and therapeutic interaction; you will become expert in psychopathology and psychopharmacology. You will probably also become really good at Rummy 500 and ping pong, too. ;)

Psych nursing is not a lesser practice of nursing. We have a different skill set, but not a "softer" one. And again, for any hands-on procedures that you may need to do, your head nurse, nurse educator and DON are there for you.

Good luck, and welcome to this wonderful specialty!

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Thanks Retired APRN, I feel a lot better! I will definitely be sure to speak to my DON next week regarding any questions or concerns I have. I can't wait to begin my new adventure. I will keep you all posted.

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Most psych hospitals don't have IV's on the floor due to the risk to the pts. If they need IV's they go to a medical unit. In terms of skills, Refresher courses are available if you ever wanted to try something else. Psych was my first job out of school 8 years ago and I don't regret it! Got my ANCC certification too! Even if you do med surge for a year, you'll forget it anyway. Do what you love right off the bat!

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When I took my physical for my first RN job on psych unit - Dr. said "Oh, you're going to pass meds". At first I thought "uh oh" & now I am furious at his remark! Med Surg nurses won't float to my unit because of the danger --- I am on a locked ward & my patients are up & walking - looking for meds - psych nurse has to be on her toes, up at the slightest sharp sound - hear a pt. crying from 500 feet - able to enter a STAT order & draw it out of Pyxis within minutes & deliver that shot yesterday & yes - leap over nurse station in a single bound! Psych nurse not only knows her labs, paper patients & recommendation before presenting to dr. to accept as admit, but the earliest signs of withdrawl, handle seizures, choke, along with, psychosis, acting out, temper tantrums & violent patients - need to know when to be empathetic, easy, hard or tough love. Then nurse must know her wound care, because these people come in with wounds - also know your critters - because there is a wide margin of hygiene going on here. House keeping is what stands between you & those critters, treat them well. You still need to know & perform daily assessments, be on the lookout for respiratory problems (I carry my own cardiac stethoscope, O2 monitor & a few B/P cuffs) - You still will pull your crash cart at times while calling rapid response or code. Psych nurse not only works the entire spectrum of nursing, you have to do it with patience & finess (the hard part). Don't get too stuck on where you work ---- do a good job, no matter & your path will find you.

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Specializes in Psych ICU, addictions.

Keep in mind that you will be developing and utilizing a different skill set. Also, you won't entirely be abandoning the medical skill set: you may not be doing foleys and IVs as much, but you will still be doing physical assessment and performing nursing interventions for many medical problems.

You're not really losing skills--you could always refresh your knowledge if you had to. And I don't necessarily buy that "work m/s or lose your skills!" argument because even if you did your obligatory year in M/S and then worked in psych after that, you really think you'd clearly remember those skills 10 years down the road?

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Specializes in Mental Health.

Whenever someone said that to me.. "you'll lose your skills" .. I always replied.. "I'm a new grad, I don't have any skills to lose" .. I graduated 3 years ago and have been doing acute, inpatient psych since.. I absolutely LOVE my job.. Funny.. in my rotations, it was the psych issues that always stood out to me.. med surge.. ER.. geriatrics.. oncology.. family birthing.. home care.. etc.. etc.. psych is everywhere.. we're all human.

I think every new grad should do psych.. the skills you learn are invaluable in any nursing setting..

Cares like IV's.. Foley's.. dressings.. etc.. aren't hard to learn if you have a reasonable amount of manual dexterity.. psychological cares on the other hand.. not so much.

So my advice is.. if you love psych, go for it! It's awesome.. I don't think I'll ever want to do anything but.

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I'm always perplexed over these discussions of skill loss. I personally don't want to be putting urinary catheters or IVs in people. It's not hard, but it's just not anything I want to do. You learned how to do it once. You can learn to do it again later. Chances are you won't forget. You just won't do it as quickly, and that's not a big deal. If you want to work with psych patients then don't worry about the extremes of medical stuff. You don't need to know it to function well just as med-surg folks can do their jobs well without knowing what dysthymia is. Equate it to my first career; a homicide investigator doesn't need an intricate knowledge field sobriety testing and drug recognition techniques. They're both certified officers. Both are capable of either, yet they have different jobs requiring a different focus. Either could easily switch fields with a little orientation.

On another note, the OP mentioned an EMT. I think EMT training is a great addition to nursing. It does a couple of things including providing a different perspective to treatment and ingraining independence. An EMT class also provides a skill set that nursing school, at least the one I went to, didn't cover AT ALL. I was an EMT then an EMT-P before I was a RN although I haven't EMT'd, as a job, in many years (and don't want to).

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Med surg is not meant for everyone. Psych nursing comes with its own set of skills. You are still doing the basics of nursing : assessments, planning and implementation of treatments.. I on the other hand work in a very busy psychiatric ER where I sometimes start IV 3-5 times in a 12 hour shift. The psych floors in the other hand is different. If you are that worried, talk to your manager and ask to follow an IV nurse a day or two.

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