New Graduate RN Just got a new job in a county Psych hospital!!!

LaCana · Jul 16, 2012

I got my RN license last year and my first (and only job so far) was at a psych unit, similar to your position. I had different advices when I was a new grad, the most common one being, "if you start in psych you'll be in psych forever." I find it to be "truer and truer" now that I am approaching my first full year as a psych nurse. Overall I love it; talking with patients, IM injections, discharges with somewhat full recoveries... but the only thing is that, if I get laid off, or hospital shuts down, i could only apply for psych jobs, and if I had started with a med-surge for a year I would be a little more marketable. I had the choice to work for an oncology unit or a psych unit, something told me to go with psych cause I loved my clinicals during school...but when I think about it putting today's market into account, the medsurge/oncology experience would have made me way more marketable. But hey, any job is a blessing these days, so enjoy your journey in this crazy world of psych nursing. If it's an acute unit like mine, you'll be drawing IM injections all the time, remember, it's medication that they need, so don't feel bad... cause you wouldn't hold out on pain meds for a post op patient. Good luck!

Meriwhen, ASN, BSN, MSN, RN · Jul 16, 2012

Congratulations!

Keep in mind that in the real world, psych conditions aren't always as clear-cut as they are in your nursing textbooks, nor do they always wrap up as neatly. You're going to see a wide range of presentations. You're going to see a lot of long-term faces. You're going to see a lot of frequent flyers. You're going to see a lot of people make the same bad choices over and over, and some days you will feel like you are talking to a brick wall.

Start brushing up on your basic psych conditions, psych medications, adverse effects of meds and how to handle them, and your therapeutic communication skills.

Don't be afraid to ask questions. There is no such thing as a stupid question. Never assume you know something when you don't because the rules are different in psych than they are in other areas of nursing.

Be prepared to do a little homework in your spare time since real-world psych nursing is a heck of a lot more than what you saw in clinicals. Look up stuff that you see/hear about during the day. Again, ask questions.

Signing up for a psych journal (Journal of Psychosocial Nursing is a good one) is a good way to also continue your education as well as stay on top of those lovely 30 CEUs that the state of CA requires.

Respect the patients. Remember that they are people and should be treated with dignity, even when they're not acting rationally.

Remember that psych patients, even the 5150s, have rights...including the right to refuse treatment and/or medications. Also remember that patient safety and the safety of the milieu trumps everything, including said patient rights.

Never lie to a patient about medications because they know more about their conditions and their medications than you realize. You can be vague and even a bit sneaky about what you're giving ("this will calm you down like Valium") but never outright lie. Because if you do, you've pretty much shot any future trust--and subsequent therapeutic relationship--from that patient.

Respect your LVNs and techs. They can be valuable assets, or they can make your shift a living hell...not that they'll outright mistreat you, but they may not be willing to do more than the basics for you. And as a new grad you need all the help you can get. How you treat them can greatly influence that outcome.

And keep an open mind. You're entering a mentally demanding and often stigmatized specialty. It's not the "passing out of meds and babysitting" that some like to think it is. There's lot more to it than you realize.

Been there,done that, ASN, RN · Jul 16, 2012

Congratulations.

Study your job description and listen (hard) to your preceptors as to what to expect.

Psych facilities have different agendas for patients.. and treatment goals.

Too many facilities are profit based.

This will impact the care you can deliver.

Remember to treat your patient for ALL of their needs... not just focusing on the psychiatric component.

Many patients are institutionalized for a combination of psychoactive and physiological issues.

You will need to know all of their medications, not just the psychoactive prescribed drugs.

Know the diagnosis, the treatment modality.. and watch what the psychiatrist... that drops in for 30 seconds does.

MOST OF ALL.. listen and learn from your mental health workers.. they run the show.

lyttlemomma · Jul 16, 2012

THANK YOU THANK YOU THANK YOU!!!! I'm so happy that you all responded!!! I am taking notes as we speak! I agree that mabey I would be more marketable as a med surge nurse, but honestly... I took what was offerd to me first as the job market for new grads can be slim to nothing. This job is a certified temp job, so mabey three or so months in I will try and apply to the California prison system. My first day is next week, I ma so excited!!! Thanks everyone so so much )

Multicollinearity, BSN, RN · Jul 16, 2012

4). I eventually would like to transition into correctional nursing. Do you think Psych nursing will put me at a disadvantage?

Congratulations on your new job! I worked as a correctional nurse for 2 years. Unless you are hired into a niche role as a psychiatric correctional nurse, I believe you might have difficulty getting hired as a correctional nurse after working as a psychiatric nurse for an extended period of time. Some correctional facilities do have psychiatric nurses.

As a correctional nurse you are sole responder for medical emergencies within a correctional facility. You will find yourself responding to patients in cardiac arrest, stabbings, seizures, fractures, strokes, MIs, dislocations, etc. I cannot tell you how many times I responded to inmates in respiratory and cardiac arrest due to overdose, started CPR, delegated CPR to officers, got the defibrillator going, started an IV, and pushed narcan. You need to be proficient in performing and interpreting ECGs, etc. You screen all routine requests to see a physician or NP/PA as well, so if you are denying an inmate's request to see a physician you better have a good knowledge base of medical conditions and document well.

For example, you need to be able to look in an inmate's ear with an otoscope and know if you need to call the on-call physician for antibiotics or not. You need to listen to a patient's chest and tell the on-call physician if it sounds like pneumonia or "smokers lung." You need to be able to look at a skin lesion and tell the on-call physician if it "looks like MRSA" or cellulitis v. abcess.

You will do some psych as a correctional nurse like monitoring patients on suicide watch/mental health watch and screening for depression and SI, but it will not comprise the majority of your job unless you are hired as a psychiatric correctional nurse. Psychiatric nurses have a skill set that we correctional nurses know nothing about. And correctional nurses need a strong medical background.

marydc · Jul 16, 2012

Congratulations! You've already been given great advice. I would only add a few things: Always be prepared for the unexpected. Remember that at anytime, it could be you or someone you love, in the same situation as your patient.

Meriwhen, ASN, BSN, MSN, RN · Jul 16, 2012

To get medical experience for the corrections position, see if you can get a PT or PD job in med/surg. If that is too hard--and it may be since many hospitals have new grad programs and won't consider you unless you're in their program--try looking in sub-acute or LTAC as the starting point.

delerben · Jul 16, 2012

You don't have to be pigeon holed into Psych forever. Just get familiar with your job and then look for prn work on the floor or home health ... something will open up. Congrats.

Pedal · Jul 17, 2012

I am wondering, have any of you had to submit to back x-rays as part of the health screening procedure? I know this sounds strange, but I declined a recent job offer due to this invasive request.

Hi Everyone!
I just recieved my RN in May! I feel so lucky to have already had an interviwe and been asked to work at a county Psych hospital here in San Diego California. New graduate nurses here sometimes have a very difficult time finding jobs because San Diego is very impacted, so I feel very lucky )
I am very anxious to start and I REALLY love Mental Health nursing! I did really well on my Mental health clinicals in nursing school and I truely enjoyed this specific rotation. I was wondering if anyone could give this newbie some tips or advice. This is my frist job as a nurse and I would love to do my best and give it my all.
Here are some questions I have:
1). What should I expect?
2). Anything that you like for new RNs to be doing?
3). Any advice on what NOT to do?
4). I eventually would like to transition into correctional nursing. Do you think Psych nursing will put me at a disadvantage?
I appreciate any input, advice or suggestions! Thank you so much for taking the time to read my post. Have a great day!

smn2010, BSN, RN · Jul 17, 2012

Congratulations on the new job!! :yeah:

As a psych nurse for a first time job, I think you WILL be marketable as you gain more experience and make attempts to move into other fields of nursing. Keep in mind, PSYCH is EVERY WHERE!!! I often hear med-surg nurses say, "I'll never work with psych patients!" But guess what....med-surg nurse DO work with psych patients---EVERY DAY!!!. Many, more than you think, patients that come to an oncology, med-surg, OB unit have PSYCH issues!!!! While their chief complaint may be diabetes, GI issues, cancer, etc. many patients in today's world also have psych issues (PTSD, schizoaffective disorders, bipolar, etc.)

So your new job as a psych nurse actually puts you AHEAD OF MOST in regards to patient mentalities.... Consider it a "stepping stone" to all the nursing experiences that you will encounter.

Best of luck on the new job!!!

Advise on what NOT to do.... Don't be a best "friend" to the psych patients. Psych patients are smarter than you think. They listen to EVERYTHING you (and your coworkers) say and they watch EVERYTHING you (and your coworkers) do. And...they will use this against you without you even knowing...if you allow it. They even know who your workplace enemies are before you do! Also, don't talk about where you life, who you live with, where your children go to school... Keep your relationships professional. I say this because I have worked on forensic units of state psych facilities, and I'll tell you this, the murders may appear to be the quietest patients in the day room but they know everything that's going on in the building!!!.....

Once you get comfortable with your new psych position (about 1 year in), look for a part-time, PRN/per diem position at a facility that allows for "self scheduling" where you can select the days you want to work. This way, you can get some correctional, med-surg, oncology (or whatever your desire) under your belt on a part-time/per diem basis. Then, after awhile you (and only YOU) can determine if you want to continue in psych or try another field of nursing to add additional skills to your resume.

As for your new psych position (and any nursing job for that matter)....ALWAYS be aware of your surroundings. Be safe!!! :up:

lyttlemomma · Jul 17, 2012

Multicollinearity Thank you! Thats awesome advice! I agree with you on the fact that I may have trouble transitioning into correctional nursing coming from a psych position. My plan is to work for about three months or so in psych, just for the experience, and than begin applying for state prision jobs. We have a good amount of prisons here in California and I plan to go anywhere. One of my instrucors told me that the more rual prisons (like in cow town lol) takes new grads. Do you think this would be a good idea? I have a bsn, a bs in chemistry and a masters in public health (applying for PHN certification as we speak). I am 26 years old and I begin my MSN in the fall. Do I stand a chance? thnak you! I appreciate your advice! I need guidence.... bad :)