I am a nursing student in a BSN program, I am graduating in May and decided I wanted pursue a career in psychiatric nursing. I just accepted a position as a psychiatric support technician in a 38 bed behavioral health unit. I just recently finished my third day on the unit but I am already feeling so insecure. My last shift, I had a male patient that kept coming on to me and trying to flirt with me and was making sexual remarks. I tried my best to politely tell him that it is inappropriate but obviously it wasn't good enough and he tried to touch me so security came and he started becoming very violent towards the security guard, eventually the nurses administered a cocktail of haldol, benadryl, and ativan.
I felt really bad because I feel like I could have handled the situation a lot better. Sometimes I feel as I am too nice to work in psych, I try to be as kind as I can to the patients but I don't want to be taken advantage of. Later on that day, I had two other female patients flirt with me. One asked me to contact her when she gets discharged for a date and the other female wanted to give me her number to hang out with her because she was being discharged that day. I guess I just need help knowing how to set boundaries, but still being as nice as possible. I just want to do well in this position so eventually I can make a good psychiatric nurse. Any advice for a tech who wants to eventually be a psych nurse?
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Sounds to me like you've got "Newbie" written on your forehead and it might take awhile for it to fade off. Lose your need to be "nice"; you're not there to win a popularity contest. Pleasantly neutral is a good way to start. As a tech, you don't really have to worry about being "therapeutic". Just focus on the tasks assigned to you. When someone says something inappropriate, you can respond with a pleasant, flat-faced "That was inappropriate." Asking you to socialize when they're out? "No. That isn't allowed."
They're testing you to see if you're open to being manipulated. You don't need to worry about letting them down too gently; they've been around this block way more times that you at this point.
I have spoken to a few staff about the situation and they just tell me to ignore them, they are always like that. I would like to be a little more therapeutic if possible. I would like a more appropriate way to set boundaries.
Sometimes the most therapeutic thing you can do is to establish and maintain boundaries. If someone has the end-goal of making you uncomfortable for the sake of their own entertainment, a conversation about feelings is not going to establish that "this is not appropriate". Deeply therapeutic conversations can happen later, after you establish the boundary.
I, myself, used to have the same issue with being too easily manipulated. It's common in newbies. Many of us women are socialized to not make waves, we have to learn how to be appropriately assertive. Sometimes, in the process of learning how to be assertive, you might go overboard, either by assuming someone's intentions or coming across a little too salty. Be willing to be nice to YOURSELF, and see it as an honest mistake in the process of learning, not a sign that you're not cut out for working in psychiatric nursing.
I don't know about the culture of your unit, but when I'm giving report to someone about a patient that is manipulative, trying to staff split, etc I will make sure that the oncoming nurse is aware of the boundaries I've established so they can be maintained. Granted my unit is post surgical and oncology, but psych is everywhere and dysfunction doesn't stop at the hospital entrance.
It sounds like you're doing the right thing by getting the experience in psych prior to becoming a nurse. This will give you the foundation that will let you feel more confident when you are in the position of higher responsibility, where the buck (in many cases) will stop with you.
Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Sounds to me like you've got "Newbie" written on your forehead and it might take awhile for it to fade off. Lose your need to be "nice"; you're not there to win a popularity contest. Pleasantly neutral is a good way to start. As a tech, you don't really have to worry about being "therapeutic". Just focus on the tasks assigned to you. When someone says something inappropriate, you can respond with a pleasant, flat-faced "That was inappropriate." Asking you to socialize when they're out? "No. That isn't allowed."
They're testing you to see if you're open to being manipulated. You don't need to worry about letting them down too gently; they've been around this block way more times that you at this point.
Yeah, it's my fourth day on the unit so I definitely am considered a newbie. The thing is that I don't feel the "need" to be nice. It's who I am, I have always been a nice guy, it's who I am. I still try to communicate with the patients as often as I can and see how they're feeling outside of the tasks that are assigned to me.
I guess I understand where you are coming from with being neutral. I need to learn how to properly place boundaries without worrying about being mean. Something I hope that I will gain with experience in behavioral health.
Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Sometimes the most therapeutic thing you can do is to establish and maintain boundaries. If someone has the end-goal of making you uncomfortable for the sake of their own entertainment, a conversation about feelings is not going to establish that "this is not appropriate". Deeply therapeutic conversations can happen later, after you establish the boundary.
I, myself, used to have the same issue with being too easily manipulated. It's common in newbies. Many of us women are socialized to not make waves, we have to learn how to be appropriately assertive. Sometimes, in the process of learning how to be assertive, you might go overboard, either by assuming someone's intentions or coming across a little too salty. Be willing to be nice to YOURSELF, and see it as an honest mistake in the process of learning, not a sign that you're not cut out for working in psychiatric nursing.
I don't know about the culture of your unit, but when I'm giving report to someone about a patient that is manipulative, trying to staff split, etc I will make sure that the oncoming nurse is aware of the boundaries I've established so they can be maintained. Granted my unit is post surgical and oncology, but psych is everywhere and dysfunction doesn't stop at the hospital entrance.
It sounds like you're doing the right thing by getting the experience in psych prior to becoming a nurse. This will give you the foundation that will let you feel more confident when you are in the position of higher responsibility, where the buck (in many cases) will stop with you.
Best of luck to you.
That makes sense, boundaries first and then worry about being therapeutic. It's something I really would like to work on so I can be successful. There is not much I can do as a technician right now, unfortunately. Fortunately, I don't feel like I am being manipulated per say, I just don't know how to approach the patients sometimes and I just don't know how to put my foot down without worrying about setting them off. I just want to be as therapeutic and SAFE as possible.
That makes sense, boundaries first and then worry about being therapeutic. It's something I really would like to work on so I can be successful. There is not much I can do as a technician right now, unfortunately. Fortunately, I don't feel like I am being manipulated per say, I just don't know how to approach the patients sometimes and I just don't know how to put my foot down without worrying about setting them off. I just want to be as therapeutic and SAFE as possible.
It occurs to me from reading your responses that I did one of my own pet peeves, assuming someone on this forum is female (as indicated in my previous post). I apologize for that, Kingvonn.
As far as boundaries go.... while no one should have the goal of "setting off" any of the patients, you have to be aware that NOT setting them off is not the most important goal. That leads to you walking on eggshells, and there are patients that will absolutely sense this and use it against you. When people have learned negative ways of interacting, they tend to be good at sensing fear, discomfort and disproportionate power dynamics. Setting boundaries doesn't have to be mean/accusatory/nasty. It can (and should be) be calm and assertive ("It is inappropriate for us to maintain contact after you leave". It can be a calm "No" or "I expect you to show me the same respect that I am showing you. We can continue this conversation when you're ready to be calm and respectful". There's nothing wrong with being nice but being easily manipulated (yes, what you're describing in your initial post -- patients making sexual remarks and attempting to make physical contact with you -- was manipulation) will put you at risk mentally and physically, and at bare minimum is the opposite of therapeutic for the patient. If behaviors can be shut down before they escalate beyond words, then it can avoid pharmacological intervention.
Learning boundaries and deescalation techniques will come with time. I bet there are a lot of videos out there that give examples.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
That makes sense, boundaries first and then worry about being therapeutic. It's something I really would like to work on so I can be successful. There is not much I can do as a technician right now, unfortunately. Fortunately, I don't feel like I am being manipulated per say, I just don't know how to approach the patients sometimes and I just don't know how to put my foot down without worrying about setting them off. I just want to be as therapeutic and SAFE as possible.
There's a book called Games Criminals Play and How You Can Benefit from Knowing Them by Budd Allen. Not saying psych patients are criminals, but there is some overlap in behaviour. The book explains appropriate boundary setting and how to avoid being manipulated. Very worthwhile read for anyone working with challenging populations.
There's a book called Games Criminals Play and How You Can Benefit from Knowing Them by Budd Allen. Not saying psych patients are criminals, but there is some overlap in behaviour. The book explains appropriate boundary setting and how to avoid being manipulated. Very worthwhile read for anyone working with challenging populations.
It looks like its an older book and there are free PDF versions for download.
I was pretty young when I graduated nursing school and started working psych. I, like you, was very "nice" and kind of socially shy. Believe me when I say you'll learn pretty quickly to set appropriate limits. One thing I did that helped was watch techs and nurses that were good with setting limits and stopping inappropriate behavior. Pretty much everybody in psych has their own "go to" phrases when a client becomes rowdy. Some of mine are "I'm not disrespectful to you and I don't expect you to be disrespectful to me." "I can't understand what you're saying when you yell." "That's inappropriate." "When you calm down, we can continue this conversation." And one that's works surprisingly well, when a patient becomes flirtatious, an abrupt "Excuse Me?" can have them backing up and apologizing. You'll come up with your own words as you gain experience. Just don't give up. We need good psych nurses.
The thing that I really fear is that I am too nice sometimes. I have heard that from multiple people. When I see the nurses and the techs on this unit, they seem very stern and have no problem raising their voice to the patients. I just can't see myself doing that, I feel as if there are other ways to communicate with them and set boundaries. I just fear I may be too nice for psychiatric nursing, which I hope is not the case.
A "stern voice" with appropriate body language goes a long way when you are working with behavioral issues. I do this...Stand up strait. Say something like..."You know this is inappropriate. Just what do you think this is going to accomplish for you?". And then move on quickly. Don't stand there waiting for an answer. It will show them that they cannot get to you and you won't satisfy their attention seeking behavior. In some places, continuing inappropriate behavior will delay their discharge. Mention that too.
Also, Im not a yeller and don't believe that is necessary. Yelling can also look like they are getting to you. Don't bite the bait. Ignoring can also be effective depending on the patient or the degree of offensiveness.
Did you get an orientation? What kind if psych do you work in? I'm in forensic psych and nurses and techs get 12 weeks. Besides time on units, we are in classes learning to deal with issues like what you brought up...how to communicate "therapeutically", being assertive, boundaries and limits, and an intense 6 day physical interventions/self defense class.
Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
Did you get an orientation? What kind if psych do you work in? I'm in forensic psych and nurses and techs get 12 weeks. Besides time on units, we are in classes learning to deal with issues like what you brought up...how to communicate "therapeutically", being assertive, boundaries and limits, and an intense 6 day physical interventions/self defense class.
I'm in an adult behavioral health unit. Orientation was 3 weeks long. I haven't took a self defense class as of yet though.
Specializes in Adult Psychiatry, Correctional/Forensic Psychiatry.
I've been working as a psychiatric support tech for 2 weeks and .... already have had a chair thrown at me, kicked in the stomach, poured water on, and been punched in the face.. what is wrong with me?!
TriciaJ, RN
4,328 Posts
Sounds to me like you've got "Newbie" written on your forehead and it might take awhile for it to fade off. Lose your need to be "nice"; you're not there to win a popularity contest. Pleasantly neutral is a good way to start. As a tech, you don't really have to worry about being "therapeutic". Just focus on the tasks assigned to you. When someone says something inappropriate, you can respond with a pleasant, flat-faced "That was inappropriate." Asking you to socialize when they're out? "No. That isn't allowed."
They're testing you to see if you're open to being manipulated. You don't need to worry about letting them down too gently; they've been around this block way more times that you at this point.