New To Psych

[kellerpatty]

Hi Everyone:

I'm moving to a job in an in-patient psychiatric facility (acute care) from a nursing career in a Burn ICU. What would be most important for me to learn or what qualities can I work on that would help me to be successful in this field? I went into nursing school with the intent of being a mental health nurse, but got into the BICU right after graduation and learned a ton about everything there. I loved the BICU, but I'm very excited to be starting in the psychiatric field. Any and all suggestions would be most welcome and appreciated! Thanks!!

[VaPsychRN]

Psych nursing is a great career choice! The most important thing is to remember empathy and respect. Read some works by Peplau and Grayce Sills on milieu management and interpersonal theory. Learn everything you can. Take the interpersonal skills you learned in the BICU and apply the same principles to psych clients. Like those patients, psych patients are in their most vulnerable times-- what an awesome responsibility it is that they allow us to help them!

[PsychMaven]

I have been working in psych. for the past 4 years or so in residential treatment homes and an acute care psych. unit and I think the best advice that I can give working in psych. is to try your hardest to practice unconditional positive regard and cultivate a completely non-judgmental stance; this is often easier said than done. Patients know when you are judging them and sometimes think you are even when you aren't so trust is key. As another person mentioned, empathy is extremely important...always remember that "there, but by the grace of god go I." I have delved into the fascinating and infamous world of personality disorders, often regarded to be the most difficult patients (especially borderline personality disorder which is my personal fav) and will tell you the two things that have allowed me to enjoy my work. 1. Don't take it personally & 2. the realization that someone must be in a seriously horrible place to be intensely emotional or hostile for seemingly no reason. The ability to remove yourself from things can really help. Be sure to work closely with a supervisor to develop strong boundary skills as it seems people really turn from psych. when they begin to feel over emotionally involved or manipulated.

Really think about what you're going to say when you're working on an intervention, as you go on you will have more experiences in more situations and be able to act "spontaneously" more easily. The tendency to "cheerlead" patients can become strong when you don't know what to say. Some things I've struggled with in the past are severe depression and suicidally...what do you say to someone who really just wants to die? Telling them everything they have to live for will just alienate you from them (aside from normal inclusion of compliments) so I've found it helpful to remind people that hopeless/helpless feelings are symptoms of their illness and that this feeling is not permanent. I work with people who self-injure often and a relatively easy way to bond with these patients is simply to acknowledge the effectiveness of self-injury. While it is a maladaptive coping mechanism, it is all they know and it is so hard to stop because it works. Dialectical Behavioral Therapy provides tons of actual skills to help deal with these and other emotional urges. Having the DBT knowledge under my belt really helps because I can give people concrete strategies for dealing with anxiety, etc.

You will make mistakes and people in psych. aren't always as warm and fuzzy it seems they would/should be, it's okay. I know we all already know this, but in such an emotional environment in the middle of the learning curve it is sometimes easy to get down on ourselves. In the same light co-workers can also be judgmental of patients and the tendency to become callus and like-minded over time is an issue. It is important to just be friendly to everyone, stay out of the gossip, and keep that unconditional positive regard as your top priority. Just the fact that you posted this question lets me know that you are in the right field so go for it, it sounds like you'll be great! Let me know if you have any other questions, I'm happy to help.

[kellerpatty]

Thanks to both of you for your helpful responses. I appreciate that you've taken the time to fill me in on some of your observations as nurses in the psych nursing field. I've started my position, and yes, it's very different from the burn ICU. However, there are a couple of similarities and those are just that people suffer and struggle with challenges whether it be more physical through trauma and injury or psychological through trauma or circumstance. Thanks again for your thoughts...I haven't gotten many responses to my post, but what I have received from you guys is invaluable.