nursing students and behavioral health units

vjhappy · Feb 20, 2009

As a nursing student doing my psych rotation this semester, it's great to see how enthusiatic you are about wanting to educate the students on your unit. That is interesting that we follow the nurse more in our other clinical rotations than in psych. The major concentration is put on therapeutic communication, but I would love to have a nurse like you at our clinical site. I'm really thinking about becoming a psych nurse after graduation. This is the 1st clinical I feel really comfortable in and I love my clinical instructor! Thanx for posting!

inthesky · Feb 20, 2009

I went into psych after graduation, but I guess that explains the one year experience next to my user name =P I'm hoping to get into a psychiatric nurse practitioner program this fall. I knew that this was what I wanted to do. The medical learning curve is high as psych patients have a lot of medical problems, but I have muddled through it by asking lots of questions and braving feeling embarrassed. My one issue right now is that I'm really unhappy at my job (political issues), but with the bad economy, there literally are no more psych RN jobs in the city that are not PRN. I still don't regret it. I'll work out my situation eventually. =P If you are thinking seriously about psych, I would ask to shadow a nurse. Students really don't get a good idea of what a psych nurse actually does. Although, what a psych nurse does varies greatly between facilities. I'm rambling now =)

Mr Ian · Feb 20, 2009

inthesky:

I'm really starting to feel for you in the position you seem to be facing. I'm going to offer unsolicited opinion and advice and it's for you to decide if you want to take any notice or if it makes any sense, or not.

Your attitude to your role seems admirable. You have motivation, desire and passion for your role. As I've said to you before in previous posts - don't lost that. Many nurses who evolve are ground down until they succumb to the politics of nursing and it's a shame because the problems perpetuate.

Your workplace sounds toxic. A day charge nurse who keeps apologising? Sounds as if they've either got the same issues of frustration as you - or they are one of those "high expressed emotion" people who doesn't handle themselves too well - or both. Night charge nurses in a permanent are often experienced but obnoxious - and are given that shift in order to keep them out of the way of day shift. Not all are like that - but many choose to do nights because of the 'politics' and it's the best way to avoid anyone in a suit.

Your limited experience is your biggest drawback. Nurse training will teach you all about engaging the patient, writing a care plan, planning a discharge, taking a BP, etc. Nowhere tho does it prepare you for the 'atmosphere' or the dynamic of a nursing or wider MD team. It doesn't prepare a nurse for dealing with inter-staff conflict and it doesn't teach a nurse how to evolve with the service.

Of course, that's because the supervisors and managers are meant to be able to negate all those needs. In reality, they rarely do and so it goes on.

- choose your battles; be aware of yourself; don't expect overnight changes and expect resistance at every level.

Regardless of how good or bad a workplace is - there is opportunity to learn from it.

Right now you're learning about poor management and how it disaffects everything around you.

My advice would be to continue your observations, realise your own reflections on them but don't get yourself frustrated about the lack of improvement in the situation.

Analyse the situations that arise and the processes employed (good and bad) and store them up.

Accumulate this knowledge and experience and in your next role you will be able to implement

Some of my best learning experiences have come from surviving the worst situations.

SweetLemon · Feb 25, 2009

Just my two cents worth....

Prior to my rotation on a psych unit I had no idea I even had an interest in psychiatric nursing and ended up choosing it upon graduation. The more good experiences as well as time really shadowing the RN on shifts the more nursing students will see how truly amazing psych nursing can be. On our units the ratios are so high you mostly find the nursing students huddled around a single table with once relatively stable patient playing scrabble for their shift. I don't blame them to be honest. Our units are not set up to accommodate more then one or two at a time but I do think that's an error on our part. Students should get to be in on treatment teams, meds passes, and any general nursing intervention that takes place... not feeling in the way and totally out of their element. :twocents:

beeenieweeenie, RN · Feb 25, 2009

It has been my experience that most nursing instructors hate psych and don't encourage students to go into psych nursing, and they really didn't put a lot of thought into our psych rotation at all.

As far as not students not interacting with the nursing staff, our instructors always told us never to bother the nurses.

vjhappy · Feb 26, 2009

My experience is quite the opposite. My clinical instructor is a psych CNS and she is very receptive to students going into the specialty, but she knows that most students don't want to do psych nursing. She was very excited about my interest & is recruiting me to go to grad school.

Inthesky, just wanted to let you know that I got into a summer program where I'll be precepting with a nurse in child psych! I'm soooo excited & I hope I really love it!

Good luck with getting into that NP program. If all goes well, I'll be headed in the same direction.

RochesterRN-BSN, BSN, RN · Feb 27, 2009

I agree that most are not hugely receptive to having students--in psych or anywhere I have seen! When I was doing inpatient I loved having students assigned to my patients and working with them--both in medical and in psych. I love teaching. Course my first career was health education so......Both in medicine and psych I always was given a nurse or two to work with and both places I was hearing the SN saying things like--oh we heard about you and hoped we would get assigned to work with you. So word spreads fast among the students of what nurses are nasty to work with and which ones actually like teaching and working with the SN's! lol -- Now I am in the psych ER and get a nursing student now and then for a short time but mostly work with medical students....and once again they tend to give them to me a lot as I am one of few who actually teaches them....its was kinda weird at first--having medical students being trained by the nurses and not the doctors so much...they don't really work with them until their residencies.

So my suggestion to students is try to get involved with the floor nurses. they may be very busy but interact when you can and ask to shadow if possible. I agree that secluding the students is certainly not a way to make them see that psych nursing is great and to make them feel interested in psych.....cause really, as I tell all the students...even if you don't CHOOSE to do psych you will get patients with psychiatric Dx, some who when well you would never know and some who at baseline are really pretty nuts still, in every other setting...these people get sick, have surgery, have babies, get old, you will see them and it is good to know how to best care for their needs and handle them.

And sometimes the things you learn in psych rotation in school you will find handy dealing with difficult families in what ever area you choose!!!!! LOL

inthesky · Feb 27, 2009

I remember that in my psych rotation, I was having this in depth interesting conversation with this guy. I found out --later-- that he was extremely psychotic and most of what we talked about was probably a delusion.

Mr Ian · Feb 28, 2009

I remember that in my psych rotation, I was having this in depth interesting conversation with this guy. I found out --later-- that he was extremely psychotic and most of what we talked about was probably a delusion.

"delusions" are simply another perspective on life.

Most often I find that psych patients get written up as deluded just for having a different perspective.

If you talk to God you are religious

If he talks back you are Schizophrenic

RochesterRN-BSN, BSN, RN · Feb 28, 2009

I can't say I agree with that-- delusions have to do with non-reality based thinking. Maybe you do work with docs who inappropriatly use this label but that is not what delusions really are.....and delusions are different from hallucinations. Both part a thought disorder but you can certainly have one or the other or both, but they are not interchangable. Just want to be sure we are on the same page here.

Mr Ian · Feb 28, 2009

I can't say I agree with that--

We're in the same book - I'm reading from a different chapter. :wink2:

If you can spend the time with the 'deluded' patient you can often establish a root-cause that is reality based.

"CIA putting implants in my head" - explains the voices.

"Man in my head stealing oxygen" - explains the groggy head feeling

etc

I recognise that thinking has gone into the irrational - but usually they are based on abnormal or difficult to explain events.

Hearing a voice in the head - then telling people God/Devil talks to you - If you heard someone talking to you an there was no one around - who else could it be? Who would you think it was?

People need to 'understand' their experiences. When there's no simple or ready explanation for them, making one up by deductive reasoning is the next best option.

Sherlock Holmes put it best:

"When you eliminate all other possible reasons - then whatever remains, however implausible, must be true"