offered position on psych floor...advice welcomed!

WantAccel.BSN, BSN, RN · Feb 19, 2014

I have been a med/surg nurse for 18 months and am in school to be a psychiatric nurse practitioner. I just got offered a job on the adult psych unit of a major medical center where I currently work! I initially interviewed for a geri pscy position at the same hospital just to get my foot in the door but it was a night position which was not ideal for me. Unexpectedly a position came open on the adult psych unit, and the supervisor who is over both units basically handed me the job. This is a coveted position. Hardly anyone ever leaves the psych floor and to get hired directly into a day position is virtually unheard of. So I am stoked and feel very lucky and blessed! The supervisor is a fantastic guy and also a minister and he had a wonderful reputation. I couldn't be happier. I am wondering if there is any advice you could offer for a newbie on the psych floor. Thanks![/quote']
I started my nursing career on an acute adult psych unit a little over a year ago. While I'm still relatively new at this myself, these are my suggestions:
(1) Learn your hospital's policies and procedures for restraints/seclusions/forced medications. Ask exactly what needs to be done in the event that a patient becomes violent. That's not something you just want to "learn as you go."
(2) Learn your state's laws/procedures regarding involuntary commitment. Your patients will have questions about their rights, and you will want to be able to accurately inform them
(3) Learn the basic rules of the unit (for example, no food after such and such a time, patients are not allowed to keep their jewelry on, etc.) Psych floors have A LOT of rules related to safety, and it is important that you adhere to them (you should know that many of these rules--at least at my hospital--are not actually compiled and written down anywhere. They are just the "knowns," and you'll have to ask a lot of questions when you first get started). It is also important that you are doing what the other staff members on the unit are doing, so as to prevent staff-splitting and inconsistency.
(4) When a patient gets anxious or agitated, the worst possible thing you can do is to become anxious and agitated right along with them. That may seem obvious, but it's harder to do in the thick of things. My preceptor told me that the louder they become, the softer/quieter you should become. I was somewhat surprised to discover that a calm, soothing approach can often be enough to deescalate a patient.
(5) Read up on commonly prescribed medications and side effects-- you need to be able to recognize the signs of EPS and other side effects when they occur.
(6) Respect and compassion go a long way. Many of these people are used to being treated like dirt by society, and it can mean a lot to them to be treated with dignity and kindness.
Those are the big things I can think of off the top of my head, but I'll post again if I think of something else. Good luck, and let us know how it goes!

NurseTot · Mar 3, 2014

Treat your patient's as you would want to be treated. Respect goes a long way, especially more so in a psychiatric setting. And be kind to your psych aide's (nurse aide, psych techs, etc.). They spend a lot of time with the patients and can tip you off on behaviors.