Outpatient psych nursing

[ItsYourJourney]

Hello all,

I am graduating in May and I have an interview at an outpatient behavioral health clinic on Monday. My only psych experiences in nursing school were in inpatient settings.

My question is, what can one expect as an RN in an outpatient behavioral health clinic?

What are the differences in your role as an RN when you compare outpatient to inpatient?

Which setting do you prefer and why?

Thanks for all your help!

[oceanblue52]

Inpatient and outpatient are very different. Inpatient will involve doing admissions, mileau management, med passes, maybe running groups, occasionally administering e-meds, using CIWA protocol if you work detox, and delegating to your techs...safety is the number one concern.

In outpatient the patient's are typically (but not always) more stable. It is a lot more medication management, administering injections, fielding questions about side effects and concerns to the provider, lab monitoring, and processing medication refill requests.

Outpatient is the bomb dignity, but to be successful requires pretty decent knowledge of the different disorders and medication classes. I much prefer it because it allows better holistic treatment, and you get to work more closely with the providers. It's great experience if you want to go on to be a Psych NP due to all the medications you help manage. Hours are typically pretty good, Mon-Friday. Inpatient is more likely to have you start nights.

As much as I would recommend outpatient, I do think it would be challenging without any inpatient Psych experience, because you need a good foundation for what the full course of mental illness looks like, from crisis to stabilization. That type of assessment is really important for catching things early in outpatient. And unless you absolutely have your heart set on Psych nursing, it might be difficult to transition from outpatient to another specialty. Do you feel like you got good exposure in your clinical? Seems like schools are increasingly cutting Psych clinical hours to give students more acute care exposure.

Do you have an idea of what you are interested in? Have known quite a few colleagues who transitioned successfully from inpatient Psych to med-surf, hospice, etc. So inpatient is a better option if you want more flexibility in your career.

Finally, some tips for the interview: review your med classes, major side effects (Lithium and Lamictal both have pretty serious potential adverse effects)...for example anti-psychotics carry a risk for metabolic syndrome so providers typically order lab work like A1C, CMP, TSH...Clozapine requires very close monitoring of the immune system and neutrophils. Know which meds require therapeutic monitoring, like Depakote, Tegretol, Lithium, etc. Study symptoms of mood disorders, anxiety disorders, and schizophrenia, as those are the most common disorders managed in outpatient. Having good boundaries is important too, patients can get very irate when you can't fulfill their requests. I would argue too that outpatient requires more independence...you can consult with providers and case managers but you might not have as many nurse colleagues to consult with like you would on an inpatient floor. Feel free to PM me with any other questions. Good luck!!

[oceanblue52]

I just saw your other thread...if you have your heart set on mental health nursing, I say go for it! It really depends on where you live, but I feel like you could probably get a job inpatient Psych down the road, even if you start off in outpatient. At least where I have lived, Psych hospitals always had job openings and would gladly take someone with any type of Psych experience. So that is something else to consider (but this is very contingent on the region you live in).

[ItsYourJourney]

Thank you so much for your input! It was a great help. The outpatient role that you described is exactly what the interviewer described to me. There were some pharm questions but I was prepared for them. I think the interview went well and I am keeping my fingers crossed!

Thank you so much for your help!!

[kaitiemarie]

This is very similar to what I work in now. Outpatient for med mgmt but we are a home based program for kids age 7-17. I mainly do client education, a head to toe when they come in, and making sure meds are in order.

I absolutely love what I do. Co workers great, not stuck in an office all day. Flexible schedule. But I'm the ONLY nurse. So.. I have to figure things out as I go. I had no idea how to complete a prior authorization. My psych meds are shaky due to only having 1 psych class in school so I'm making charts for reference. I also didn't know I could do certain things. Nursing school did not provide ANY direction on office nursing. Everything was about what would happen in a hospital. So for the first 3 months I felt a little lost and the doctor and NP would give me strange looks when I asked certain questions. But it's getting better!

I did work in a inpatient psych hospital as a tech a few years previously. It was scary. Bad environment. Bad hours. Just my experience. The job I have now is a dream come true. I didn't realize that being scared before going to work was ABNORMAL before I got this job.

The only other problem is in-laws. "I don't know why you'd even bothered getting your RN if you weren't going to work in a hospital". They think that's all there is to nursing. Jerks.