Perhaps this Wasn't for Me

[PG2018]

Ok, so as the name implies I have an interest in psychiatry. Actually, I only became a nurse to become a psychiatric nurse practitioner, and in four weeks I'll finish a MSN program to do just that. Oddly enough, I've never worked in a psych unit in any capacity other than budding APRN. Of note, I've really taken to psychiatry to the point of devoting much of my leisure time to learning more about the field, e.g. history of psychiatry, applicable psychology (neuroscience, cognition, social psychology), neurobiology, psychopharmacology, etc. This has really become my "thing."

A couple of weeks ago I left my other position and took one on a psych unit under the auspices that I would remain there until I become fully credentialed in a few months. As a lateral transfer, personnel and everyone else involved was fine with it.

My intent was experiencing more of the inpatient side of things despite the fact that my career interests lie in outpatient psychiatry. However, I am seriously bored to death, and I am considering quitting and not working again (at all) until I start my already contracted APRN position. I realize that psych nursing is hard work, and over the years I've become intimately acquainted with the nuances of an inpatient setting.

I've already learned about and dealt with unit security, escalation/de-escalation, psychopathology, psychotropics, therapy, therapeutic dialogue, etc. The computer system is the same as my previous RN department since it's the same hospital, and there was really nothing to learn but what boxes are checked (and which aren't) when someone is admitted, discharged, or how this particular unit goes about accessing the Pyxis which is grossly different than what I'm used to.

I'm not saying I'm overqualified or even overtrained for the psych unit, as a RN, but I'm dissatisfied with my role expectations, I finish my required work early, and sit in the day room talking ad nauseum with patients or explaining how medications work to nurses that have been there for varying lengths of time such my reply to a "seasoned" RN lamenting "I don't understand why our unit's blood pressures are always so low." This isn't bad, but I'm watching the clock thinking "if I were at home I could be finishing x paper or reading y chapter."

Basically, I think I took the position with a different mindset, and I'm bored. I don't dislike it, but I don't like it either. I'm not dreading going to work tomorrow, but I'm completely numb to it. Previously, I was staffing urgent care, and I enjoyed that (not the emergent side though) because I would spend the day talking to the PAs and APRNs that staffed UC about their treatments, and in the psych unit the residents and attending don't seem approachable. I'm not timid of them, but they're just not available for that type of dialogue.

I suppose I'm looking for coping strategies other than "just suck it up." I'm not financially obligated to work, but I have a dim view of people that don't so I keep slugging away everyday.

[Jules A, MSN]

But you still think you are going to like OP work? I guess I don't totally understand it because I loved floor nursing on the locked acute unit for seeing the different patient presentations, medication reactions both good and bad, repeated de-escalation techniques and the occasional hands on with IM injections. I find it hard to believe that in a couple weeks you have mastered everything there is to learn in that environment. Maybe spend your down time reviewing each patient's medication regimen? I seriously can't imagine being comfortable trying to put together a complicated medication regimen for patients with only NP school as a guideline.

In any event I wonder how excited you are going to be sitting on your butt behind a desk while patients come in every 20-30 minutes largely working you for stimulants and benzos in the outpatient setting.

[PG2018]

Oh I love outpatient!

[Whispera, MSN, RN]

How do you see OP as being that different than when you're sitting with the patients on the IP unit? It seems to me you could be stretching those APRN skills-muscles with the patients on the IP unit, so they'll be well-flexed when you're not there anymore. It's a golden opportunity, in my opinion.

In OP you're not going to see the incredibly bizarre as much as you're likely to see it in IP. Take advantage of the opportunity. See how bad the illnesses can get and tuck it away in your memory for when you need it. See what can be done to help besides meds, since IP staff deal with this often, and can be experts at it.

It's up to you to find a way to make your experience worth the time to you...

[elkpark]

I find it hard to believe that in a couple weeks you have mastered everything there is to learn in that environment.

Ditto. I would add that, if you're "bored" practicing inpatient psychiatric nursing, you're not doing it right.

In "a couple weeks," you've already learned (all there is to know? all you need to know? all you're interested in?) about "unit security, escalation/de-escalation, psychopathology, psychotropics, therapy, therapeutic dialogue" -- really? I've been practicing in psychiatric nursing, as a staff nurse and as a psych CNS, for 30 years, and I and most of the other psych professionals I know feel that there is always more to learn and understand, and things we could be doing better. You're bored "sitting and talking ad nauseum with the patients"? What exactly are you doing in outpatient psych that you enjoy so much that isn't "sitting and talking ad nauseum with the patients"? What is that is so interesting for you about that in outpatient psych that is "boring" in inpatient settings?

[PG2018]

All good questions and concerns. I don't have all of the answers. I anticipated my initial comments as not being well received. I suppose the one patient at a time arrangement is one reason I like outpatient. This isn't my original career or education. I've learned that I have focused interests. Also, the general nursing duties of being around the same patients all day (completely opposite of outpatient and my previous urgent care experience) aren't for me. I suppose the fact is I don't like general nursing as a job and that manifests as monotony. I think I prefer sitting at a desk, as another mentioned, managing treatment. The charting for the unit is grossly redundant and really doesn't touch on the history or constellation of symptoms in the same manner a psychiatric evaluation, even with formulation, follows. Thank you for your replies.

[Whispera, MSN, RN]

There's no reason why you have to be with all the patients schmoozing with them all day, if there are other staff people available. You could set a goal of getting to the heart of one patient per shift by having a conversation with him or her, without the other patients being part of it. You would learn so much about people, disorders, and help patients get better by doing that. Besides, thats part of what you'll do in OP and you can never get enough practice in that. It's seldom the same, and can be very interesting. You'll hear fascinating things.

I agree with elkpark...if you are bored, you need to do something other than what you're doing to make it better...

[PG2018]

I agree that my psychotherapy training is limited and I could continue to practice it during my downtime. It is rather hard to break away with them either in the hallway or day room all day but doable I suppose and a good idea indeed. I know the stories can be interesting. My first exposure to this population and this type of environment came as a byproduct of my previous career. I think I'm really just disillusioned and suppose I was really just searching for another way to do PMHNP stuff sooner, yet instead the position is wrought with charting no one will ever read and other elements of nursing I never liked. I'm also tired of juggling roles. Thank you for your consideration.

[Whispera, MSN, RN]

I truly believe that you can find the time to do more than the recordkeeping if you decide it matters enough.

I'm not talking about psychotherapy because that is outside scope for a non-APRN. I'm talking about listening and therapeutic use of self.

What PMHNP stuff do you want to do? What do you see yourself doing as a PMHNP?

[Barnstormin' PMHNP]

Psychguy, I get where you are coming from. I work inpatient acute as a perdiem RN and I am currently doing clinicals for psych NP on the same inpatient unit. They are completely different roles and I have to say, I LOVE inpatient as an NP sudent, it really challenges me and I just find it fascinating and always fresh. I feel like outpatient would kill me with boredom. I am wondering if you are just done with being an RN and all the tedium that goes with it and it's not really the unit that is the problem rather it's your position. I can't help but think that with your interest in psych being so deep, you would have benefitted from a rotation on an inpatient unit during clinical. Sounds like you are ready to graduate and get on with it!

[PG2018]

Absolutely! My first PMHNP rotation was on an inpatient unit at a VA hospital. I really enjoyed the work. It was the first time I ever did an evaluation (true H&P) that will be part of permanent health records. Loved it. However, I decided today what the problems are with being employed as an inpatient RN. Like you say, I'm over it. I don't care anything for the arbitrary charting and other mundane general nursing duties. More specifically, I'm sick of hospitals! The fluorescent lights, corridors, nurse's "station," etc. I carried more patients today and led a really well received group I'm proud to say.

It wasn't bad today. It's not my vocation, but more days like today are more doable.

Psychguy I get where you are coming from. I work inpatient acute as a perdiem RN and I am currently doing clinicals for psych NP on the same inpatient unit. They are completely different roles and I have to say, I LOVE inpatient as an NP sudent, it really challenges me and I just find it fascinating and always fresh. I feel like outpatient would kill me with boredom. I am wondering if you are just done with being an RN and all the tedium that goes with it and it's not really the unit that is the problem rather it's your position. I can't help but think that with your interest in psych being so deep, you would have benefitted from a rotation on an inpatient unit during clinical. Sounds like you are ready to graduate and get on with it![/quote']

[DanaerysTargaryen]

I could finish my "required" charting in probably an hour or two of my shift. Make it 4-5 hours if you include a decent assessment of the patients I'm charting on and pulling and giving the meds. I sometimes have trouble dealing with my downtime because I work a lot of night shifts and it's not good manners to wake the patients up for a chat , but I get the sense that's not your situation. If you find psych patients interesting, or feel a genuine desire to help them, get out of the break room and onto the unit. Talk to your patients. Be approachable. If they are in a bad enough way to be on an inpatient psych unit, they need someone to talk to. No, you are not qualified to be their therapist but you are qualified to be a knowledgeable and compassionate human being who shows tangibly that you care about them.

As far as educating other nurses on "basic" aspects of meds, I agree a lack of knowledge in experienced RN's can be frustrating to encounter. But think about the difference you will make in patient care by educating these nurses and hopefully, making a difference in their practice. Most of psych nursing-- and any other nursing care I've been a part of-- and life for that matter-- is not thrillingly exciting most of the time. It doesn't mean that what you are doing is beneath you or doesn't make a difference.

I empathize with you to a point. I too love the scientific and technical aspects of nursing. I too would like to be a PMHNP eventually. So I'm answering your post with that empathy in mind. But I will also be honest that there are aspects of this post and the way you phrase your concerns that make you seem a little arrogant, like you think you are somehow "above" this job or your patients. I would encourage you to consider where this attitude is coming from, and whether it is coming across to your patients, your peers, and possibly the MD's who seem so unapproachable. You are doing the job for which you are currently qualified to practice-- you aren't qualified for the APRN role until you've finished your program and passed your boards, so the fact you're most of the way there is basically irrelevant at this point. Your current work is probably more relevant to your future role than work on another type of unit, even if you like the outpatient setting better. If nothing else, take it as an education in one major aspect of your field (inpatient care), even if it is not an aspect that you want to engage with for the long term.