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.
OP: After rereading this thread and reading some of your later posts more closely, I feel my initial comments were possibly a bit harsh. I do still think there is more for you to learn from this experience than you are recognizing BUT I also see that you are understandably very burned out on the staff nurse role. If there is no financial need for you to work for the few weeks until you graduate (and then for however long it will take you to study for and pass your boards), I would reconsider working only because you take a dim view of those who don't work. Taking a few weeks or months to relax, study, and prepare for your next steps is a very different thing from simply choosing not to work indefinitely, and paid work is by no means the only way to be productive or to define oneself. If you are uninterested in what you are doing and can afford the time off, there is no shame in taking it.
On the other hand, I feel like working on inpatient units with varying populations has given me a much better gut feeling for what a reasonable medication regimen, including appropriate crisis meds, looks like, and on the other side of things, what types of meds/dosages/etc. would raise concerns for a specific patient or population. (I mention crisis meds even though inpatient isn't your main interest because this is a situation where you could not compensate for lack of experience or knowledge with extensive research due to time constraints. I'm guessing similar situations might arise in an outpatient setting, but lack the experience with outpatient care to name one.) But that is just me, and not having gone through an NP program yet, I really cannot say how much of that knowledge I would have absorbed from clinicals or coursework by the end of such a program.
Whatever you decide, the very best of luck to you in your present and future career.
But that is just me, and not having gone through an NP program yet, I really cannot say how much of that knowledge I would have absorbed from clinicals or coursework by the end of such a program.
.
You might not have the NP school experience but imo you are correct. As someone who has been through, a well respected b&m university, for my psych-NP I can say without a doubt I did not gain the insight and knowledge to safely practice simply based on the courses and clinical rotations.
Maybe it is because I'm not the sharpest knife in the drawer but the knowledge I have that actually staved off emergencies such as the patient with schizophrenia who the ED thought was psychotic but was actually going into alcohol withdrawal or the psychotic patient who initially seemed to have the flu that actually had early signs of NMS did not come from classes or clinicals. I'm not sure I would have picked up on those before they became painfully obvious and could have ended in disaster for my patient. I could go on and on but those are the type of things I knew from instinct and experience thanks to working so many hours on an acute unit having seen a variety of presentations and medication reactions as a RN.
People who think OP work is easier are not being realistic imo. There are no safety nets, no one looking at your cases, often no labs-definitely no immediate labs, unclear information about substance abuse and medication compliance. Something as simple as reports of insomnia which I take with a grain of salt and ferret through for accuracy ie. "I haven't slept more than an hour a night in a month". Really? that is doubtful and my experience with inpatient is their reports of sleep are often incongruent with the sleep chart documentation so before I pull out handfuls of Ambien that will eventually become addicting and then they won't sleep there are other thing that need to be considered. These examples might seem trivial to those who believe they can just step in and be a competent prescriber without any background but I would disagree and assert that in all but a very few cases those without inpatient experience might be doing their patients a disservice.
OP - as a soon-to-be PMHNP who took a per diem psych RN position recently, I feel you. I know exactly how you feel. I am pretty bored and the work feels rote. It's definitely way more boring than the outpatient psych NP training I'm getting. And yes, juggling roles is a weird feeling. One reason is because the NP and RN roles are really, really different. The duties of a psych RN in an acute setting vs a psych NP in an outpatient setting are miles apart. It doesn't mean one experience can't inform the other, though. I feel you on the boredom, though!
I agree that training for the PMHNP role can make you look at your current position differently. For example, some of my colleagues at work with will look at a complicated psychotropic regimen and try and piece it together†or think that the psychiatrist must have been doing some complex planning when titrating all those meds… I tend to be more cynical and roll my eyes at long lists of psych meds and think someone was throwing darts and kept whatever stuckâ€, because 99% of the time, that's what the case is when a person is on a lot of psych meds. The field isn't scientific enough for the polypharmacy that goes on - we simply do not have research backing any of it up. Or the other day, for example, a surly psych tech began lecturing me on how lamictal isn't an antidepressant (It's a mood stabilizer!!!â€) when I referred to it as having antidepressant effects. I just keep my head down and take it in stride. This job will look good on my resume, the money is nice, and it will help me learn ways I want to practice and more importantly, ways I will NOT practice.
I'll just start off by saying that I've happily reserved myself to the fact that I am probably going to die a forensic psych nurse. I've done some detours (Pediatric Periop and will be staring an Acute Psych position in a month or so while I attend a local PMHNP program) but I always come back to forensics. It's very long term psych (I've worked with the same group of patients for the past two years) and the acuity goes through highs and lows (some weeks everything goes perfectly, others... well, naked room extractions with a schizoaffective patient smeared down in feces that has soaped the floor and has a weapon is quite intense).
When the acuity is high and I'm managing multiple violent behaviors, doing crisis intervention the entire shift, multiple admissions, initiating seclusion/restraint procedures and running around armed with IM thorazine - I struggle to get all my work done on time (and my unit has 2 - 3 RN's, an LPN, and sometimes up to 20 staff depending on constants). When I get those blessed low acuity weeks, I can pretty much finish up all my work in a couple of hours - leaving me with 6 hours of shift free.
Meeting with patient's one on one and seeing how they are doing in terms of meeting their treatment care plan goals (getting out of hospital, reintegrating into community, cutting down on violent behavior, and attending groups that will enhance their coping skills so they can transition out of maximum security ect.) can be really helpful. If your having problems working with patient's one on one - practice limit setting with the other patients. Validate the groups feelings but explain that you need to meet with the one patient right now to discuss treatment.
Organizing groups can also be really helpful. They can be therapeutic focused groups like coping skills, anger management, 12 step or even just fun groups like art, music or "where's waldo". It will give you a chance to assess the patient's coping skills in social situations, group dynamics and so on - find problem areas that they can work on to better help them in community transition.
Other stuff - medication teaching with the patients can be extremely helpful. Medical management education (since so many of my patient's have comorbidities like diabetes and hypertension) is usually necessary. If I have not competent to stand trial patient I'll do a legal skills class, law library outings and run legal flashcards to help them with their case.
Then there is the administrative stuff that can be touched on. Like reviewing medication records, checking that everything is correct, looking through historical chart data and seeing what the behavioral trends were in correlation with the medication regimen. I've caught some paradoxical side effects from benzo's by doing this. Or I'll look through patient charts and see what days/times/activities tend to be there "trouble times" and create behavioral support plans in order to keep them safe through these periods.
Also, look at your unit's overall goals. Is it to cut down on violent behavior? Increase community placement? Resource utilization? We use LEAN and I'll talk with my supervisor and manager about what they're trying to accomplish (cut down seclusion and restraint times - currently) and try and brainstorm ways to help them meet this goal. Right now we're trying to use music therapy and the iso principle to help patients return to baseline faster so that they can safely reenter them milieu.
Now every facility runs differently, and I know that in comparison to some, my job offers a lot of autonomy. However maybe some of these ideas can help you.
I love forensic psych. Love, love, love it and intend on starting grad school soon and hopefully working with the same population.
That being said...yes, it can be horribly boring at times. I can be finished with my paperwork by 1000 and spend the next 9 hours doing nothing but counting down the hours and passing out meds. My pts stay with us anywhere from 60 days to a year, so once they're stable, not much changes from day to say. I spend the hours hanging out with my pts and assistants.
But there are also the times when I spend the entire day dealing with aggressive patients, ETOs, and wishing there were more hours in the day. 99% of the time it's calm, but that 1%...busy busy.
That being said, I'm more the "busy, busy" type. I think I'd probably be more suited to the constant bustle of outpatient as a floor nurse. I'm just looking to the future at this point. Down time gives me time to get through school and then I can join the hustle and bustle of the APRNs.
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?
As PMHNP in the future, I want to combine medication management with neurofeetback and supplements with clinical research.
Many clients need treatment and medication, so may be "adherence" compliance will be better with complementary ways of treatments.
For sure, I am not going to psychotherapy school.Why should I pay for 4-3 years psychotherapy program? I will consider EEG training and NYU Holistic internship in the future.
Geesshhhhh! PsychGuy, APRN, NP I am sorry. I'm sorry that from what I've read you seem to be getting attacked when what you truly wanted was advice. I am new to psych nursing (not new to nursing) and I can tell you I AM BORED!! My situation is a bit different. I work night shift at a military hospital so after 10PM our patients are sound asleep and I spend my night reading and doing little odd jobs around the unit. For this reason I am seeking employment at a civilian psychiatric hospital as the military tends to weed out the mentally ill and therefore we don't see "real psych." We mostly get family members in need of acute stabilization, people expressing SI/HI and young people having their first break.
My advice? I say do what you feel is best for you. Maybe change the unit you work on? Maybe you look elsewhere for employment? Maybe you take some of the non-judgmental suggestions some people have made or try to get the most out of this experience? Whatever you do just be sure you are happy. Life is too short, your almost done with school and soon you'll be doing what you love. Best of luck to you!
You should stick with it. As a Psych NP I'd take you more serious knowing that you have worked and experienced the field rather than just being a book NP. Experience matters a lot. I have worked outpatient psych and adolescent long term psych and it can get a little boring.
I have to agree with a previous poster--you do come off a bit arrogant. The thing is, the mundane, tedious stuff you hate so much is really the backbone of psychiatric care. Psych isn't Superman flying in to save the day--it's the boring, everyday things: are you able to care for yourself, keep up a household, pay the bills on time, hold a job? How are you coping with the daily stresses of life? Frankly, I'm surprised you don't like inpatient care, as the people are, kind of by definition, not coping well and in need of more intervention than outpatient therapy and medication management can provide.
At this point, it sounds to me like you are more in love with the role you want to play than the actual work. I know that probably sounds nasty, but I don't mean it that way. It's kind of like the difference between adolescent puppy-love and real love: real love is work--it requires communication, compromise, comfortable (and uncomfortable) silences, and the ordinariness of life. Puppy love is wonderful--it feels great to be swept up in that kind of passion. But of course it doesn't last. I think you just need some growing-up time--the boring details of charting and whatnot are the "work" of nursing; you have to put up with it in order to earn the stuff that makes you feel good and happy--the stuff you fell in love with.
DanaerysTargaryen
42 Posts
OP: After rereading this thread and reading some of your later posts more closely, I feel my initial comments were possibly a bit harsh. I do still think there is more for you to learn from this experience than you are recognizing BUT I also see that you are understandably very burned out on the staff nurse role. If there is no financial need for you to work for the few weeks until you graduate (and then for however long it will take you to study for and pass your boards), I would reconsider working only because you take a dim view of those who don't work. Taking a few weeks or months to relax, study, and prepare for your next steps is a very different thing from simply choosing not to work indefinitely, and paid work is by no means the only way to be productive or to define oneself. If you are uninterested in what you are doing and can afford the time off, there is no shame in taking it.
On the other hand, I feel like working on inpatient units with varying populations has given me a much better gut feeling for what a reasonable medication regimen, including appropriate crisis meds, looks like, and on the other side of things, what types of meds/dosages/etc. would raise concerns for a specific patient or population. (I mention crisis meds even though inpatient isn't your main interest because this is a situation where you could not compensate for lack of experience or knowledge with extensive research due to time constraints. I'm guessing similar situations might arise in an outpatient setting, but lack the experience with outpatient care to name one.) But that is just me, and not having gone through an NP program yet, I really cannot say how much of that knowledge I would have absorbed from clinicals or coursework by the end of such a program.
Whatever you decide, the very best of luck to you in your present and future career.