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The psych ED can be an exciting place to work. You see absolutely everything in the DSM-V. Some patients are experiencing their first psychiatric emergency, such as suicidal ideation resulting from depression. You might be the very first mental health professional they've ever seen. At the opposite end of the utilization spectrum, you'll have patients who have been involved with mental health services for their entire lives. A fairly common example is a patient with schizophrenia or schizoaffective d/o who has lapsed in taking medication and presents with increasing signs/symptoms (I.e., acute decompensation). Sometimes they are brought in by law enforcement due to unsafe behaviors; other times, they are brought in voluntarily with family or an ACT team member. You'll see lots of people who need to restart medication for a variety of reasons, e.g., missing outpatient appointments, inability to pay, lost/stolen meds, bad side effects, etc. You'll also see patients who struggle with substance use disorders and seek access to specific medications, same as in the medical ED. Others will be seeking detox/rehab. Children and adolescents present with a multitude of behavioral disorders and are often referred by schools for urgent evaluation. They also present with many of the same complaints as adults. The acuity can be quite high, so you'll need to function well when adrenaline is running high. (This can come with exposure and practice.) You are often seeing people at their worst stages of illness and exhibiting dangerous behaviors as a result. Physical restraint and administration of medication against a patient's wishes are common. Another uncomfortable reality is the domino effect of high stimuli; one explosive episode can trigger reactions from others. Your job is to keep everyone as safe as possible, including yourself and your staff. Inpatient psych units come in many different flavors, and some see more healing than others. In the psych ED or observation, you may or may not see the benefits of treatment. There tends to be much less, if any, milieu or therapy. It is a place to be evaluated, emergently stabilized, and/or held for placement. It is important to keep this in mind, lest you begin feeling useless. It is also important that you keep your humanity and understanding of mental illness. Do not follow the lead of those who assume the role of warden or judge. Always remember what brought you there to begin with.

Congrats, and welcome to the specialty (in advance)! Working in child/adolescent psychiatry presents a host of unique challenges, but can be quite rewarding at times. We need strong nurses who are unafraid of advocating for these highly vulnerable patients.

All else being equal, I believe working in psych would enrich your educational experience immensely. The opposite also true.

I'm polling the audience here [you]. Quick scenario: Insulin (Humalog) vial is empty. We need more, though not urgently or imminently. Pharmacy is not answering the phone right now. RN takes empty vial and syringe to another unit, grabs their insulin vial (already in use), draws some up, and shoots it into the empty vial. RN returns to home unit and says, "Here we go... got some!" Seems pretty heinous. Your thoughts?

Wait... going to the bathroom while you're at work? That's stealing! You obviously don't have enough to do. Kidding. I work in acute child/adolescent psych, and some days are dominated by moments of, "What the hell did I just do?!" You are obviously competent and you care. Think of this as a message from a higher power advising you to pee more proactively, and be done with it.

We spend a good amount of time processing with our patients and helping to put their emotions into context. I try to partner with my patients by letting them vent about what's troubling them at home or school, finding those areas where they really feel unheard or unwanted, and trying to get their buy-in on focusing there. I continue to hone my approach and can be flip-floppy depending on how the interaction goes. Often times, my patient feels their behaviors are due solely to factors outside of their control, e.g., "My mom is crazy, not me! Get her a$$ in the hospital!" or "My foster dad doesn't know what I've been through and he's not even trying to learn - he just gives me rules that don't make sense." In those cases, I go with something like, "You know what? I hear you. Sometimes we end up here because of the challenges we have with other people. If there's nothing you feel like you need to change, maybe we need to focus on something that's gonna actually be useful for you, like "how to deal with difficult people." You'd be surprised how often this can spark an alliance (however fleeting), even with hardcore kids. I also tell them that they can probably be really helpful to the younger kids in the milieu during group discussions, because they've got a story to tell. I also let them know that they can always look for me or ask for me if they start feeling "some type of way" during my shift. Sorry if that all sounds really simple or hokey. I'm still working on it, but it's what I've got for now. Also, finding alternate activities can be helpful. For kids that just cannot bear sitting in the dayroom all day long, and really aren't about the life of crayon-coloring mandalas in the hallway either, I enlist their help. Sometimes their interests can surprise you. And we all like feeling useful. I try to find some work around the unit that can be safely done, and let them know I could really use their help with it. Even if it requires keeping an eye on them while you work, it beats de-escalating and chasing them in and out of the quiet room all day and night. I've had teenagers help me by folding unit sweatshirts (even if I then take the folded sweatshirts into the back, ball them up, and present them as a new batch to be worked on). I've had some inspect the unit, clean the baseboards with purple wipes (really!), sort print-outs and books, make lists of stuff like topics we could use for groups, get shower supplies prepared, etc. Don't get me wrong. Some -- maybe even most -- kids with ODD aren't gonna buy what you're selling, no matter what. They will present one long behavioral management task for the duration of their stay. But I make it a personal challenge to crack them somehow. If not, nothing lost in trying. Hope this helps somewhat. Best!

On my child/adolescent inpatient unit, we see good success with the use of Intuniv (guanfacine). It can be a great alternative to stimulants for a host of reasons, including the avoidance of weight loss. It also lacks the addictive qualities and street value of Adderall, Ritalin, and their cousins. The main concern is potential hypotension, but in otherwise healthy and hemodynamically stable kids, it's simply something to monitor. Most of my patients are also on SSRIs and/or antipsychotics, so it can be a safe option in polypharmacy. Just throwing it out there! (smile)

One of the things I enjoy most about psych nursing is the ability to structure my day however I'd like... to an extent. True, there are tasks that must be completed each shift. There are groups and meetings that you cannot reschedule. Charting can be time-consuming and keep you more acquainted with your sticky keyboard and broken chair than your patients. But the extent of patient interaction is really within your control. Can you be a psych nurse who works from inside the fishbowl and emerges only when nature calls, doing your "assessments" while en-route to the loo? Sure. But can you work towards maximizing your efficiency in computer tasks, log out, and go mix it up in the milieu? Heck yeah. When an A&O patient with intact memory comes up to me and says, "Who's my nurse?"... I know I've been spending too much time at my computer. Boring? I say it's largely what you make it. Best!

I agree with @maxthecat with regard to the narrowed scope of vision we often have when working acute inpatient psych. You're looking at a snapshot -- a single episode in a lifetime of many -- and it's often quite "unpretty." I too work inpatient psych, but my facility is designed (unintentionally) in such a way that I frequently encounter past patients waiting in the outpatient clinics. This often results in big smiles, fist-bumps, and even some boundary-breaking hugs. Seeing a patient who has reclaimed at least some of their resilience, however temporarily in the grand scheme, is actually one of the most fulfilling parts of my life. It can be very energizing. Yes, there is no shortage of struggles, headaches, and heartaches. I learned very early that if you don't amplify the significance of victories and accomplishments -- small they may seem -- the negatives can be stifling. While I do work with adults, my primary area of specialty is child and adolescent psychiatry. If you want countless opportunities to make a positive impact, this is the place to do it. Don't get me wrong, it is heart-wrenching work. And interacting with damaging parents/families, guardians ad litem, social service agencies, magistrates, etc. can be taxing. But when a patient is being discharged with some new coping skills, hopefully strengthened resilience, maybe some new medicine, etc., and you get the side-hug, handshake, or even just the "that was my awesome nurse!" comment on their way out the door, you feel like a million bucks. And even if the situation is not ideal, you know you were a positive force for some period of time. And that's a privilege. OK, so this post took a slight turn (smile). But my point is... try to find an area of passion, if you're not already there. It can make all the difference in helping to keep burnout at bay. One last thought. The burned-out RNs/MDs you mentioned... they can definitely influence the culture. But you can work against that. Being the smiling and at-times-slightly-annoying-but-always-likable RN on the unit makes people feel better at work, even if they snark. And research shows that the physical act of smiling, even falsely, actually improves mood. So fake it! (big smile) Best!

Absolutely! Many of my colleagues had 10-20+ years of experience in PICU and various pediatric specialties before transitioning to psych. I started in child/adolescent inpatient psych as a new grad RN, and it has been tremendously rewarding. I really can't picture doing anything else.

We all know plenty of reasons to avoid revealing our identity on forums such as this one. We also know the potential pitfalls of "social media" as it relates to our work, especially for those who prefer to be less than easily discoverable by patients/families, etc. Well... what about "professional" social media, e.g., LinkedIn, nursing association message boards, etc.? I am eager to expand my network and engage with others in my profession/specialty, yet I hesitate to make myself "searchable" by name or workplace. Of course this is antithetical to the entire concept of networking - but we simply cannot choose WHO will find us once we're out there. What are your thoughts/experiences with this? P.S. I realize this issue isn't limited to the realm of psych nursing, but that's the angle I'm coming from.