sarmedic70

I left nursing for all the reasons (well most) of what this article shared. I was a RN for quite awhile (nearly 10 years) before I opted to go LOA. Right now I am working in my Criminal Justice degree; however, I don't have the satisfaction as I did as a RN (despite management, excessive demands, no lunches/breaks (and not getting paid for it - of which is illegal), covering another unit if a RN is on break or there is no RN, the list is endless. I do work as a RN in EMS but only part-time limited shifts. So, I have my somewhat involvement in nursing. I am not so sure I want to return back to nursing at this stage of the game. And I am always on the lookout for something else. I spent 39 yrs in the military (combined active duty and reserves - non medical - went to nursing school while a Reservist).I don't foresee things changing nor improving in the medical field for RNs and foresee it only getting worse unless things change drastically from nursing management, overall management to this patient-satisfaction nonsense driving by the "insurance" industry (of course, I want my patients to be satisfied, but it has gone overboard - as some of the others had shared). It is just nuts.

Totally agree on pretty much all of the points made as to why RNs quit. I lasted for a few years till I had it. I spent 39 years in the military (combined active duty and reserves), became a RN (while serving in the Reserves afforded me to go back to school and obtain my RN), and as a result have been appalled as to how RNs are treated by peers, nurse managers (from unit on up to the DON), and overall management. I never ever would have treated my fellow soldiers in such a way as what I have seen in nursing. There are many factors as to why the way things are still remain the same. We all have seen and experienced it. So you know what I am talking about. I loved my patients and I loved being a RN, but I will not tolerate "status quo" and poor management and caring of nurses who have a difficult job enough as it is from so many levels. This article presented hit the nail on the head as to the immense issues still faced RNs. I try to warn new nursing students as to what they will be faced with. Not to be a "Debbie Downer" or be negative.....but to prepare them for the REALITIES of nursing. This is something that is NOT taught in nursing school. I loved working with nursing students when they were doing their clinical rotation through my specialty area. I would ask them what their goals were, why they want to be RNs, etc. I spent as much quality time with them that I could. I wanted them to see the POSITIVE side of nursing BEFORE they entered into the field. However, the reality check is just what this article shared. Hopefully, one day, things will change. I have talked to several friends who have remained in nursing (due to being close to retirement) and have said things have not changed, but actually have become worse. Makes me very sad to say the least. I still think nursing is a VERY noble PROFESSION but until management changes (from the bottom up), we are going to continue with these continued issues and see many discussions and articles, such as this one.

I cannot say that I am surprised. I have had the same thing happen to me. Same sort of response of not being RN experience, yet they will hire newly graduated RNs with ZILCH emergency medical experience right out of nursing school. Go figure. I would always hold my tongue from saying things such as "Can you intubate? No! Didn't think so, 'cause I can!" (In ERs nurses do not intubate for the most part, and it usually a respiratory therapist or anethesiologist for the most part. That is for starters. I further want to say/ask: "What about critical thinking skills? WHO do you think gets the patient stabilized BEFORE being sent off to the ER, working under very nasty conditions, sights, sounds, smells, chaos, etc.? Ahem.......me! Do you think that takes critical thinking skills to decide load and go or stay and play - i.e., TRIAGE! especially if is a mass casualty situation." It is just not toward military medical veterans that this mentality prevails but also towards any EMS types. I was not a combat medic (even though I put in nearly 39 years military non-medical service in), but I was a medic and did the medic-RN bridge. I am so fed up with this sort of mentality to say the least and seeing "baby" nurses getting these positions. The only thing I can think of, in lieu of the "canned" response it is not nursing experience, is that there is that perceived threat of the medic having more experience, knowledge, and skill base than the RN(s). I feel that is a lousy reason, but that is probably the reality of it. I do wish you the best of luck and hopefully somebody will hire you and see the true value you have to offer to them overall. I am no longer pursuing going into an ER (even though I still work part-time paid position for a major county as a RN/medic) and remain with psychiatric nursing that I am doing now. My goals have somewhat changed overall in what I want to do in nursing IF I remain in nursing. Well wishes to you!

Thank you, YosemiteRN I am quite passionate, hello duh, about this topic of violence in the work place. You are so very correct as to how we ALL must be ever vigilant about those who are cavalier about the violence inflicted upon those of us who work the "front lines." I (and my staff) are so frustrated with how the "attitudes" are amongst most of our treatment team, demeaning our psych tech staff because they do not have masters' degrees (quite a few have their Bachelors in either Social Work/Sociology/Psychology and are awaiting to get into a Masters-producing course, one postponed furthering her education to raise her family and she has life experiences; however, none of that matters. I was sitting in a meeting a couple or so years ago reference how to reduce the numbers of our seclusions and restraints (this was when they were about 1/3 of what we have been having of late........hmmmmmmmmmmmmmmm)....and our PhD Neuropsychologist in particular made demaning comments about our staff and how they are just a bunch of high school-aged kids. Another RN, who was in a similar meeting later on, made the mistake of saying this to our staff of what was said from the treatment team and this neuropsychologist. That didn't help matters at all. Yet these same individuals who made these comments are the FIRST ones who spend very little to nearly no time on the unit. The neuropsychologist has been on the one maybe twice since I have been working there over the past several years; the therapists/social workers only come on unit for either a therapy group (less than 1 hr per week) or to grab a patient for individual therapy OFF of the unit or do points cash outs. The psychiatrist comes on the unit periodically but doesn't spend a lot of time on the unit at all and it goes from there. But yet, THEY are the first ones to say the staff don't know what they are talking about regarding the patients or criticize the staff. VERY little praise occurs. Staff are scared in some aspects of making the wrong decisions in intervening be it seclusion or restraint. I always tell them to always inform the RN on duty and let the RN bear the burden of making the decision (it's the least I can do to assist and support them and ease their fears as much as possible). Staff are NOT provided adequate enough training overall, especially for our type of unit. Yeah, SMT of our unit had provided SOME training, but it was NOT exactly what the staff truly needed (and not the type of training that I had proposed to be conducted and even provided the materials as a guidelines). But of course, I am JUST a RN. If you get my drift. At any rate, we are expected to "deal with" the violence on our unit and constantly get hit, kicked, bitten, scratched, peed/poo'd on, smears on us, punched, you name it......this happens EVERY DAY. Not to mention the vile and vulgar names thrown at us by the patients and swearing at us. But they are "excused" because..............and we are expected to "handle it" because................ We are limited as to what we can do on our unit, as determined by the treatment team/SMT even though federal law mandates otherwise and our staff know that. That makes our job that much more difficult as well..............Well, I need to get off of my soapbox. Nothing will ever change to say the least on many levels. Yes, on other units we hae had staff severely injured, but NOTHING changes......it is always asked "What did staff do/not do?" and rarely about what about what the patient did..........but because the patient has a mental illness.......that justifies it all, as it would appear by the attitudes of administration on down. Well, i can only hope and pray that some day somebody will "get it" and take on the mantra that was posted by missarahRN: "Mental illness is not a risk factor for being violent nor is working in a psych facility a risk factor for being a victim"........Cheers!

Great and interesting/informative posts from all. Elkpark, I wish I could same was true where I work reference the decrease in violence. We are quite the opposite. In fact, it is a constant topic as to how our numbers have increased in seclusions and restraints as a result of the violence on our unit. A lot of "theories" have gone around from: number of patients, number of back-to-back admissions, types of patients, etc. We have had this number of patients on the unit before so that can be essentially ruled out. The current staff we have of which the majority did not work on our unit when we had that many patients as we have now, and were hired on when there were half that number, so it was a "shock" to them. THAT could be a factor of the "new" staff not having worked with the number of patients we have now compared to when they first were hired. There could be the possibility of the numerous of back-to-back admissions have contributed to the increase of negative behaviors in that it could have contributed to disrupting the milieu of the other patients already adjusted to the unit. But I personally feel it is much more than that in that we have had back-to-back admissions, and yes, the milieu was disrupted, but for a SHORT while. This has been ENDLESS. So that leads to the possibility of the types of patients we are getting now vice before. But then again, we had violent patients back then, too. But even with that, those patients could be worked with and despite their violence, staff still enjoyed them. NOW, it is a different story. I personally think (as do some of our more seasoned core staff) that it is a mix of the type of patients we have been getting coupled with the current treatment program that was "redeveloped" since I was hired on the unit. All of us who worked on the unit under the other programming have all agreed that when the "new" programming was instituted we saw a dramatic increase of the negative behaviors and that was with giving the new program time. Heck, the patients even verbalized various things about the new program of how they could have certain behaviors and nothing could be done about it (compared to the "old" programming). The treatment team feels that programming was too "punitive"............the old program developed REAL WORLD life skills and in the real world they are NOT going to get all of these options and chances. What we all feel we are teaching our patients is "enabling" overall. At any rate, I could write a book on all of this. LOL At any rate, I personally feel the KEY in reducing violence on the units is the ENTIRE treatment team is actively involved, working side-by-side with our psych techs and us RNs. A few years ago, when JAHCO was at our facility, another team (not affiliated with JAHCO) also was visiting. I believe they were out of MA. At any rate, they told us that they essentially reduced their number of seclusions and restraints to ZERO. HOW? the ENTIRE treatment team was involved actively ON the units. The rationale was that the psych techs and the RNs are involved with the patients 24/365, so why not the treatment team (at least during the patients' waking hours. I have brought that up from time-to-time, every time something is mentioned about how our seclusion/restraint numbers have gone up (which is quite often.......we were averaging over 10/day and then some....it has dropped down somewhat, but the violence still remains even though not to the point where intervention is warranted). It falls on deaf ears. Heck, one of our social workers/therapists, when asked to be on the unit, always has some excuse or another. She is scared to death to be on our unit. A few years ago, when it was directed that they be on our unit by their supervisor, as a result of having so many of our core staff off duty due to injuries, she refused to be on the unit and when she was had one of our OTs with her. But yet SHE is the first to complain abuot what staff is doing wrong and criticizing. She is a HORRIBLE therapist (as you can see by the outcomes of so many of her patients overall). She is doing NOTHING for and with her one patient we have at the moment and this patient has been with us for nearly a year. But that is another story. So, what make sense totally it is not being done at our facility. WHY? More-than-likely, as with everything else, it comes down to $$$$$ ...............and the fact the therapists/treatment team would actually have to work a weekend or evening............Hmmmmmmmmmmmmm.............and not have their Mon-Fri schedule of coming in after 0900 hrs and leaving by 1600 hrs (seriously)......Add to all of that, we are also in a staffing shortage not only on our unit (just lost two more staff...........they "quit".....translation: they would have been administratively removed from the unit/hospital), and the entire hospital being short staffed (amazingly always on weekends and holidays and holiday/weekends............FMLAs abound, etc.)...........and no consequences as a result, even with the requirement of having to have a doctor's note, especially on holidays, holiday/weekends. I have worked weekends that we were so critically short-staffed throughout the entire hospital that the DON came in to work and mandated that the Administrative Dir/Unit Nursing Directors come in (all of the units) to work as psych techs that weekend (all shifts).........vice something being done about this, this has gone on for as long as I have been at the hospital. Our DON is way too laid back overall is the general opinion. When that happens, we see an increase in the violence on the units. We are lucky if we have TWO security officers on duty, most of the time it is ONE for the entire hospital. And the patients pick up on that, and act out as a result. I guess, unfortunately, before somebody wakes up and truly listens to all of us about our concerns (and how we also have a right to be safe and protected) it will take something extremely bad to happen. Vice being proactive all-too-often it is reactive in approaches. We have a very close-knit unit with our staff. Many are waiting to get into masters-producing schools for their social work, and truly have a love for what they are doing. The come in day in and day out and put up with getting punched, spit on, kicked, scratched, bitten, peed on, etc.........and feel like there is always a dark cloud luming over their heads out of fear they could lose their jobs if something goes amiss in that so many things are in the gray area or how it is "interpreted" by the treatment team when they are watching things on the video cameras (of which can be a blessing but have also been a curse) vice the team actually BEING on the unit to see how things are from start to finish with the patients. We sure are NOT doing this for the $$$$, that is for danged sure. At any rate, just because people are mentally ill does not justify them to be violent towards staff nor justification that staff have to "take it" because they are working with the mentally ill. They KNOW full out what they are doing in MOST cases. I know that from the debriefings I do with my patients after a seclusion/restraint. Just as the patients have full rights to be protected and safe, there MUST be measures in place to have the same rights for staff, too. And it should be mandated by law as it is for the patients. I am tired of seeing so many of the professional publications constantly talking about work-place violence but yet I have to see what is truly being done about it. When I (and some of my staff) have presented suggestions as to how to protect us (simple things such as enclosing the nurses' station not only to protect us but also our expensive equipment in the station (camera monitors, cables, comptuers, etc.), they won't do it at all and flat out told us it is not going to happen. Yet our equipment is constantly being broken and damaged. That is really saving money when we are in critical budget crisis and having to constantly cut back on spending all over. Hmmmmmmmmmmmm...........................Well, again, I hope it doesn't take something so serious to happen before something is done to protect staff as equally as the patients are protected. WE ALL have the equal rights to feel safe and be protected. Maybe one of these days......as I keep telling myself. This has been a very interesting discussion forum. Great info! :-)

Yes, most definitely document everything in addition to having your staff document......this is a hard situation to say the least in that you are at a disadvantage with regardless to skills set in dealing with a possible psychiatric dx. I am utterly apalled as to the alleged lack of response from those above you with regards to dealing with assaultive patients. If the training and skills set are not provided to the staff then it is shame on them and THEY should be hitting the door. It is hard to say what is truly going on with this patient as to why she is being this way. There are a number of possibilities and she should be seen by a psychiatrist to rule out any possible psychiatric disorders. In the meantime, the suggestions given to you of going to your RM, if you have one, or to your BON, is an immediate thing you can do.. Also, you have every right to have charges filed on this patient. We do it at our state psych facility if need be. In your case, the patient could be pinked slipped and removed from your facility. I have seen it done.in fact, before I became a psych RN, we had a LTC pt come through our ED to be transferred to another facility....a psych facility......I had to remain with this pt all night as his 1:1. So it can be done. Best of luck to you. Keep us posted as to the outcome, developments.

Great posts I have been reading.......As I stated in an earlier post, I work on one of THE most violent units in the hospital, and since that posting, it has become worse..........unbelievable. :uhoh3:The thing that comes to hurt us as staff is that because of the population of patients we have, THEY have more rights (because they are under age 18) and are more protected.......and they know it! My staff, currently, are very leery, worried, concerned,etc., in anything and all they do due to this. We are currently under the microscope AGAIN because the number of our seclusions and restraints have gone sky high........vice it being looked at as to WHAT is REALLY:eek: going on, it seems what is staff doing wrong (well, they are NOT perfect, but at the moment, they are totally doing the best they can overall) ...........I had a discussion the other day with our staff psychiatrist that I am totally convinced that it is the programming that is being used. We have been trying to say this ever since it was instituted; however, the "powers-to-be" totally disagree...............I am totally realistic that it does truly take time for a patient to come around and finally be in compliance, but under the programming we had when I first started, it was FAR more effective (even for the most impaired of the patients in their executive functioning) than what we are using now. Even the patients make comments about it. They know and know how to totally manipulate, especially with this current programming. :mad:The other thing that is so frustrating is that our staff are highly educated (most have their bachelor's degrees); however are treated less than............mostly by the therapists (a couple in particular), because staff do not have a master's degree et al. However, it is OUR staff who are working with the patients day in and day out 7-days a week and holidays/weekends, whereas the therapists see them for their once a week ONE hour group or sometimes for individual therapy depending upon the patient. They do NOT see the day in/day out actions of these patients and only see/know what the patient does when they have that short period of face-to-face. But yet, overall, our staff are not respected to actually be totally listened to. Every once in awihle, they get lucky. Heck, one therapist is totally "terrified" to come onto our unit. The only time this therapist comes onto the unit is for therapy group(s) and if it is at any other time, it is for a VERY short period of time. :uhoh3:Another thing is that our nurses'/tech station is totally exposed and we have complained a multitude of times to have it enclosed (like on the other units), but the powers-to-be won't allow us to have an enclosed place when we have made suggestions/recommendations as to how it could be done:mad:; however, when we tried to have a boundary set around the nurses'/tech station, we were told to remove it in that it was too "restrictive" or something like that.................so here we are supposed to be teaching patients about boundaries, respect and limit setting, safety, et al, but yet nothing for us to be protected. I have been sitting at the computer doing my charting and getting hit, attacked, et al, because patients climb up over the countertop or barge into the station. I feel that there is very little to nothing done for our safety except for what we are taught when dealing with the patients out in the milieu. Also, we get bullied by patient's family members (one, who got upset, because patient ended up in a physical hold with the intent to seclude, actually called the local police on me and they actually showed up at the unit). Long story on that one of which I won't go into here, but we deal with violence (verbally and physically) on all fronts like I have never seen before........even moreso than in the ED, et al.......... That all said, I would not leave psych nursing for anything (except maybe to go to a Trauma/Level 1 ER here)........... :redbeathe

Yes, it is true from what the predictions are, once the economy stabilizes, that "baby boomers" will plan to retire and there will be a return to the major nursing shortage; however, the real question comes into play as to WHEN? For now, it is not very helpful for the newly graduated RNs or those about to graduate soon. Travel Nursing companies rarely take (the reputable ones at least) new RNs without a minimum of ONE year experience in a specific specialty area. Some staffing agencies, similar to travel nursing companies, might, but it depends and where. THere are companies like CNS who do the annual immunizations (influenza et al) who will hire temporarily RNs for that period of time (generally Oct-Dec) and some have been hired on full time. I know this doesn't pay, but volunteering at various clinics that service the homeless, et al..........that is a fantastic way to also get your foot into the door and also meet your various state RN board requirements to maintain your RN license. In some ways, I agree with lsvalliant's post of about the international RNs. I have seen where they have been getting hired but yet an American citizen RN has not been hired. I have had patient's complain with having a non-American RN attend to them due to not being able to understand them. I have seen some that are not very competent but there are also some very dynamic and awesome ones out there as well. I do feel priority is taking care of our own first and foremost; however, I see this in other areas (especially the tourist industry, i.e., ski resorts where VISA employees get priority over citizens due to their VISA criteria............the defense is that an American can get a job anywhere/any place else but the VISA employee cannot.............you get the picture)...........At any rate..........it will be a matter of time and jobs will be opening back up. Nursing is a cyclic profession.............we went through something similar back in the 80's (if memory serves me correctly) and it was very difficult for a newly graduated RN to find a job and took multiple applications/interviews to get on somewhere...............then we went into the huge nursing shortage................now, due to the economy, we still have the shortage, but to due cut backs, et al..........jobs are very hard to come by. The shortages in are specialty areas of which several years of experience in that specialty is required. Even very experienced RNs are having a hard time finding jobs. At any rate, all in due time...........where there is a will there is a way. I have heard that NV is in dire need of RNs.........just a thought! Best of luck to all of you new RNs.................I wish you all well! :-)

JulesA writer is so right. Yeup, tell that to my staff too who have also had countless injuries due to our patients (again, I have one of the most violent units in our state psych facility). There are times, staff just didn't approach the patient in the right way. As with a caged/cornered animal, patients at times have the same reactions............and as a result, that is when staff get hurt. Vice just waiting it out for a bit, geting the rest of the patients out of the milieu, having enough staff (or campus police) to assist, etc. No matter, though, being is psych is very dangerous overall; however one of THE most rewarding specialty areas IMHO. And nursing HAS become a more dangerous profession to the point that the ANA, APNA and ENA have been addressing this more aggressively than ever on all levels............between later-to-lateral violence to violence inflicted upon nurses by either patients or relatives, etc. The reason it is not on the "Top 10" listing of the most dangerous professions is that there had not been that awareness made until relatively recently. At any rate, psych nursing is fantastic and I, too, cannot imagine doing anything else (except ER since I am also in EMS).

Best of luck to you. Everybody posted some really great advice and so very true. Depending upon your facility, as long as proper traning is given to you all and good policy and procedures in place, yes, psych is a very violent career area; however, since you already know that when you go in to it (or hopefully realize that there is that risk), be smart when around patients (expect the unexpected; never EVER let your guard down, know you WILL be manipulated (especially when starting out.........and especially if dealing with Borderlines, but not limited to Borderlines); never EVER have your back turned on any patient, don't get yourself into a situation of which you cannot get out of/escape (patient's rooms, etc), remember that when a patient has a violent outburst/physical aggression, it is nothing to do with YOU personally but something transpired that possibly brought up past memories/trauma, et al; remember that with most patients that it will be a fight or flight and generally it will be a fight (especially in dealing with pediatric/adolescent population of which are trauma survivors with PTSD and RAD (oops Reactive Attachment Disorder)..........the list is endless, so I think you get the point:lol2:) From my own personal observations, staff who get hurt generally got themselves into that position/corner for many reasons........it is rare that is NOT the case. As Dave posted, don't listen to the naysayers. You have come to the right forum to get some fantastic advice.......psych nursing is one of the most rewarding career fields you can be in on so many levels. Those patients (and their families) truly do need us:heartbeat, especially when there still is that general perception/misunderstanding out there about mental/psychiatric illnesses because it does affect behavior:confused:. I have had the opportunity, by being in the career specialty, to educate people on so many levels. I also work in EMS and my supervisor has oft said (he does ER, fire, and air ambulance too) he does not understand how I can "do it"...........yes, it is NOT for everybody...........you are not going to cure your patients..............however, there is a service that you can provide to your patients like no other:nurse:..........on so many different levels. I am on one of the absolute most violent units in our entire state hosp facility............we average of late 10-20 holds/seclusions...........I have a fantastic staff:yeah:.................of whom truly do not get paid nearly enough for that they endure day in and day out..............they do it because they truly do care about our patients.........I knew early on in my career as a RN that I was going to do either one of two things once I got my Med-Surg experience done (felt it was wise to go that route for and very thankful for doing so even though I HATE Med-Surg)........and that was either ER/EMS or Psych.............I am both (full-time is psych)...............by being in this career specialty area has also assisted me in non-nursing situations every day......more understanding of people as a whole, et al................:redbeathe At any rate, welcome to the "family"...................may it also be your passion! :redbeathe:clown:

I, too, have to agree with Elkpark. When I read that new grad's post, I shuttered. Having worked psych for quite awhile, in a major psych hospital, and on one of the most violent and active units of the hospital........and being an experienced RN (med-surg, et al) and also currently still working EMS (medic/RN), that reading from the newly grad RN.............I am still somewhat shuttering.........I would seriously question that facility as well..........not to say anything against the newly graduated RN...........but to put somebody into that position in the first place as a newbie.............regardless...........Our facility puts all of our NEOs through an extensive orientation, and then orient them additionally on the units once nearly through the classroom portion (be they RNs/LPNs or psych techs. At our facility, due to the fact the jobs are very scare for newly graduated RNs, we have TONS of newly graduated RNs.........one of the differences is that many were either psych techs or LPNs working our facility prior to becoming RNs to they had a "leg up" overall. However, in some cases, some new RNs were hired right off the street, and it's been scary.............it's one thing to have to deal with psychiatric issues, but one really does need to be relatively strong in med-surg skills in that patients with psychiatric illness, due to medications or just poor individual care, will have medical issues. And one needs to be alert and able to discern between what is an actual medical issue or patient is simply being somatic. I have seen serious issues to where a patient, with a history of being very somatic, did not get the proper assessment for a possible medical issue and had a VERY serious medical issue as a result. I personally would not advocate (and I am no doubt going to get some angry respones on this) going into psych straight out of nursing school unless have already had experience working in psych as a psych tech or LPN, et al. Just saying...............Best of luck to you, AngeloRN. I do wish you well.............

I belong to the American Psychiatric Nurses Association and we get the journal with it. It is more of a research-centered based sort of "technical" magazine. Unless you are into statistics, et al, it is a "heavy hitter".........I have not checked out the other one mentioned though.....JPN.............However, I think I will in that it sounds to be more down to "earth" with regards to day-to-day issues within psychiatric/mental health nursing. It's great to know of the various research that has been done in various areas of psychiatrist/mental health field, but my eyes start to cross when it comes to all of the stats and mumbo-jumbo.............

I have been in psych/mental health nursing for awhile now, having come from Med-Surg, ER, L&D (and still working EMS as medic/RN). I was working, till about a month ago, day shift. I am on one of the most violent and active units of our entire psych hospital. Currently we have over 20 patients. When I worked days, I was the ONLY RN on duty except one day/week then I was doubled up with another day shift RN assigned to our unit. Our make up is, (if I could digress for a second here), 3 day shift RNs and 2 night shift RNs assigned to our unit. We all work 12-hour shifts and have one shift that is our 8-hour to get in our 80-hour pay period. Our shift time is 0600-1830 hrs/1800-0630 hrs. Day Shift has rotating shifts with working every other weekend. Night shift has more set shift. Ok, that said. When I was working days, as mentioned above, I was essentially on by myself (the otehr two day shift nurses were doubled up most of the time.....of which a lot of the times, one of them would get pulled to another unit). We do our CofS at 0600 hrs (RN-to-RN), then at 0630 hrs Day Shift RN will do CofS with day shift Psych Techs. Once get them going for the day, then review emails, check staffing assignments, do med watch (if not doing own meds.....usually there is an LPN assigned to the unit....and on our unit, the LPN also serves as the unit clerk). Staff meeting is generally at 0900 hrs. Once a week, we have patient staffing and that is at 0930 hours where the entire treatment team and those affiliated with the patient meet to review specific patients staffed for that particular day (each patient is staffed monthly). On our unit, we have an enormous amount of seclusions and physical holds/restraints of which can get up to as high as 20/day. Day Shift RNs chart on DOS, 1:1's daily, do any PIRS for seclusions and restraints, RN data notes, as applicable. IF there is time, RNs do RN groups of various sorts. I had about three different groups I did........not as regularly as I would have liked to have been able to do, but with how our unit is, I was busy doing charting most of the time. It was RARE if I ever got a lunch break at all. Essentially never. No coverage essentially. At 1430, another CofS with afternoon shift psych techs.....get back to the unit a bit before 1500 hrs...........get patients ready for their various scheduled groups........and this time period is THE most hectic time period/most chaotic until 1530 hours. That transition period.................and most challenging especially when therapists do NOT show up on time and patients are anxiously awaiting..............that is one of the time periods we have seclusions/retraints increased..........On our unit, due to the design/set up of our type of unit, we do it ALL: housekeeping/cleaning (except once a week, housekeeping comes in and does the "deep" cleaning), laundry for patients, meals (hospital kitchen sends over meals, but we are responsible for cleaning up/washing everything to be sent back to the kitchen) .....we do it ALL. We also have several DOS/1:1's and a lot of time we barely have enough staff to adequately cover our unit. If we have a seclusion (and we have multiples), it really taxes our staff immensely. Another CofS at 1800 hours between the RNs (one going off and the other coming on). Throughout the day, we are constantly monitoring patients, caring for any who have medical conditions/illnesses, etc. This is just the tip of the iceberg for Day Shift. Night Shift is a bit less hectic and less stressful. The most stressful time period is from the time the NS RN comes on at 1800 hours till patients go to bed around 2000-2100 hrs. During that time, there are still on-going groups/activities for the patients, on-going cleaning, laundry, et al that didn't get done during the day shift. NS RN has charting on all of the 1:1s/DOS's as well, any data notes, as necessary, then (only on our unit) it is the NS RN who does all the RN weekly charting and treatment assessment notes (TANs- monthlys) in that Day Shift simply does not have the time. On other units, that are far less hectic than ours, they divide up the Weekly's and TANs amongst the RNs and shifts. We have enough to keep us busy throughout the night although we do have more down-time during the night shift compared to day shift overall and it is a bit less stressful overall. I have found that I am far MORE busier working psych than I ever was during Med Surg et al (and before switching to night shift, far MORE stressed out). It is a different type of work overall...........and everything is relative.............I would suggest having a strong Med-Surg background before coming to work in Psych though.....in that have to be on top of your game with being able to do thorough assessments on patients and being able to differentiate between somebody who is being somatic or one who truly is having a bona fide medical issue. I have know of cases of patients who have died as a result of not getting adequate and thorough assessments because of their reputation of being very somatic.........you know the old crying wolf "syndrome"..............There are so many of the psych meds that cause medical issues and some mimic other things..............I know there's been an age old argument about there's not that necessary "need" to have med-surg before coming to psych..........I had kinda thought that once, too..........but since then I have seen the light..........and see the results of such..............so..........just saying.............Psych is truly rewarding..........psych is NOT for everybody........it takes a special person to be able to do this type of job.........and have that compassion and understanding of our patients........even the Borderlines................At any rate, I gave you a somewhat idea/overview of what we do.............but there is a LOT more we do do on a daily basis.................Best of luck to you in your decision...............

I am on one of the most violent and active units in our psych hospital. People who get hurt are those who generally are not using approved verbal or physical SIT procedures. As the charge nurse, I have watched staff many times approach a patient who is being violent and how they approach them. Sometimes, when patients are going "off", they are in "animal mode".........and to be able to work with a violent patient is also similar as to how to approach an animal (understanding animal behavior). Sorry for the comparison there but those who have worked psych know exactly what I am talking about.......First and foremost (and somethign I also learned in Martial Arts and also taught my students when I was teaching Martial Arts).....avoid the situation as much as possible.....don't get yourself into a bad situation (i.e., ALWAYS be vigilant and expect the unexpected)........secondly, if the situation arises you cannot totally avoid it, that is when Verbal SIT comes in. Being able to know how to use the right THERAPEUTIC sentence starters and avoid the "fighting words".........remaining in control, but firm and matter of fact (but not making "threats" such as "if you don't calm down, you will end up in restraints/seclusion", "you are going to lose your home visit because I will knock down your level", etc. Remain out of power struggles/plays.......... Thirdly, IF it comes to the point of having to use Physical SIT, then if it becomes to the point YOUR life is in danger, etc., as our campus police have told us, you do whatever you can to protect YOUR life. In RARE instances, has that actually happened...........we have received oustanding physical and verbal SIT training at our facility. That is one of the major benefits we have, by working in major psychiatric facilities, is that we get that training, whereas in hospitals/EDs, they do not get that same training..............I also work EMS as a medic/RN. And I have worked Med Surg et al. Believe it or not, Forensic units are actually the safest of all the units as a whole, and the most violent units are the adolescent and pediatric units. I LOVE working psych and outside of wanting to work ER, I have no desire to work anything else.......been there, done that! I have been with psych for a few years...........it is one of the most stressful specialty areas, and most misunderstood on many levels, but it is also one of the most rewarding.

I work on one of the most violent and busy units of our entire psych hospital. I switched to night shift recently to get a break from day shift (of which we average 10-15 PIRS/day and it's become much more active since), and it has become way too stressful. However, it does extend over to night shift (since our shift starts at 1800 hours-0630 hrs). It is nothing unusual to walk onto the unit, and it is utter chaos. On night shift, on our unit only, the RNs do all of the RN weekly notes and the Treatment Assessment Notes (TANs) of which keeps one busy enough along with some other things. Granted it is not nearly as busy as Day Shift (of which will usually have two RNs on (unless one gets pulled to another unit), but we (night shift) are on by ourselves (currently have over 20 patients). When I worked days, the way my shift was set up, I was on alone MOST of the time. At any rate, if I am doing my job correctly (during night shift), I will have some down time around after 0300 hrs, IF I am lucky. Generally I do NOT get a break. On day shift, I NEVER EVER got a break. Nobody to relieve me, etc. The other NS RN who is counter to my shift doesn't do nearly as much as I do in the way of charting (i.e., it is required that per shift all DOS and 1:1's be charted on in addition to any of whom may be on home visits). I do all of that. Just a habit I got into. In my down time, since I am working on my Masters and my Psych/Mental Health RN certification, I do some studying. I will, just for a break, check out my personal emails, et al. Facebook is essentially blocked (although we all know the "back door" to be able to access Facebook except for the games of which are totally blocked).