nmb81

Hi all. I'm new to psych and and so thrilled about it. I do have common sense when talking with my pt's but.... I'm having a hard time feeling comfortable assessing my pt.'s. Assessing for orientation, suicidal ideation, and the little questions like "how are you feeling today", "any concerns i can address for you today?", ect. i can pull off without sounding like i'm scripting. But for those that answer and don't talk much...i sometimes don't know how to probe for info. I feel a little lost. The therapaeutic communication we all learn in nursing school helps but there wasn't a whole lot of that talored to psych even in my psych rotation. Also with boundaries i'm feeling a little lost. I'm having a hard time feeling it out sometimes and knowing what's appropriate to say or not. I watch some nurses who are very professional and talk about setting boundaries, but then i see their pt. interaction and sometimes they say things and i wouldn't think coincided with "boundaries" so i'm totally confused. For example...how do you handle.... 1. being asked your age? 2. a covertly flirtatious pt. 3. listening and validating their concerns without agreeing with them (ex. the doctor doesn't care about me, i hate being here, etc) Sometimes i feel like i'm starting to develop a healthy rapport with some, and then they throw a question at me like, "do you live around here". And then i say "you don't need to know that" it comes off as harsh and all is ruined and they don't really share much with me after that. Is there a better way to answer that? IF not how to you recover from that? Do you guys know what i mean, i know alot is common sense but there is such a fine line sometimes. Any pointers, scripting, ANYTHING would be helpful!!!!!!!!!!!!!!!!! thanks!

Thanks so much for the helpful advice. And no that wasn't too much info...i actually also had the concern of how to set boundaries too. I know alot of it is common sense...but it's not always easy. Especially when you're trying to establish rapport...and the pt.s asks you something personal. For example...i'm young and don't look like i'm in my late 20's, more like 16. So my young pt.'s sometimes ask me how old i am, after a long vent about how know one cares about them etc and they thank me for listening. So a good thing is going and then they ask me that....can you guys give me senarios on possible things that pt.'s could say and some scripting that doesn't sound harsh. When asked my age i said, "well, you don't need to know that". But i felt like i could have handled it a little better, or maybe it was awkward because i'm not used to doing that. I dunno. I'm having a hard time feeling it out sometimes and knowing what's appropriate to say or not. I watch some nurses who are very professional and talk about setting boundaries, but then i see their pt. interaction and sometimes they say things and i wouldn't think coincided with "boundaries" so i'm totally confused.

I've been an RN for a year on a critical care unit and now have finally started psych nursing, something i KNEW i wanted to do before i even started nursing school. So i'm thrilled to be here now on an inpatient psych unit....i'm taking CPI training so we are learning how to block punches and such... now i keep thinking of all the possibilites for being punched, kicked, and having my hair pulled out of my head.....now all of the sudden i'm wondering if i think it's worth that risk! Because YOU NEVER know, and most of those times it happens to nurses and other staff they never saw it coming. Now i'm sorta upset and am wondering....despite my love for nursing and especially psych....do i really want to risk having my teeth knocked out or having my hair ripped out of my head? Not to sound totally ignorant, i know it's possible on a med floor too, but you guys know there is a higher risk in psych. Most of it inadvertant as the pt's are responding to some kind of internal sitmuli in most cases. I know not all psych pt's are liable to inflict harm. BUT now i'm worried about it. Maybe because i just need to vent the fear. Have any of you been psych nurses for years and never had their hair pulled out or their nose broken, etc? :uhoh21: I'm so frustrated now.

Hi! I've only been an RN for 10 months...i've got nearly a year's experience on a step down tele unit. I have an AA. in Psych and went for a BSN in nursing to become a psych nurse. I'm trying to decide on what move to make here as i'm leaving the step down unit for something more suited for me. I'm trying to choose between home health, SICU, and PSYCH..... i guess i'm just trying to find out what you guys think about it....i really want to try it but i'll miss the medical aspect of diseases of all body systems and things like that. Do you retain alot of those skillls on an acute psychiatric unit or do those fizzle out??? Thanks for any advice in advance!

Hi all! I can't sleep, i'm really conflicted on what path to take here. Okay to make a long story short.... I've been an RN for 10 months. I've had experience on a Progressive care unit for 12 months (started as a GN, then became licensed 2 months into it) Prior to that i was a CNA on a med-surg floor for over a year. Well, i'm ready to move on. I was considering home health as i've been offered this really awesome position with this really great home health agency with a nice solid orientation program. But i fear that i shouldn't take on that responsibility as i've only had about a year of experience and i don't want to set myself up for failure. BUT what i love about nursing is the pt. interaction and teaching. Also, i love to really concentrate and work the details of one thing at a time which you don't get to do in a hospital and that's why i'm constantly frustrated where i work now. So i guess my question ultimately is... 1)Do you guys think i should get some more experience under my belt before i venture out into people's homes all alone ( i know a supervisor is always a call away)?? 2) Not to say HH nurses don't do alot, so don't get me wrong when i say this....i'm afraid i'll lose some skills, but then again, i'll acquire alot more right. And if i do try HH and decide years later i want to tackle the hospital again...will i still be equiped to do so after working in HH, as far as the ease of transition goes. I just don't know what to do...the perks of it are that i'll get to provide that one on one care, i'll have DAYSHIFT hours which i would LOVE, i'd work with really great people, and i'd have a change to become WONC which i've always wanted to do as i LOVE wounds. So i think i know i want to do it....but i had ANOTHER home health agency turn me down because they said they didn't want to set me up for failure and to get another year of m/s experience (but on that interview i didn't build myself up because i knew if i went into HH i would want a VERY supportive atmosphere so i kind of wanted to see the response i would get being very honest with not having alot of experience). So now that the OTHER hh agency i interviewed with seemed to reply to my concern of lack of skills seemed eager to help me with what i wasn't comfortable with. I just can't get those words of the other agency out of my head "setting you up for failure". Also, i'm not too crazy about the driving part, especially in inner city. But that con might not outweigh the pro's. By the way...the other choices i'm trying to choose from are SICU (evening shift) and Psych (evening shift). What to do?????? Any suggestions???