K8TLittleone

Thank you both for your replies! At our facility, if someone presents with some kind of obvious issue at admission we send them to the local hospital. And no, I wouldn't want acute medical issues on a psych unit either. We are told to do focus assessments as the need arises, but the RNs don't do EKGs or even blood draws- that's all done by med clinic. And honestly, what passes for a nurse's assessment is downright criminal. The RNs here seem more like overpaid secretaries and babysitters. And maybe I was spoiled at the hospital, but my attendings and residents actually listened to me when I had concerns about a patient. I tried talking to one patient's social worker today after we had a code with this particular patient. While I was sitting on observation with the patient for an hour after th code, the patient said some things and fixated on a few issues that I thought may be pertinent. While talking to the social worker, she looked at me like I had 6 heads, and basically ignored me. Funny thing is that later on in the day, the veracity and importance of the patient's statements were confirmed, but only after another incident and she told the same thing to the psychiatrist. I'm sorry to vent like this, and I'm just hoping that things are going to get better. I really do like working with this patient population, but I also want to be treated as a professional with a unique skill set. Any advice for me?

Hello! I am a May '08 grad and after working on a neuroscience floor of a big teaching hospital decided a few weeks ago to get a job at the local state mental health hospital. I will tell you that I am VERY glad that I did my time doing hospital nursing because it gave me the opportunity to refine my clinical skills, really learn to interact with attendings, fellows, and residents alike, and learn how to organize and prioritize my patients and time. Now that I am in the middle of my orientation at my new job, I am actually complaining because I don't feel like the RNs at my facility are doing enough RN work, but are more like unit managers. I'm not sure where you are looking for a job, but civil service benefits are hard to beat, so that is one thing to keep in mind. Also, yes there is the possibility that a patient can come after you and you could be hurt. You also have to remember that a patient's verbal assaults on you cannot be taken personally. To boot, you will probably be dealing with forensic patients if you work in an inpatient setting, and you have to be okay with that (some of the crimes that you learn that the patients committed sometimes makes it hard to give compassionate care. . .) I hate to say it but we are all human and it's natural to have an emotional reaction to dealing with a child rapist- you just have to learn how to cope with that, put it aside, and continue to give good nursing care. Honestly, I am using this as a stepping stone to getting my psych nurse practitioner. I am also considering getting a per-diem gig at a hospital just to keep up with my clinical skills. Concerning any sort of outside perception of psych nursing- most scoff at it because they don't understand it. To imagine that someone could be called "lazy" when instead of 4-6 patients I am now responsibile for 30 on my unit. . . well. . . that's just silly. Yes, you do have to have a certain mindset to deal with this patient population because you can't just tell these patients to follow a certain medical regimine and expect that they comprehend what you are telling them. They wouldn't be hospitalized if they were able to take care of themselves. You will find that a patient just getting out of bed and taking a shower without being told can be a major achievement for that patient. Yes, it is stressful to be dealing with a medical emergency in a hospital, but it is also stressful to be dealing with a whole unit of patients when two or three have psych emergencies at the same time. Good luck with whatever decision you make. That's the wonderful thing about nursing- lots and lots of options!!

Hello everyone! I am a relatively new nurse (graduated May '08) who until a few weeks ago was working in the Neuroscience unit of a large teaching hospital. I got great clinical experience on my high-acuity and fast paced unit. Prior to my nursing career, I was a corrections officer for 7 1/2 years. I made the switch for a few reasons: 1) my back wasn't handling the lifting and turning of large adult patients very well (I was injured while employed as a C/O), and 2) I wanted my awesome state benefits back (NY's retirement and medical are pretty damn good- I didn't realize how good until I got a job in the private sector). I now am in the middle of orientation in a state-run mental health hospital. I am finding it very frustrating that many of the things that I routinely did as a hospital nurse is now "off limits" as a psych nurse- we don't even do a head-to-toe physical nursing assessment upon admission!! I'm told that those duties are the provence of the med clinic, and not my job. I see so many holes in the medical care of the patients, and feel strapped. A few of the nurses share my view that RNs should be able to do everything it is that we are trained and LICENCED to do, while some take the route that they don't want to have to bother with it. I thought as nurses we were supposed to take care of the WHOLE person, not just one facet! If someone has medical issues in addition to psych issues, they why aren't we addressing both on the unit instead of merely writing out a med clinic referral and passing it along to the med doctor? Is it the same in other inpatient psych hospitals, or is NY just way behind the times? Does anyone have any advice for a transitioning nurse like myself? BTW- I am SO glad that I did hospital nursing right out of school instead of psych! I think it was really important that I refined my clinical skills and learned to deal with major medical emergencies before working in this kind of setting. I like working with this patient population, but again, I just feel that my practice is so limited!!!

I am a new grad (May 2008) and kind of fell in to neuro at a large Level 1 trauma center/teaching hospital two months ago. It wasn't my first choice, but I think the Lord works in mysterious ways because it's a perfect fit for me! It is very challenging, and forces you to hone your assessment skills right quick because in neuro, assessment is everything! Then, depending on what part of the brain is involved, other systems become involved that you are now taking care of in addition to the brain injury. In my short time there, I have learned ALOT about a myriad of conditions! It is sad sometimes, because your patient may never fully recover (or recover at all), but so is the case with many areas of nursing. What is really rewarding is when someone you have been taking care of for awhile that is non-verbal says "Goodmorning!" to you for the first time. It's when the coma patient suddenly opens his eyes for the first time in months while you are doing your daily assessment. Its so many of the "little victories" that make such a huge difference in a patient's life. Think about what the difference would be for you between being fed or being able to feed yourself? Sometimes it's frustrating. Sometimes it's emotionally wrenching. Often times it's incredibly rewarding! I guess all I can say is give it a try, and be open to learning. If you don't like it, you can always transfer to another area. Just want to add this: it's interesting to note that our neuroscience unit has the highest nurse retention rate in the entire hospital!

Hello! I too am a new-grad (May 2008)- just passed my boards! Yeay! I started on a neuroscience unit at a major teaching hospital two months ago, and have an amazing preceptor. One of the best pieces of advice that he gave me is to try to use your time you spend with your patient to the max! While you are doing your physical assessment, talk to the patient to determine LOC, level of orientation, etc. . . while you're listening to lungs/heart have them wiggle their toes and fingers. You get the picture. Also, I tend to find that helping the PCAs with AM care is a great time to not only perform some of your neuro assessments, but also to check over their skin. Believe me, your PCA will appreciate you helping them out and it's much easier to position patients with help. Remember to be careful of your back! Never be afraid to ask for help with T&P or moving a patient OOB to a chair or whatever. You will not only be looking out for yourself but also the patient- less likelihood of a fall. Besides this, pay attention to the way senior nurses manage their time. Everyone has their own routine, but I've gotten better with mine by stealing their ideas! LOL I've found neuro to be challenging but very rewarding! When a person's brain is involved, you never know exactly how things are going to manifest- and things can change dramatically very quickly!! Just be sure that no matter how you perform your neuro check, make sure it's thorough!! A slight change could signify something major! I had a patient in my second week who's pupils were equal and reactive at the beginning of the shift. Four hours later, one was slightly larger than the other. Called the MD, got a CT scan and low and behold the patient had an emergent hemorrhage! Best of luck with everything! Hope this helps a bit!