VaPsychRN

When you look at your barriers to grad school, what are you thinking would help? That would be helpful to know as we update our programs. Thanks.

If you wait a few days and check your state's Board of Nursing website, you can look up your nursing license. If it says "active" it means you passed! The Boards of Nursing get the results weeks before the test-takers do. I did this and it resulted in far less anxiety.

I agree in that "difficult" patients on a medical floor require a case conference and a "united front" (a term we use in psych) from all the staff involved in the patient's care. Sometimes the nurses do a great job and then the MD happens to get manipulated, and the plan falls through. Same thing could happen with any particular staff member who is not sticking to the plan. That being said, as a dedicated nurse, your role may very well be to coordinate the treatment team to get together and discuss the case. Of course, you can set limits within your shift for your own sanity, that patient's need, and your other patients. I sometimes tell my "needy" patients that I will come see them once an hour and during that time, they can make any reasonable request. Between that time, I will not be able to respond to their needs (you have to word this very carefully). Also, when you have "difficult" patients, make sure you are taking care of yourself and getting feedback from your nursing peers. A "complaint session" behind closed doors can help burn off steam. If the patient is really pushing your buttons, have another nurse take care of him/her so that you can keep your sanity. Remember, we cannot be effective nurses until we take care of ourselves first. I work in psych... most of our patients are "difficult"... but use compassion, boundaries, and empathy and you will be able to handle those more challenging clients.

At my hospital, almost all psych patients are triaged through the ER. Keep in mind that a psychiatric emergency is as important as a medical emergency -- without treatment, a psychiatric patient could be injured or die without intervention. I spent some time working an ER and realize that this is a difficult concept for trauma nurses to understand. However, just because a patient wants to be admitted does not necessarily mean they should be. Other patients don't walk in and say "I'd like to be admitted to telemetry" and then we give them a bed. A psych patient must pose a danger to themselves or others through suicidal/homicidal ideation, poor judgement, poor impulse control, etc. A psych clinician can make that judgement; however some hospitals (like my own), that judgement is made by a ER doctor. If they have any hesitation, they call our county's mental health services or one of our physicians or nurses for a second opinion.

What's holding you back from getting an advanced practice degree in psychiatric nursing? I am a research assistant at Catholic University of America School of Nursing. We are conducting research assessing the barriers to pursuing graduate education so that we can better tailor our programs to the needs of students. This includes online/distance learning, which is why it may be applicable outside the metro DC area. By clicking on the link and filling out the survey, we can acquire valuable data as to the needs of potential advanced practice psychiatric nurses. Thanks! http://surveys.cua.edu/soundings Click on the last survey listed "Psychiatric/Mental Health NP Survey"

The notion of doing a year of med-surg before psych is a fallacy to get more nurses to work in med-surg, where the crux of the shortage exists. In reality, your med-surg experiences from school will still put you years ahead of the nurses who have been doing psych for 20 years and have long since forgotten their med-surg skills. I went straight into psych as a new grad and have never regretted it. We take new grads into the ICU, ED, and L&D - they don't have to do a year of med-surg first! Go to the area of nursing where your heart lies.

Psych nursing is a great career choice! The most important thing is to remember empathy and respect. Read some works by Peplau and Grayce Sills on milieu management and interpersonal theory. Learn everything you can. Take the interpersonal skills you learned in the BICU and apply the same principles to psych clients. Like those patients, psych patients are in their most vulnerable times-- what an awesome responsibility it is that they allow us to help them!

My advice? Quit that job ASAP! It would be impossible to safely care for patients -- which is heart of psychiatric nursing (and any type of nursing, for that matter). There are better hospitals out there and better psych nursing positions. I work on a psych unit of a general hospital and they are decreasing our staffing (solely for money), and I am seriously considering quitting. Stick to the standards you learned in school and give yourself respect.

I work on an acute psych & detox unit-- of my daily patient load of 4-7 patients, at least half are detoxing from alcohol, opiates, or benzos. The biggest thing to keep in mind is that addicts/alcoholics have a legitimate illness that is beyond their personal control. That is what defines them as having an addiction. Perhaps a good place to start is the AA literature. In terms of physical symptoms, there a lot of great resources out there. The main things to keep in mind-- alcoholics can and do die from withdrawal if not medicated properly (they die from seizures or DT'S). People in benzo withdrawal are at extremely high risk for seizures. Opiate withdrawal is not life threatening; however these tend to be the clients that have very poor tolerance to discomfort (hence, their addiction), so they can be very challenging if you don't understand and respect the pathology. Opiate withdrawal can be equated to having a bad case of the flu. If you have prn meds from a doctor, give them liberally and if you don't have prn's, advocate for them! Also, they need fluids, vitamins (PO, IV, and/or balanced diet), falls precautions, seizure precautions, and a lot of EMPATHY from the nurse. Hope this helps!