jewlsRN

Just looking for advice on being torn between loving what it means to be a psych nurse and having serious concerns about safety of entering the unit where I work. Have been there for 2 years now and even though there are short intervals where things seem to be running smoothly, most of the time we are operating in some pretty scary conditions. The acuity is high, beds are filled, short staffed, in a facility separate from the hospital by a few miles with no emergency back up or security other than calling 911. Psych is my passion and currently going to school for a psych NP program. My plan is to work in outpatient eventually, but really would like input for others on inpatient units as to how safety/staffing is managed. If this is how other inpatient units operate, then there really needs to be a complete overhaul of the mental health system. We are also being overtaken by the use of bath salts. Feeling like I am putting my license on the line every day, not to mention physical/emotional well being.

I would say to check out the public health position and if you really think that it is something you will enjoy, then go for it. Staying per diem in your current job is a good idea to stay current and "in" if it doesn't work out. However, if you are looking at public health nursing for the working hours don't be fooled. I did 6 months home care and really loved it before having to leave for health reasons. Luckily I had stayed per diem at my previous job in psych acute and had that to fall back to (also realized with this experience that mental health is exactly where I want to be so it was all good). The thing with home care is that there is A LOT of documentation. Now, I know that doesn't sound bad and it isn't, but it is very different than at the hospital with what medicare and other insurances require that it is VERY time consuming. I was surprised to find that more of my time was spent linked to my computer documenting late into the night and early every morning before work (since the laptop comes home with you, the work is always there....not necessarily a time clock to punch in and out which can add up to way more than 1-2 hrs of overtime) than actually with the pts. If not on the computer, then on the phone trying to verify orders and update the MD, etc. usually playing phone tag. Also, if case managing then fielding calls and follow up for entire case load. The perks are that it is flexible, but that also means flexible sometimes on the end of when the pts can be seen and this can make the timing of the start and end of your day be different all the time. Some places require on call time in the evenings and on the weekend so be sure to ask about that as well as compensation for extra hours. Make sure that the orientation is one that will allow you time to adjust and definitely ask about turnover rates. As with any specialty, it seems like home care is right for some and not for others. Also, you will still have your hand in quite a few skill areas such as PICC lines, wound care (wound vacs), IV, blood draws, etc. as well as lots and lots of education on diagnoses (which is a good part) Good luck!

I am currently in a MSN program for Family Psychiatric Mental Health NP. With this program, I was able to use my BA and take a few bachelor level courses to bridge at the same time as the masters courses. Just finished my first year and have probably 2 more to go (taking those bridge classes added some time)....also thinking about maybe going a little longer to do the FNP requirements to have other options open when job searching. Start focusing on the mental health related courses more in the fall and clinical in the spring - very excited!

Remember feeling the same way when I started in psych right out of school a year ago. All the advice here is great! I would add that sometimes the best therapeutic communication is nonverbal. Sometimes just sitting with someone quietly is what they need the most. Even when someone is yelling, ranting and raving....being calm in return can do wonders to de-escalate the situation. Everything is situation-based and each interaction is unique. Sometimes redirection is necessary, while others times being outright and boldly direct is needed. Follow your instinct and yes, expect that it won't always go 'textbook' style....but, along with a heart for psych stay strong and persevere....this population needs more people who care. :-)

I just graduated last year and went straight to psych, which was my dream/goal throughout the nursing program. When I tried to orientate to charge right away, I found myself completely overwhelmed. Of course, I did not have any nursing experience at all behind me....but, I found that working on the floor and learning how the unit works and how to communicate effectively as possible with patients, family, staff was more beneficial than jumping right into a charge position. Just from my experience of going straight from nursing school (more medically orientated) to psych, I would say that it would be better to work on the floor first, before becoming charge. This helped in gaining respect as a team player from all staff so that when I now work as charge, the overall environment is less tense than when others who never worked the floor are charge. Psych is so different from med-surg....and although the medical experience will be helpful, it is necessary to learn how to deal with some severe behavior and potential safety issues before running the show yourself. A few months after I started, a nurse with 30 yrs of med-surg experience was hired. She has become my mentor in many medical related situations....but, even she says over and over what a different experience this is and has been like learning a whole new field (and even she stays away from being charge as much as possible since it can be very stressful and overwhelming at times). All the best in whatever you decide to do! Psych is an awesome and rewarding specialty - just takes some time to adjust is all :-)