Oh, I connect just fine and definitely prefer it that way (though I have yet to get a paranoid psychotic patient to connect with me in the first few days -- which doesn't mean I don't try). I also work really hard to find the things that motivate that patient and share it with all the other staff. If there are severe personality disorders, then I am more businesslike so they don't misread the boundaries. They misread them anyway, but it's a little clearer for the other patients that I am not giving the personality disorder folks special privileges. One of my favorite lines when they are attempting to wheedle me into giving them pain meds too soon or some other typical outrageous request is, "No, I like my job and I like my license." Not a one has ever pushed it farther.
Livingdeadnurse, I have only been in locked hospital inpatient units. Some patients are brought in by police, a few are walk-ins, and the majority have been medically cleared at an ER after a suicide attempt. There's a lot of anger because "the ER said I would only be here 3 days" and the typical stay is 7-10 days. Sadly, there are a lot of frequent fliers as well, so I don't always have the advantage of being nice and knowing they will go away soon. I do a fair bit of wound care for self-inflicted damage and you would see the typical spread of chronic medical issues, like diabetes and asthma. Lots of substance abuse in my patients. Also, you would be putting patients in restraints and seclusion from time to time. Despite all the weirdness, I really enjoy it. No two days are alike and I get to see marked improvement from admit to discharge. There is a ton of teaching involved and you get to test the upper limits of your patience. Any chance you could stay PRN at your current job and dip your toe in the psych waters?