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  1. PS1CK_RN

    A (Long) Note to New Grads

    So you graduated, eh? Now you're in the big leagues. Maybe you're getting ready to graduate and on the brink of your journey into and onto the field. The only thing in your way that separates you from those sweet, delicious fruits of your labor is the NCLEX. Go kick its ass. Why? Because you can. Believe it. But then what? So many of your classmates are lining up jobs at ICUs, NICUs, ERs, and telemetry floors. But not you. Oh, no, not you. You never liked those things. The smell of death too much for you, maybe? Don't feel comfortable around the terminally ill? Seeing too many family members bereave at bedside taking a toll on your heart? Can't stand the thought of working 12 hours in a HOSPITAL of all places? You may be wondering why you even entered the field at all. You thought it was to help people get better. To be a good provider of care. To exercise compassion to your fellow humans. To promote and propagate health and good habits of living. Yes to all. But why doesn't the thought of hanging an IV bag of Flagyl excite you? I'll tell you why. It doesn't have to. In fact, none of the things a nurse would typically do in the traditional hospital setting has to excite you. If you've ever considered, or are open to, a career in psychiatric nursing, read on. If not, find something you like to do and good luck (you won't make a good nurse). I... "disliked" the traditional hospital setting from day one. It was interesting, sure, and sometimes fun. But I did it because I had to. The experiences I had in clinicals were fundamental to my growth as a student and, ultimately, as a nurse. They were stepping stones to my ultimate destination. They were necessary. I learned how to interact with patients, I gained confidence in my ability to target the areas of care that they each needed, and I learned about the procedures and medications that would be around in the field for as long as I'd be in it. Those days of getting up at 0500 in December on a short night's rest when it was still dark, cold, and often rainy outside, by and large, were of paramount importance. There's a line in an Oasis song ("All Around the World") that really stuck with me as I'd listen to it on the path to my clinical destinations, and I hope it sticks with you too: It's a bit early in the midnight hour for me, to go through all the things that I wanna be. Read that one more time. I'll wait here. That one line summed it all up for me so well that I'll never forget it. I did my time and got through it, just like you did or are doing. Even though I knew I would never be a "medical" nurse. Ever. From day one, and well before I ever got accepted into nursing school, I knew that I wanted to and would be a psychiatric nurse. So as soon as I finished up my bachelor's degree in psychology, I applied to the nursing program at the same school. The only school I applied to. If I got in, I'd be a psychiatric nurse. If I didn't, well, I didn't have a Plan B. I got in. The field interested me from the time I decided to get a bachelor's degree in psychology. It's new, it's fresh (relatively speaking), and there's a whole hell of a lot that we still don't know about it. Just like the patients we serve have, historically, had stigmas attached to them for being born different, psychiatric nursing has its own. First of all, don't ever let anyone think psychiatric nursing is "easy", or that psychiatric nurses "don't do much". We may not read EKGs all day, hand over surgical instruments, get STAT orders for an IV antibiotic, start a PICC for chemotherapy, or triage 20 patients with stuffy noses in an ER, but we work just as hard as any other nurse you'll ever come across. So don't be fooled yourself. Don't think it's a walk in the park, easy money, or "just listening to people's problems". It's work. Hard work. And doing it well will make you a better human being. You will, and I promise you this, make a difference in someone's life. You will also save lives (although not necessarily in an exciting, right-before-the-commercial-break-in-a-made-for-TV-medical-drama way). You know, without the AED pads. "What's so hard about being a psychiatric nurse?" you wonder to yourself, having made it this far in my meandering post. The hardest part about being a psychiatric nurse is this: doing all the things they don't teach you how to do in school. Knowing what's going on where without looking. Recognizing "that look" in someone's eyes before they explode. Picking up on when someone's actually suicidal versus the borderline with the short end of a broken plastic knife making empty threats for an extra snack. These skills are all skills you will acquire in the trenches. What about your other skills? The Foleys and the IVs and the... just stop. Relax. Take a breath. Now reach into your pocket of skills, remove the ones you don't need right now, and put them up in a mental shelf. Now close it, lock the door, and tuck the key somewhere safe. Those skills aren't going anywhere. They may collect a little dust, but they're still there. You can wipe them clean later and freshen them up a bit if you ever have to. Do you use every skill you've ever learned your whole life all the time? No. You'd go crazy (and be crazy) if you did. You use what you need to use to get the job at hand done. If you find that one day you suddenly have the burning itch to remember how to put a Foley in, I assure you with 100% confidence that someone, somewhere in the world, will know how to do it and can show you. And if you're one of the millions (billions, maybe?) of people on the planet with access to the Internet and nobody's reading this to you over the phone due to the fact that you're not, there's always YouTube. It's 2015. You can look up just about any instructional video on any skill in any field from anywhere in the world... in an instant. Amazing, ain't it? I assure you that you'll still keep the necessary knowledge of general medicine with you in your career as a psychiatric nurse. Who the hell told you that mentally ill patients don't get sick? They do. All the time. You'll still know what Metoprolol is. You'll still know the therapeutic range for an INR. And I guarantee you'll get your fair share of wound dressings. And who doesn't like wound dressings? Oh what fun! (and I mean that!) You'll still be calling the medical doctor for orders, deal with the damn pharmacy (yes, it's always their fault), and have to explain Synthroid to a curious party of the patient's family. So really, what are you afraid of losing? So what if you have to look something up later in life to remember how to do it? Do you think physicians remember everything they ever learned in school? Hell no. Why do you think Physician's Desk References are about a quarter mile thick? Nobody remembers everything. Nobody has to. And nobody will ever need to. Now I can see the gears churning in your head, cranking out all the possibilities. You're starting to feel a little better about being part of the dirty stepchild of nursing that is psychiatric nursing. And you should. If that's what you're considering or that's what you know you want to do, take pride in it. That goes for anything you do in life. Stand up for what you do and the people you serve. I can't stress this enough: they need you to. They can't always do it themselves. Your patients will be part of a demographic of the human population that is globally stigmatized. No other type of patients were ever tied to a pole by the hundreds, thousands, and were literally beaten and enslaved to their label like psychiatric patients have been. No other type of patients can be stereotyped from across the street as they're seen talking to themselves while others shuffle over to the other side to stay away from "them" as if they're sub-human. No other type of patient needs a voice in today's world more than the ones you will serve. Look around you. Read the headlines. Police have been on trial for killing them over the most trivial, frivolous, non-violent offenses. Why? Because of this exact reason. I told you earlier that the field of psychiatry is young. It's the new kid on the block. Not everyone understands it, so what do people do when they don't understand something? They become afraid of it. Maybe a small part of you is afraid of it too. Perhaps that's a natural response to everything you've ever come to know about it through popular media and everything else that's been force fed to you before you decided to become a nurse. But that's where you need to look inside yourself and realize that you became a nurse to help others. To do this, you must first understand others. Take that initial step, for when you do, you can then help them. By "them", I'm not only talking about the patients but everyone around them. It's your job to help break the stigma associated with the individuals whose only crime was being born with a neural anomaly that gives them the gift of seeing the world in the unique way that they do. Nothing else. That's why I did it and that's why I love it. I've been doing it for all of six years now, mostly inpatient. I started out as a new grad and got hired without any experience as a per diem nurse and worked the floors as a charge at a small 35 bed hospital. To this day, I have never set foot in a medical hospital as an RN providing care and I haven't one regret about it. I jumped straight into what I wanted to do because I knew I would love it. I knew it would be a challenge, but one that I could rise to. I also knew the reward was rather a mystery. In other departments, the rewards seem rather obvious. It's not as flashy as running a code blue in an ICU with 20 people around you while you pump out compressions and save a dying man. It's not as sterile as an operating room, either, where every minute and movement is so precisely calculated and planned for all to go accordingly. Nor is it as fast paced and edgy as a busy emergency department in a metropolis where lives are saved by the minute based on keen observation and assessments. So what IS the reward of psychiatric nursing? I'll give you my answer and, hopefully, someday you'll have your own: making my patients feel like everyone else, no different. You'd be surprised how many times I've had patients come in to my assessment area as transfers from emergency departments who had been there all day and were never once offered a bite to eat or a sip of water. It infuriated me. The patients aren't all going to ask for what they need. Part of being a good nurse in general is knowing what they need before they even have to ask, because many won't ask at all. Ten, twelve, fourteen hours or more in an ER at some of the worst times in their life, often feeling ashamed of themselves and unable or unwilling to speak up, and never offered the most rudimentary, basic, and necessary elements of care all day: food and water. Note to ER nurses who may be reading this: Please, be a kind human and make sure this isn't you. Although I did one semester of being a mental health clinical instructor for the BSN students at the university I attended (where the clinical site was my main job site, which was nice since I knew the staff and patients), I eventually got out of inpatient nursing. Towards the end of my career at that hospital, which was all of 5 years and a month, I also was on the clinical informatics team for a year where I helped design the charting system that would eventually (and to this day) be used there. I left because the administration was becoming a problem and at odds with what I thought was proper nursing care and because I felt patient safety was being compromised in the interest of saving money. I left and started teaching again (I have a BSN so in my state I can lecture and be clinical instructor for LVN students). Teaching was fun, though short lived. It was nice to be able to give back to academia. I was lucky enough to have been able to give about four to five lectures on psychiatric nursing to the students at a vocational school. It felt good to stand up there and talk about it to a room full of young, enthusiastic people, providing real life experiences and putting my own little flavor into the content and delivery. If you've ever wanted to be a teacher at any point in your life, consider being a nursing instructor. The beauty of being a nurse are the endless permutations and pathways you can take to providing a variety of experiences to both your life and career. I would have kept at teaching had my dream job not landed right in my lap when I least expected it. During a lecture I was giving, a recruiter from a large, well known health care organization called me with a mental health opportunity at a nearby clinic. The job? Serving as a liaison between patients and their psychiatrists. Monday through Friday, nine-to-five with weekends and holidays off. Full time, benefitted, $140K/year (it makes for comfortable living, yes, but don't ever do it for the dollar sign alone. Nurses who do can be spotted a mile away, just ask their patients. I only mentioned money at all to share what's possible with a BSN in California since this site is seen coast to coast and it may influence someone's decision to make a move out west!) In my head, during some of the most stressful, infuriating, and seemingly helpless nights working the floor, this was what I had in mind for myself... some day. This offer was seven years in the making and I wasn't going to turn it down. If you ever feel like you're getting burnt out where you are, that's okay. Chances are, no matter what you do, you will at some point. Even if you don't, you'll want a change after awhile. You'll want new experiences and to learn new things. You may have something in mind already for your future. A company you'd like to work for, a city you'd like to live in, a pay range you'd like to be at. Just remember one thing, everything you've ever done to this point and everything you'll ever do, EVERYTHING (every experience, every patient, every interaction, every good day, every bad night, every medicine you give or forget to give, everything) matters. Not only does it matter, it makes you who you are; as a nurse and as a person. Be your best and the best things are yours. Even if it doesn't look that way now, it will later. Even if it's dark, cold, and possibly rainy outside and you're tired, burnt out, and hungry; and even if it's a bit too early in the midnight hour for you, to go through all the things that you wanna do, it will be worth it. Peace, love, and compassion. Sincerely, A nurse who has never worked a medical/surgical floor his whole career and still found happiness. P.S. - Don't ever let anyone tell you the direction you HAVE to take. I didn't.