HealSpec

I can post mine if anyone's interested, they're pretty generalized and I'd have to check and make sure it's okay with the board rules. But if it can help someone with psych then I'd be happy to.

A brain is a sheet that you use to guide your shift, like a more dynamic to-do list. They're used in cardio, ICU and stuff like that, but I haven't found one for psych. I had to make one, and it's helpful when I remember to use it! But that's not always.

Thank you so much for the reply. I feel like we have a lot in common! I haven't tried different meds and so that is possible, although I'd still be anxious about starting them and then coming in to work. As far as staying organized, I'm trying to start doing that with a brain... psych brains don't seem to exist online so I made my own. But while it's helping, it's not helping "enough", if that makes sense.

Thanks for the advice. I did want to clarify that I'm not floating to med surg, just to a different psych unit. We are standalone, but there's one unit in particular that is really challenging and I really hate it. However, since my home unit is RTC, we're often asked to float there if we're not full. This other unit is a sensory minefield, full of screaming kids and literally multiple holds per shift. It's not med surg though, and I think you're right about the pressure and time management aspects (I'm awful at both so it would be a bad fit). However, I already know my manager/ leadership's opinion on it, which is basically that my unit is going to keep floating over there to cover them. So discussing it with them, I'm not sure if it would get me anywhere.

I don't, but I'm afraid to do so because I remember trying meds when I was a kid. They turned me into a zombie. I felt like my brain was moving through cold mud and couldn't think at all, and while obviously not everyone has that response to meds, I don't think I could do nursing in that condition. I do try to get off the unit now for break, but I used to hide out in the report room in case the phone rang or a restraint happened, especially when I was the only nurse on the unit.

Thanks for your post. I appreciate the advice, and your response made me realize that I probably should have been more detailed about my rationale. Here are some of my reasons for potentially doing better out of psych: Longer orientation. I didn't get enough shifts to feel comfortable and I feel like in a more medical setting, where orientation takes weeks to months, that might be avoided. Less (different) floating. Right now floating could mean also working with adolescents, like usual; working acute instead of RTC, with very frequent holds and yelling, or doing adult (so many meds and so many comorbidities...), or pre-ads (100% of which have RAD and 200% of which get in daily holds and I just cannot with this demographic). At least if I "floated" in non-psych it would be from 4 East Nephrology to 5 East Nephrology, instead of 4 East Nephrology to 2 Dozen Screaming Toddlers. If they happen, mistakes are caught and dealt with early. I'm so glad you put the line in about still being on the schedule because that is exactly how I feel; especially because it takes so long for documentation to "trickle up" to someone who might take issue, then they come find you four days later. Coming back after the weekend feels like walking into a minefield! However, these aren't meant in argument, just clarification. I think you may be right about staying in psych for now, and without a clear plan, a move could definitely make things worse. I don't even know where I'd go. Thanks again and have a good day!

When you finish every patient's med pass by checking for cheeked meds. I'm probably going to wreck some poor hospital's Press Ganey scores by turning to a non-psych pt someday and going "Okay, now open your mouth. Let me see! Aaaah!"

So, as the title says, I'm having issues with whether to stay in psych. I went straight into it after school and I've loved it from day one, it's fascinating and I really love my current position. But lately, my job and me just aren't getting along. I have ADHD and SPD, and while this makes it easier to get on the level of patients who also have it, it can also make everything so much harder. I feel like I make a lot of mistakes about charting and forgetting paperwork and stuff like that. When I float to another unit, being out of familiar territory makes me so anxious. If the unit is higher acuity or louder, it can cause flat out sensory overload. I've actually had to take a minute to go cry in the med room--more than once!--because of the horrible results of executive dysfunction + nursing. I've gone home and bawled for the next couple hours over mistakes and just generally being frustrated. And it doesn't feel like it's getting better. Lately, due to staffing changes I'm floating more, this is happening more, and I hate it. I'm considering leaving psych. But I'm afraid that leaving would make things worse, not better. If I left, I'd be going into a different field entirely with much more to learn. Maybe it's different in other geographical areas, but around here psych nursing is seen as this gravy train, easy money specialty. (No offense to any of the awesome people on this board, this is absolutely not how I personally feel about psych. It's not easy for me at all! I work really hard at my job and can't see how it could be considered easy. But all my coworkers ever talk about is how this is barely real nursing and what a joke it is.) So if I can't cut it in psych, what if I go to cardio or med surg and make a mistake there? In psych, it would be a missed assessment that I could go grab, quickly, and punch in, or a precaution change that I could flag down a passing tech and go "hey, heads up". In cardio (or neuro or med surg, etc etc) the patients are sicker, the mistakes are bigger... I might make a med error, or hurt or kill a patient. At least in psych, no one is (usually) that sick. I'm really stuck on what to do, and I don't feel like I can ask anyone who works with me for obvious reasons. I'd love to stay in psych but I'm getting frustrated and I'm not willing to go home crying 20% of the time (that doesn't feel normal. Is it normal?). I didn't pour my blood, sweat and tears into a degree and license to be so upset and discouraged so frequently. But what if my coworkers are right, psych really is "easy mode", and I'd be setting myself up for an even worse job if I left? I'm so confused, and I'd be so grateful for any advice on anything here at all. Sorry for the rant, and thanks in advance for any help.

Maybe I'm just one of those spoiled rotten new grads, but I can easily see the other side of this. I refuse to be a floor nurse. Not because there is anything wrong with the profession, but because I've been working for my RNFA since high school, and working in regular med surg with my fifteenth unfixable COPD/DMII/CHF patient instead of fixing fractures in the OR would quickly start to suck at my soul. I'm about to leave a psych position to pursue a surgical career, and plan on securing my CNOR ASAP. There's nothing lesser about floor nursing, but personally, I don't want to work med surg and so I'm not going to; it's just not for me. I feel that this should be our right as nurses--we do a very demanding job and choosing where we work should be a decision that's protected from judgment. On the contrary to some previous posters, our instructors prioritized total patient care; we did the hygiene, education, ambulated patients and more... and it only made me more conscious of the fact that I don't like that kind of patient care. I got some flak for this, and wanting to be an OR nurse was almost seen as trying to 'get out of' the bedside (and bedpan-side) role. But not only is that not my reason, I feel that as nurses--any nurse with any degree--we poured our collective heart and soul into graduating, and worked so hard for this degree. Whatever we want to do with it should be fine. It's your hard work, tears, and sleepless nights... if you want to take it somewhere that I'd rather not work, more power to you! It makes it less likely that I will ever have to float there! Throughout nursing school I also saw a lot of students who wanted to work as "regular nurses" but wanted to specialize, in OB, LTC, etc. I was always grateful for these folks because a unit should be filled with people who want to work there, and they had a real passion for these fields. But med surg didn't seem to be a popular 'passion'; instead, people often said that they were going for a year or two to get experience, and then leaving for their chosen specialty. Med surg is changing, even in its role to nursing students.

ETA, meant this as a reply to Ruby Vee but musty have missed a click Regarding spiritual distress: yes, it is real and I use the stuff we learned about it frequently (because I work acute psych), but in our classes I often saw psychosocial stuff stressed as if it were just as important as medical stuff (yes, spiritual distress is important, but if we need an airway then that needs to come first). It was mixed in with the stuff about being called into this profession to care for the whole patient, and their family... and while I use that stuff in my psych job, I can distinctly remember sitting in class thinking that I'll never walk onto the floor and hear "he's coding! Push one of epi and ask about his family structure and coping skills!" I realize that the rhetoric and all the "psychosocial stuff" are different, but they were so often presented together, and so often on the heels of some exciting medical topic... the patient's family life and coping skills are important, but I'm not going to pause mid-code or mid-surgery to ask about them. They're simply not as important. And while we were taught to prioritize care, the extra attention and weight given to the "soft skills" over actual medical practice still rubs me the wrong way... and it's become inextricably tied with the whole bit about how nurses are angels (if not outright martyrs) for whom the medical parts of the job are secondary to the social and personal parts. I don't like that idea--we are healers first, not second.

I'd like to chime in from the perspective of a new nurse, who never felt "called" to nursing (I'll tell anyone who asks that I actually wanted to go to med school... I just didn't want to take calculus). We got drilled on psychosocial stuff and got a lot of the pedestal building rhetoric. I really had trouble with those lectures. Nurses are angels, with fluffy little wings on their all white Alegrias, and all that. It was disheartening to say the least--I wanted to learn about respiratory distress, not spiritual distress. I remember feeling like the classes weren't geared toward the practice of nursing so much as the idea of nursing, and that was frustrating; and I think that the tendency to see nursing as a sacred calling contributed to that. I now work psych and I use that psychosocial stuff frequently, but the winged clogs? Not so much. It's still just a very good job, one I enjoy and one I'm passionate about, but a job, not my life's purpose. And thank goodness--if it was that important to me I'd never get any sleep, worrying about my patients and their various problems. I think that it should be okay if nursing is "just a job" to you, the same way it should be okay for you to have a preferred specialty. If you got into nursing because you felt called and you would do it for minimum wage because you love your profession, that's wonderful! If you love the specialities with a great deal of care and investment in the patients' lives, hey, more power to you. But if you wanted a job, promising a nice paycheck with good job security where you were unlikely to ever get bored, and you come to work to enjoy practicing medicine, that should be okay too. We don't all need sneaker wings.

In my so far limited experience, this looks like an environment problem. Where is this patient? Is it a hospice or LTC where she's basically in her "home" and the POA has turned into a PITA? Or is this a psych setting, where therapeutic milieu is sacred above all, and she wrecks and decks it if she's not kept awake? Even as a new nurse, I've asked the oncoming shift to "please keep this patient up today, they were awake all night having behaviors, their roommate hasn't slept a wink". I wouldn't dream of doing this at a hospice, but in an acute dementia ward? Absolutely. Either way, if you're at the point of considering it an ethical concern, this patient isn't doing well where she is, and it's possible that you're looking at a med adjustment, transfer, or discharge to somewhere that can work with her cognitive stuff more easily.

If you miss paper charts and MARS, counting scheduled meds, kardex being king and using crank beds, just go work in psych. I love my job, but those are daily realities--we even reconcile our MARs by hand every week, checking back and forth with the chart for the handwritten orders. Like a piece of history, I tell ya.

It's not so much that I think it would be bad, as that I'm about halfway through working there (I started in late July and plan to leave in mid January). I can't really put it into words, but it feels weird to me to tell them this far in advance, not having worked there very long.

Hi, I'm hoping you guys can help me with a bit of a catch-22. I'm a new grad RN and I love my job, but unfortunately I'm moving in a few months. I'll be too far away to commute and will need to resign. I'm excited for the move but I'm running into problems trying to line up a job. It's not that there's a shortage of offers, or anything like that. But I haven't given my notice yet, and no one at my job knows I'm considering leaving. I'm afraid to apply to anything because of the possibility that my hospital would find out that I was leaving before I planned on telling them (I plan on giving a month's notice). I know that's something that shouldn't happen; it's a nasty surprise for your superior and it's unprofessional as well. On the other hand, I've always heard that you need to have a job lined up before turning in a letter of resignation. To follow one rule would require breaking the other, vice versa, and I feel stuck in the middle. I've never done any of this before, and could really use some advice. Thank you guys in advance for any help.

Sorry to necro this thread, but I found it while googling the issue and figured this was better than starting a new one. Out of curiosity, how do you deal with those "little voices"? I usually consider myself a huge proponent of least restrictive environment, but I have a button or two like any person, and I've found that patients refusing care pushes them. The patient might be belligerent about it, jerking away from me or yelling... or they might be perfectly polite, but they're simply not going to take those meds tonight, thank you. It drives me nuts that I even have this button! It feels very un-nurse-like. But each time it happens I find myself trying to cool down afterwards. Obviously I'd never force a patient to do anything, or perform something they'd refused against their will unless it was an emergency (we do very occasionally have emergency orders for things like IM antipsychotics). But from the other side of you guys' discussion, how do you deal with the urge to stay on the hill and fight?

"Media-sty-num" and "umba-like-us" (mediastinum and umbilicus). I have much more trouble with pronunciation than vocabulary...

When I made this account, I was a nursing student. Thanks to my teachers and some of the awesome posters here (And your awesome advice on coping with nerves!) I passed my boards last month and now I'm a new RN! I have a license, a job, and an apartment, and it's all going well! I'm working a specialty with low physical acuity (acute psych) and my anxiety is nearly gone. Going to work actually feels good, not nervous and terrifying. I like my co-workers, and I'm finally getting the hang of our charting system... but there's a problem. After coming home, I'm pretty much useless. I work a twelve hour night shift on a rotation with two to three shifts in a row, and when I get home from work, I sleep until two hours before my next shift. I'm always too tired to do much besides eat a quick breakfast and drop onto the nearest vaguely horizontal surface. Housework is difficult to remember, let alone complete. Even ADLs are iffy sometimes. It wouldn't bother me personally, but I have a roommate who often winds up picking up the slack, which I know isn't fair--she works, too, and her threshold for "I need to clean this" is unfortunately lower than mine. So since this forum is always so helpful, I decided to ask the professionals--literally! With all that in mind, what are some things that help you get stuff done despite working, and make the most of your time between two consecutive shift days? Are there any general tips for adjusting to 7P-7A that make it get easier, sooner? Thanks in advance for any help.

It's happened before. And I've had a reprieve for a while--my preceptorship went well. I settled into an area where I felt knowledgeable, comfortable. As a nursing student, that's such an unusual feeling! But that time is over now, and as I look toward my first job as a tech or new grad, I know it's going to happen again. Another attack of Sentinel Syndrome. Maybe I should back up, and explain this disorder a bit. I made the name up, I'll admit it, because naming things seems to help make them less scary. So, what is Sentinel Syndrome? It's an acute anxiety response that makes you feel as if, quite literally, you are a walking sentinel event waiting to happen. A time bomb made of never-events and things-not-covered-by-insurance. As if despite every good test score and productive clinical day, tomorrow, things will be different. Tomorrow, you're going to walk onto that floor and mess up--and this time, no one will catch it, and you will hurt someone. It doesn't even feel like a "could happen" at the time--you know it, with the same certainty that you know the sun's coming up. The symptoms start between twelve and sixteen hours before the shift starts. They gradually dissipate within the first 20-30 minutes of the clinical experience, even if there are minor setbacks or mistakes during the shift. By the day's end, the symptoms are gone--but this doesn't make them less intense during the next attack. I think the worst one was the night before, and morning of, my first shift in the ER. I can vividly remember getting up an hour early to make sure I had extra time... and spending forty minutes of that hour in the parking lot of my dorm, sitting in my car, bawling. I was convinced I was going to mess things up so badly that it would need at least five incident reports. Such is life with this syndrome. I've asked around a bit--people tell me it goes away, but no one is sure about when. Most of the people I've talked to didn't have much experience, but were already over it. I realize it must be different for each person, but there has to be a ballpark. When on earth do these attacks stop? Is there a cure or treatment for Sentinel Syndrome? Or is there just a time frame, in which it runs its course and eventually leaves you alone?

Does anyone else see a connection between this comment coming up more often and the whole "patients are now clients, spiritual distress is nearly as bad as respiratory distress" movement? They seem to be coming from the same place--that nurses are no longer a type of medic, now we do psychosocial work and health promotion, keeping the patient 'happy', and actual medicine is an absolute last resort.

I have tried looking at a few sites for specific hospitals, but I run into the same thing--nothing specific to OR, or difficult to tell if it's simply a med-surg floor. One listing was for a "surgical floor", but I know the facility, and the wing listed is regular med-surg. OKC has a whole medical district downtown, with a few different major hospitals, so I don't think it's a simple lack of openings. Taleo seems to be a site similar to Indeed where job listings can be searched; several of the hospital sites' "Careers" pages used it to aggregate results. So far, I haven't run onto any OR position that doesn't ask for at least one year, if not two, of continuous surgical experience.

Take this with a grain of salt, because it's not from experience, but if I were you, I'd be afraid of your job description not changing very much if you take a different job at the same facility. That has happened to classmates of mine, who found themselves at their clinical facility doing the "CNA stuff" they did when they were there to work--and running out of time and energy for their RN skills. You also mentioned that the new position is in your field of choice. That would be an awesome opportunity! Maybe you should at least interview--and find out about the position firsthand.

Hi, I'm embarking on my first job hunt a little early, on the advice of a recruiter, but I'm getting a bit confused. I want to start in an OR, and was told this was possible at some-or-other meeting full of recruitment booths and free loot. However, my notes have failed me--I can't remember who said it, where they worked, or, most importantly, if I'd be able to start circulating (honestly, I'm not even sure I thought to ask this). Thinking I could find what I was looking for online, I took to Google, then Taleo. However, when I pull up what appears to be a surgical position, it looks like post-op and mentions caring for multiple patients, I'm assuming at once, which is a bit of a red flag. Now, I'm not lazy, nor am I afraid of hard work. But I want to work towards getting my RNFA, and the OR is where my heart and soul live. I want to be sure I apply somewhere that will put me into circulation, not stick me in what sounds like PACU when it's not what I applied for. It's not that PACU is terrible or anything--I just want to specialize. Does anyone have any advice on where to look, who to call, or know of hospitals that do this? I'd originally been looking at ones with a residency or orientation program, because they seemed like a good idea, but working in my field of choice is more important still. Thanks for any help!