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Discussion

Psch Nursing Question from Newbie

I'm a nursing student who is interested in pursuing a career in psyc. nursing. I wanted to observe the role of a psych nurse so I decided to shadow one of the professors at my school this coming weekend. However, I was talking to an upperclassmen today and she was telling me about her psych clinical rotation. She mentioned that she had a patient who was making moves on her, and as she said, he was "sexually obsessed". I haven't taken my psyc. rotation yet, that's next semester, so I don't have any textbooks or knowledge about the field. I'm seriously worried now that I am going to make a fool out of myself on my shadowing experience. Can anyone help tell me what the "textbook" way to deal with a pt who is, "sexually obsessed". What am I expected to do as a nurse with a patient who acts like that? I know there are tons of policies on nurses not being allowed to push patients away, ect. If anyone can help give me an idea of what they were taught in their psych clinical lecture on how to deal with this issue I would be sincerely appreciative. Thanks!!

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    • Expert

    Umm, why don't you just wait until your psych rotation comes around, and I'm sure many of your questions will be answered. Did your psych professor agree to take you to work with her/him this weekend? I would be v. surprised by that. Confidentiality and security restrictions in psychiatric settings are even more strict than in other healthcare settings, and it would be v. unusual to allow someone to just come "hang out" in a psychiatric setting just because s/he was curious about what it was like, with no legitimate reason why the person was required or authorized to be there. I wonder whether, even if your professor is willing to do this, it has been approved by her/his employer? Also, having been a psych nursing instructor in different programs over years, that seems to me like a big boundary violation (your professor taking you, individually, to work as, what?, a personal favor?) that I would never consider doing.

    I strongly encourage you and your professor to reconsider this plan.

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    • Author

    I'm sorry you are so offended by my instructor allowing me to shadow her in a different department. The truth of the matter is we do it all the time at my school. If an instructor knows you are a reliable and mature student, and that you wish to explore an area they specialize in, they are often more than willing to allow us to shadow them. This doesn't mean I just go and "hang out" but I observe, ask questions, and engage in pt. communication. In addition, I am given an opportunity to understand how that hospital functions. All the hospitals surrounding my school, for the most part, are teaching hospitals. This is not uncommon. I have also observed in OR, ED and was offered to follow around a NP on a support team for palliative care. All areas pose risk, and although psyc deals with different situations I don't presume I am at any more risk that I am on my own, current, clinical rotation floor at a VA hospital, on e of two clinical sites I am at this semester. I have just never dealt with "sexual obssessions" before and was looking for a little guidance. Furthermore, I am not waiting until my rotation because we have 4 to 5 hospitals we can choose from for our rotation. Since I am already at this hospital, have gone through all the background checks and hospital policy seminars I am cleared to go to the floor. Since I am genuinely interested in psych nursing I wanted to have the opportunity to see if the psych floor in one of the hospitals I am at would offer me a valuable experience. I hope that explains and again I am sorry to see that you were so offended.

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    • Expert

    I'm not "offended" -- I just think it's a really inappropriate idea, and I'm surprised it's allowed. It would not be anywhere that I have ever practiced or taught.

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    • Expert
    I'm not "offended" -- I just think it's a really inappropriate idea, and I'm surprised it's allowed. It would not be anywhere that I have ever practiced or taught.

    It definitely doesn't happen at my facility. I would think there'd be too many liability issues to allow visitors without cause (and unless this shadowing is a sanctioned part of your clinical, you're a visitor) on the unit. Besides the privacy issues, most facilities wouldn't want a lawsuit brought on by you should something happen to you while you're there. And should something happen to one of your instructor's patients while you're there, you could be the target of legal action/lawsuit brought on by the patient and/or facility even though you're just "shadowing."

    As far as dealing with sexually inappropriate patients, you need to set boundaries with them: tell them what behavior is and isn't acceptable, enforce the boundaries, and be sure not to encourage the unacceptable behavior. I've seen more than enough staff set boundaries, then fall through on them.

    Also, though you should never be alone with any patient, be doubly sure to never be alone with a sexually inappropriate patient, not only because of the potential physical harm to you, but they also could make accusations about what you said/did to them....and if there are no witnesses to it, then it's your word against theirs. Any accusations are investigated no matter how psychotic the patient is, and being a non-employee already puts you in a weak position.

    I also agree this isn't a wise idea to do outside of an official clinical...but if you do decide to do this, good luck and be sure to protect yourself.

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    • Author

    THanks for answering my question, I appreciate it.

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