Psych Clinicals?

akulahawkRN, ADN, RN, EMT-P · Jan 5, 2015

It will be different than what you're going to be used to, that much is certain. A lot of the focus will be on learning therapeutic communication techniques and full physical assessments are rarely done in a psych facility because most of the patient's problems will be between the ears, not below them... the patients are generally physically healthy.

As for what the nurses do, well, they do a lot... and you're right that medication knowledge is huge.

SopranoKris, MSN, RN, NP · Jan 5, 2015

I just completed my psych rotation on a high security lock-down unit. Before I started, I was very nervous about what to expect. Would I be safe? How am I going to talk to these patients? How can I use therapeutic communication and not sound phoney?

First thing you can do is know that the staff is very knowledgeable and runs like a well-oiled machine when there's an outburst. You will definitely be safe. Just make sure you don't disclose personal information that could allow your patients to figure out where you live. You'll be having VERY long conversations.

Brush up on your board/card game rules. We spent a lot of time playing games between group therapy sessions.

Realize that your patients have probably gone through some incredibly painful tragedies & abuse in their lives. Because you're on a lock-down unit, they're more inclined to want to talk to you than patients who can come & go on their own accord.

I was surprised at how open & honest the majority of my patients were. Because you're in a lock-down unit, you'll get a chance to work with a wide array of patients. I worked with patients who had acute psychosis (drug-induced and NOS), schizophrenia, schizo-affective disorder, bipolar disorder, antisocial personality disorder, borderline personality disorder, histrionic personality disorder, panic disorder, major depressive disorder, PTSD, etc. I spoke with patients who were hallucinating, hearing voices, refused to take meds, etc.

It was such an interesting rotation! Most of all, it helped me to learn how to address the psycho social needs of my patients. This is something that is often over-looked outside of the mental health setting. It has made me much more aware that I need to care for my patients' needs as a human being, not just "the stent in Room 202" or the "CHF in 315".

And don't worry about therapeutic communication. The more you practice it with your patients, the easier & more natural it becomes. It actually enables you to get your patient to talk in detail, instead of yes/no responses. That's a skill which applies to any aspect of nursing.

Good luck to you! I hope you enjoy your experience as much as I did :)

Nibbles1 · Jan 5, 2015

Our group didn't know what to expect. We were divided into two groups. My group got geriatric psych and the other group got the really specialized psych level.We were not allowed in their rooms and we had to have buddy with us at all times. Don't share personal info. We had a blast to say the least. On our final day there, we had a huge bingo game. Each of us brought items such as soap, candy, hair brushes, deck of cards and each winner got to pick a gift. We played until everyone won a prize. The other group that got to go to the specialized level, had the worst time.

akulahawkRN, ADN, RN, EMT-P · Jan 5, 2015

I apologize in advance if this seems like a bit of "train of thought" as I'm writing this a bit late at night and I'm on the tired side.

My psych rotation was also in a lock-down unit. One of the above posters reminded me of something... because people can't come and go as they please and because of the rules in place, the patients do feel like they are able to talk openly about what's going on. Many times they do get used to lots of people asking them the same set of questions over and over again... including students asking them those same questions. Sometimes it's could be the only place that someone truly feels safe. The units I rotated through didn't do cards much... but each place will have it's own quirks. I never did feel like I was in an unsafe environment either.

You really will get more comfortable asking patients about their moods too. It's a somewhat safe place for you as well. Just make sure that you don't inadvertently give out information about yourself because sometimes patients will find out who you are, where you live, and attach themselves to you in an unhealthy way. You have a life, they have theirs, and you need to keep your life outside the facility outside. You'll also come to find out that it's a lot like the description of Las Vegas... What goes on in there, stays in there. If you see a patient from there out in the world, you need to act as if you have no clue who they are.

Oh, and one thing you'll learn is that you don't want to follow the patient down the proverbial rabbit hole during conversation... Sometimes they'll want to take you along for the ride. Also, get to know the rules of the place. Because the patients do know you're a student, they may want to try to split you vs staff so watch for that manipulation attempt. Some of them can be very good at it.

Don't be afraid of this rotation. You'll learn a lot from it and you'll find that some of your patients in hospital or wherever you end up working has a psych component at play so this isn't just something to introduce you to psych, you'll be able to use this stuff on your patients on a med/surg floor.

Did I mention that it kind of deconditions you about asking patient safety questions? You'll be so used to asking those kinds of questions that you'll just ask them in a very routine way and your patients won't be alarmed by it because it's just so routine to you. The answers, of course, should very much be paid attention to because you might be the first person they report something to.

But that's all going to be revealed in more detail in your psych lectures!

LoriRNCM, ADN, ASN, RN · Jan 5, 2015

We didn't do physical assessments or meds in psych rotation. But lots and lots of therapeutic communication and games. You still had to know the meds and all the illnesses, we just didn't pass any. I found it very interesting! And yes, that first day was intimidating!

Bbett, MSN, NP · Jan 5, 2015

Such was the easiest blow off rotation of all of them. Don't feel intimidated. As a student you don't pass psych medications or do assessments. All you do is talk with the patients and then discuss your day as a group at the end.

SopranoKris, MSN, RN, NP · Jan 5, 2015

Oh, and one thing you'll learn is that you don't want to follow the patient down the proverbial rabbit hole during conversation... Sometimes they'll want to take you along for the ride. Also, get to know the rules of the place. Because the patients do know you're a student, they may want to try to split you vs staff so watch for that manipulation attempt. Some of them can be very good at it.

Absolutely!!! We had one particular patient who was constantly trying to split the staff. "She called you a $%^& when you walked out of the room, but I defended your honor" or "you're the only one who listens to me". At first, you don't realize what they're doing, but it's easy to catch on after you see it happen. We also had another one who was very needy and wanted to give me her phone number. I kept telling her that it wouldn't be appropriate. Since the name of our school is on our scrubs, she said "well, when I get out, I'll just go over to the school and find you and then we can go eat pizza". :eek: I doubt she'll follow through on it, but it was disconcerting to hear that. The facility we were at required us to have our full name on our ID badges. I had one guy that found me on Facebook and kept sending me friend requests. I just ignored the requests.

akulahawkRN, ADN, RN, EMT-P · Jan 5, 2015

As a student, you may actually pass meds. You'll do certain assessments and the like, but on that end of things, the staff will be responsible for doing the majority of the assessments. In our local area, I know that in my local area, some facilities allow students from certain program to pass meds and students from other programs aren't allowed to pass meds.

The majority of physical assessment stuff that we did was limited to quick neuro check, listen to heart & lungs, and vital signs. This was, as I said before, because the patients there are generally physically healthy.

NurseGirl525, ASN, RN · Jan 6, 2015

My psych rotation is also this semester. We are going several different places. An addictions center, the local psych institution, and we have to attend an AA meeting. I'm looking forward to it. We were told we were maybe going to have to go to the prison, so I am grateful we don't have to go there. But I am looking forward to working with this part of the population and getting to know and understand them.

Fruit Sucker · Jan 9, 2015

You won't be passing meds. It will be a lot of sitting around talking with the patients, then sitting around in group therapy, then sitting around talking in post-conference. I found it very boring compared to med-surg. The nurses on the psych unit do a lot of sitting around. It would kill me to work on a psych unit. You won't be doing any physical assessments, and all of your patients will be sent out if they have any medical problems. So, you pretty much don't use 90% of what you learn about nursing. It's all about therapeutic communication. And if there's a major problem with any of the patients, they call the intervention team to talk them down/sedate them. Honestly, the most interesting part of it to me was learning about the legal system.

CoachChris · Jan 10, 2015

Any advice for those of us who may have several years experience working with the mentally ill when it comes to a psych rotation?

I've done so much crisis intervention while dealing with children and adolescents who have serious issues that I'm afraid I might just jump in and start intervening when I should be backing away and acting like I don't know what to do. I've worked in residential facilities where I gave out meds. I don't want to come across as a know it all. Should I just stay in the background and let those with less experience with that population get more in the mix of things?