Psych ED

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Wondering if someone could tell me what it's like to work in a psych ED. What kind of things do they see, their experiences working there, maybe even how it compares to a regular inpatient psych unit. Thanks in advance!

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The psych ED can be an exciting place to work. You see absolutely everything in the DSM-V. Some patients are experiencing their first psychiatric emergency, such as suicidal ideation resulting from depression. You might be the very first mental health professional they've ever seen. At the opposite end of the utilization spectrum, you'll have patients who have been involved with mental health services for their entire lives. A fairly common example is a patient with schizophrenia or schizoaffective d/o who has lapsed in taking medication and presents with increasing signs/symptoms (I.e., acute decompensation). Sometimes they are brought in by law enforcement due to unsafe behaviors; other times, they are brought in voluntarily with family or an ACT team member. You'll see lots of people who need to restart medication for a variety of reasons, e.g., missing outpatient appointments, inability to pay, lost/stolen meds, bad side effects, etc. You'll also see patients who struggle with substance use disorders and seek access to specific medications, same as in the medical ED. Others will be seeking detox/rehab. Children and adolescents present with a multitude of behavioral disorders and are often referred by schools for urgent evaluation. They also present with many of the same complaints as adults.

The acuity can be quite high, so you'll need to function well when adrenaline is running high. (This can come with exposure and practice.) You are often seeing people at their worst stages of illness and exhibiting dangerous behaviors as a result. Physical restraint and administration of medication against a patient's wishes are common. Another uncomfortable reality is the domino effect of high stimuli; one explosive episode can trigger reactions from others. Your job is to keep everyone as safe as possible, including yourself and your staff.

Inpatient psych units come in many different flavors, and some see more healing than others. In the psych ED or observation, you may or may not see the benefits of treatment. There tends to be much less, if any, milieu or therapy. It is a place to be evaluated, emergently stabilized, and/or held for placement. It is important to keep this in mind, lest you begin feeling useless. It is also important that you keep your humanity and understanding of mental illness. Do not follow the lead of those who assume the role of warden or judge. Always remember what brought you there to begin with.

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Thank you for the detailed reply!

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How would a new grad get a job in the psych ED? I love psych as a counselor and I’m switching careers to become a psych nurse & later a psych NP. Don’t see myself specializing in anything else but I know that could change once I’m in nursing school

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Specializes in Psych, Addictions, SOL (Student of Life).
3 hours ago, FuturePsychNP30 said:

How would a new grad get a job in the psych ED? I love psych as a counselor and I’m switching careers to become a psych nurse & later a psych NP. Don’t see myself specializing in anything else but I know that could change once I’m in nursing school

Weather it's in a Psych ED or just a regular ED(Some facilities don't have the luxery of two seperate EDs) Psych nurses have a skill set that if highly valued in the ER setting. As a new grad if would to see if there are any psych residencies for nurses in your area. Think big teaching hospitals. This will give you a great base to start from and decide weather the ED or working a acute inpatient setting is best for you.

Have fun, and good luck.

Hppy

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9 hours ago, hppygr8ful said:

Weather it's in a Psych ED or just a regular ED(Some facilities don't have the luxery of two seperate EDs) Psych nurses have a skill set that if highly valued in the ER setting. As a new grad if would to see if there are any psych residencies for nurses in your area. Think big teaching hospitals. This will give you a great base to start from and decide weather the ED or working a acute inpatient setting is best for you.

Have fun, and good luck.

Hppy

Thank you! I’m in Atlanta. I will definitely look into it

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