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Psych nurse needs advice please

Nurses   (1,301 Views 10 Comments)
by jennerRNer jennerRNer (New Member) New Member

417 Profile Views; 3 Posts

As the title mentions, I am a psych nurse and have been for several years. I started psych right out of school. I love my job, my patients and my coworkers.

Before I started in psych, I was also interested in a few other areas. I applied for those but got the offer for psych. I would not trade my experiences here for anything.

I was a real "scaredy-cat" when I graduated, I had no previous medical experience and I was terrified of hurting someone by accident. Several years later, I have much more confidence in myself and my abilities. Even though this seems to be unusual in my department, I am one of the handful of nurses that will actually carry a stethoscope to a room and do a full head to toe assessment of all my patients that are appropriate (i.e. not wildly psychotic and/or homicidal.) In other words, I care as much about my patients' medical care as I do about their psych care.

I have come to find over the years that psych nurses are looked down on as ones that "settled" for psych because they are somehow not proficient enough to do any other kind of nursing. This seems to be true not only in my hospital, but I find it to be a pervasive attitude with many nurses I talk to or otherwise communicate with.

Even though I am fairly happy with my current job, I really find myself wanting to 'break out' of this psych stereotype and try for another area that I am interested in. Several of my friends who are also in psych told me it was now or never, too much more time in this specialty and I can pretty much kiss my chances of ever moving elsewhere goodbye. BTW, they tried to transfer departments within the institution where I work, and although they are excellent nurses, they never got so much as an interview. They ended up having to leave and go to another institution.

What do you think? I am interested in hearing feedback from nurse supervisors/managers too.

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21 Posts; 1,661 Profile Views

Hi Jenner

I too graduated from a nursing program and went straight into Psych nursing. I really enjoyed my two years working a PICU department. Your perceptions of how this classification is perceived by other nurses is dead on right. Often the psych nurse is de-valued and under paid. So, not only is the patient marginalized by society but so are the healthcare professionals that dare to render care.

I remember my first week as a Public Health Nurse (following my psych experience), another nurse was having a medical crisis and she wanted another new hire (with 5 years med surg) to assess her rather than me (b/c I was just a psych nurse)...well as it turned out, when all was said and done, my assessment skills turned out to be better than the other new hire. Why, b/c in the psych setting, we nurses are reliant on our nursing judgement--away from the technologies found in an acute care setting.

Most people (nurses included) don't realize that the mentally ill come to MH settings with a host of medical issues--HTN, hepatitis, Diabetes, AIDS, pregnancy, communicable diseases like TB, dual diagnosis where chem dep is just as bad as their suicidal ideation--and the list goes on, much like an ER department. I once had a unit of twenty patients, three were DNR b/c they were actively dying.

Bottom line, hold your head high and know that your skills (psychmotor, communication, caring, meds) honed in the mental health milieu are just as valuable as any hospital nurse. The other tasks such as IV lines, feeding pumps and the like can be learned with a couple of in-services and return demonstrations.

In today's market where there is a nursing shortage, go into job interviews with a list of skills, types of clients that you have rendered care to, and let the free market do its job--mainly, treat you as the valued RN that you are.

Good luck.

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1,343 Posts; 5,653 Profile Views

I couldn't agree more.

I came to Psych after a long and varied career, which included:

ER, Med-Surg, Telemetry, Recovery Room, Public Health, doc's office, skilled nursing/nursing homes, nursing instructor in Fundamentals, school nursing, and lots of agency, which included all of the above + a smattering of Psych ER, adult and adolescent Psych (bulemics, chem dep, all the other diagnoses), and probably more areas that I just can't think of right now. I have been a manager and a staff nurse. Am I an expert in all of those fields? No. Did I survive, grow, and learn? Yes. Was it all good learning material? Sure.

No, I have, thank God, never been involved in any litigation ever. I follow policy, I ask for help when I need it, I call docs or supervisors whenever I feel the need, regardless of their nasty personalities or what time it is. (I am reasonable but I always put the patient's and my own well-being first.)

I require that aides do their job and that smoking colleagues not exceed their break times (by refusing to cover for them more than during their true breaks). I get lunch, I get paid when I stay late to finish up, I refuse OT, mandated or otherwise, unless it suits me to work it. I'm too old, too wizened to let anyone take advantage of me, plus I know the law and sweetly, gently, with all due respect, remind the boss of it on the rare occasions when an issue comes up.

And I do it all graciously and with a smile - no sense in being ugly. I just have learned to stand up for myself because no one else is going to. I don't sweat the small stuff, like an un-restocked med cart or coffee cups and other trash left by the previous shift, but I do gently remind them that "Oh, Johnnie, don't forget your coffee" and "Oh, Sue, listen, be a sweetheart and grab me a few med cups before you go, will you?" And I clean up after myself, too, so no one has to give me any hints or seethe with resentment. (Of course, human nature being what it is and, as Elton John said, honesty is so hard to find, they probably do seethe with resentment anyway. But if my conscience is clear and if they lack the courage to talk to me directly, then they can just go ahead and seethe. I try very, very hard to be nice and helpful to everyone, pleasant and thoughtful to all but I don't kid myself that everyone likes me. If they do, it's wonderful. It not, it is sad but I just can't fix everything or be all things to all people all the time. I have tried and I can't and life is too short now to worry about it any more.

My skills and knowledge were increased in each specialty and certainly carried over to each new area.

Psych was an area of physical respite and it taught me a lot about people. It was often unsafe but I learned a lot and am very glad I worked it for 5 years, both acute and chronic. I apply my knowledge of Psych to my present work and to my life dealings with people in general all the time.

I think you should branch out if that is what you feel led to do right now. And just plainly talk turkey with your prospective new boss(es) about your abilities. Remind her that you completed successfully all of the assessment and other classes in your Nursing curriculum. Let her know you will be reviewing _______ (whatever area you are applying to) and doing whatever it takes to become a great _____ area nurse. Just be confident in your approach, shake off the dust from anyone who doesn't wish to hire you, and move on to the next interview until you get what you want.

It might be good to interview at a facility or 2 other than where you really want to work, just for practice, before you actually approach the one you really want.

In the old days, we could just walk up to the manager of the area we were interested in and ask for a job, tell her "I'm ready for you to teach me everything you know about _____(her area). When can I start?" And we had sort of an informal interview right there. Do that instead of going through HR if you possibly can, as they always drag their feet and turn something simple into a total nightmare of delays and unreturned phone calls. You will have to deal with them eventually but it is so much easier if the hiring manager already knows she wants you.

BTW, you might find that a male manager is easier to deal with - they seem to be, generally, more straightforward and stand on ceremony less than females. For instance, the hospital gives the interviewer a list of questions to ask you, stuff like what are your weak points, have you stopped beating your wife, and other crap. And the interviewer feels she has to get an answer to every question, whereas I have seen males skip over some of the questions and eventually throw the darned list away and give you their decision right then and there because they think you're ok for the job and they want to hire you and they do.

I see and hear of so many interviewers come into an interview determined to find your weaknesses and they just probe for any reason not to hire the interviewee. If I ever encounter that again, I'm going to call the person on it and ask why they bothered to call me for an interview if they don't really want to hire me.

Know that you can and will succeed in any new area you wish to work in. I wish you all the best. What area do you want to try? Believe it or not, I'm thinking I might like to try L&D one of these days. At my age. Imagine!

BTW, the HELL with what anyone else thinks of you. Unless they want to support you in the manner to which you could easily become accustomed, the HELL with their stinking opinions. One saying that bothers me so much is that "Those who can do, those who can't teach." Well, my answer to that is, "Those who can are able to do because they had great teachers. Those who teach have already done it and are sick of doing it, so now they teach." Amen.

One more thought (sorry this is so long): The nurses who never go the interviews - did they take the initiative to check back with the hiring managers? Perhaps those people were on leave, were too busy, never got the word from HR that interviews were requested (you never know - life is full of hanky panky and under the table dirty deals), maybe the budget changed or a former employee came back, or God only knows what might have happened. Don't assume it was because they were from Psych.

Be willing to take a part-time job to see if you like it and let the manager see that you are able to learn the new area. Or you could request to spend a day with a nurse in the desired area before formally applying. This could serve to create a desire in the manager to have you come aboard. And the nurse you shadow could be in your corner if you have a good time with him or her. This side door approach often is easier than trying to go in the front. Do whatever you have to do and good luck.

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3 Posts; 417 Profile Views

Thanks for the support!!

I really don't understand the stigma of transferring depts though, that is really boggling my mind. They would rather hire a new grad rather than one that is trained and experienced in their own facility? It just amazes me.

In any event, I plan on putting out resumes. Thanks for your words of wisdom!

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303 Posts; 4,417 Profile Views

don't worry about what other people think. At my facility I hear that some of the critical care nurses feel they are better than us general care nurses. Who cares, general care nurses have skills that critical care nurses do not and vice versa.

Critical care nurses that switched to general care on my unit had a hard time initially convincing us all that they did not know everything about general care plus all critical care. It took awhile for us to understand that their specialty is critical care and that they need training in general care skills.

The same goes for any field of nursing. Once you do a specific type for many years, your skills in that area excel and you lose some of the skills you had learned from other areas. I have worked psych so i can see both points of view and contrary to what aaa rn says ...

The other tasks such as IV lines, feeding pumps and the like can be learned with a couple of in-services and return demonstrations.

this is NOT the case.

Being a competent med surg, psych, critical care or other such nurse takes time, effort and practice far beyond taking a few in services and giving a few return demonstrations. I doubt you would say that a med surg nurse could learn the psych nurse skills with a couple of in services and return demonstrations.

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old rural nurse has 27 years experience as a RN and specializes in med-surg, home health, hospice, LTC.

36 Posts; 2,169 Profile Views

I think one of the reasons HR seems to want to hire new rather than transfer staff is that then they would have 2 people to train to each area, with associated expense, rather than just one new person!

Trudy-you said a mouthful, and said it very well! However I think the saying should be- "those who can do, those who can't become surveyors". I'm also a nurse who has worked in different areas in my career and can tell you that long term care nurses get the same bad rap as psych nurses. People, including most other nurses, think that LTC nurses have no skills or can't hack it elsewhere. I hate that , its so unfair. I wish everyone would see that every nursing specialty has its own talents and use of skills, and usually the nurses called to work in those areas possess those skills and talents-just like any other occupation!

Anyway, I think if you follow Trudy's suggestions, you will be successful at the right time and place. I believe that God will lead you to the right area or facility for you.:icon_hug:

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EarthChild1130 has 9 years experience and specializes in Psychiatric.

576 Posts; 8,191 Profile Views

I hate that people seem to feel that way about psych nurses too...My orientation was 4 weeks longer than the other new hire because I was coming onto a medical floor from psych (not by choice, mind you LOL...the psych unit wasn't hiring when I moved here)...

I love psych and there's nothing else on this earth in nursing that I'd rather do...I think all our skills as nurses are important, but our chosen specialty determines which ones will be honed and which ones will fall by the wayside...Do I have the best IV-starting skills? Nope, I sure don't...but I do have a wonderful way of assessing a patient's mood and behavior at a distance and for diffusing a potentially violent situation, and I also have a gift for communication that I find some of my med/surg counterparts lack...In the end, I think we should all do what makes us happy...I choose to float to psych a LOT while working medical to keep up, but I'm transferring back to psych QUICKLY! I will, however, float out twice a month to the medical unit to keep those medical skills I honed over the past year! :nurse:

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deeDawntee has 12 years experience as a RN and specializes in Travel Nursing, ICU, tele, etc.

1,579 Posts; 8,906 Profile Views

To be honest with you, I had no idea that there was that kind of discrimination out there against Psych nurses!! That blows my mind. I have wanted be crossed trained in Psych nursing, but to be honest with you, I have been very intimidated. I think being a great Psych nurse is an amazing feat. To deal with human behaviors and to make a difference in people's lives who are hurting so deeply is such a huge responsibility in my mind. I'm an ICU nurse and have worked in "medical" nursing my entire career. I certainly don't consider myself superior to any area of nursing. It is just a different set of skills. For crying out loud, I never have more than 2 patients! They may need to be kept a close eye on, but that isn't too hard with only 2! Anyway, I'm babbling, just know that some of us truly value what you do!! I hope you do as well.

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17 Articles; 4,167 Posts; 31,276 Profile Views

I went into psych with only six months of med/surg. Stayed there a long time. Then took a break. When I wanted to come back into nursing, I took an RN refresher course, just because I hadn't used acute care equipment for so long. This was a great help in finding a hospital job. Others in my refresher class had not been out of nursing at all, but wanted to change specialties or type of nursing. Clinic nurse wanted to work in a hospital. Occupational health nurse wanted critical care. I believe all fifteen of us found jobs.

If you can find a course like this, it might make you more marketable.

I think the very idea of psych--working in it or needing it--scares the bejabbers out of a lot of people. We tend to dismiss or diminish that which we don't understand.

Be confident in your abilities and enhance them whenever you get a chance.

One true thing--you will use your psych background no matter where you end up!

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3 Posts; 417 Profile Views

Update!

I have a med-surg interview in the near future. I have good interviewing skills, but any advice based on the above would be appreciated! Thanks in advance!

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