Psych nurse. Questioning if psych is for me.

[itsbekah]

I've been a nurse for two years on a medical surgical floor and recently transferred to a psych facility. I've always loved psych since I was a kid and did good in school when studying psych. I told everyone getting my first job as a psych nurse was my dream come true and now three to four months in I'm questioning it.

I don't know what it is but I feel emotionally drained already. We had psych patients on med surg but it never emotionally drained me like now. I feel incompetent and like I'm a bad psych nurse. I'm good at communicating with other people I know but for some reason with psych patients I'm at a loss for words. I'm not good at handling situations where patients act up. I'm fearful sometimes and doubt myself. One nurse even joked and said I was a wimpy nurse which really hit me and made me think.

The other night I had a patient talking to herself all night in a loud voice. I told her to try and get some sleep or lower her voice because she might disturb other patients. She lowered her voice but stayed awake until 4am. The other nurses were telling me to give her an IM dose of haldol to put her to sleep. I said she was not agitated and responded politely with me. They argued and said she wasn't sleeping and needed to sleep. One nurse said "you need to think about what kind of day she's gonna have". I held out hope that maybe she was going to fall asleep but eventually didn't and I gave her a shot at 4am. The nurse jokes loudly "I would've done it three hours ago but it was your patient".

I don't know if I'm too soft or if the nurses working in psych for a while have just become tough skinned. I've seen some nurses talk to patients so rudely. I never like to be rude and like to be professional but they laugh and say I need to be direct. I talked to my sister about it and she said nurses were not and never will be seen as authority figures and laughed. I don't know what to do or how to act. I love psych and even planned on going to NP school but this whole experience is turning my confidence upside down. It also doesn't help there are a lot of new nurses on the unit and it's hard to get a correct concrete answer from anyone. If anyone has any advice it would be greatly appreciated. I feel like my dreams are being crushed.

[Davey Do]

If you're looking for empathy, support, and encouragement, itsbekah, you've got it!

As you are most likely aware, sometimes it takes a good amount of time before we find our niche and get in a groove. It would be a shame for someone with a such a passion for psych nursing, who's also empathetic, like yourself, not to continue in this field. You've also got a good foundation in Med-Surg and are an asset in that area.

As far as the tough-skinned Nurses go, that's okay. Some Nurses become tough-skinned as a protective mechanism for their own frail psyches. Others are selectively empathetic caregivers intertwined with being tough-skinned as each need is called for.

I like to think I fall in that category- I'll go to the ends of the Earth for you, but I also send out the message of "don't mess with me".

If ever your Sister was on a unit where I'm working, she would see a Nurse who's also an authority figure who cares about his Patients, Peers and Coworkers. Even if they don't like me, they know they can count on me. I am pretty much at peace with who I am as a Person and a Professional.

You will be too, itsbekah. It just takes time and work.

The very best to you!

[MMC.RN]

Yes, it does take time to get comfortable! You will be just fine so relax, take a deep breath, and cut yourself some slack. You got this!

As for the IM Haldol to sleep...I probably wouldn't administer IM Haldol unless the patient was agitated in addition to not being able to sleep. In my opinion, there are much better medications to use for insomnia not to mention that it doesn't always work, especially if they're used to high amounts of psychotropic meds. However, just my opinion!

[nurse lala, BSN, RN]

No that doesn't feel good. You are not alone itsbekah. I think many new psych nurses experience the self doubt that you are feeling. I know I did. What worked for me may work for you. Think about the different professionals you work with. Some have strengths de-escalating, others are great helping process issues, someone else may be best at redirecting inappropriate behavior. When a situation occurs when you need a skill set that you do not have, consider pretending you are that nurse or SW or MD with the skills that you need. I wasmthe charge nurse of a locked adolescent unit in the 80s. I was a brand-new grad and pretty clueless to mental health, a subject I almost flunked in nursing school. I just pretended I was Nathan who was so capable with agitated or aggressive teenagers. Nathan was the most capable of avoiding a take down, by soothing and educating and redirecting. I learned the importance of staying calm from him. I became very proficient at adopting and adapting the strengthes I observed daily in Others. In time you will have an orificenal of skills learned from other professionals.

Haldol for sleep is not appropriate unless the practioner wrote in the order to give for sleep. Please request a sleeper is ordered.

From what you have shared it sounds like your being bullied. It's important you learn how and when to set limits on other people. Patients, MDs (carefully) and fellow nurses. It's okay to stand up for yourself and expected. Sometimes you have to show muster to get respect. I've learned that standing up to bullies, for example, make them back down. I have witnessed a fellow RN (she couldn't weigh more then 80#) stand up tall at 4" to patients and staff twice her size. And she controlled them because she expected them to comply. Reflected in her body language, words, tone of voice. I learned lots from that pipsqueek including how to be stern in a caring manner. Over time most nurses find comfort in the milieu. While I no longer work the locked units I visit as a consultant regularly. I still feel safer there then anywhere else in the hospital. its funny how frightened I was in the beginning. Good luck.

[chevyv, BSN, RN]

I would not want to give haldol for sleep either. If the order states 'for agitation', then I won't use it, especially for sleep. I work Acute Mental Health and we normally have standing orders for Trazadone for sleep prn. I would have let her be as long as she was appropriate and then address doc in the AM (if you can't call on NOCS). The patient should have prn order for sleep aid.

As far an feeling the burn....well that first year or more likely two, you are learning. It takes a lot out of you so you are not alone. Take care of yourself when you leave the facility. It's difficult to switch the mental health off, but you need to take care of you so you don't burn out. It's not an easy specialty, but I love it!

[Scarlettz, BSN, RN]

I am new to the field and also feel unsure of myself at times. But honestly, I would not have given the shot for sleep either if the patient wasn't agitated. I had an aide say the other day, "If it was me, I'd have given her a shot a long time ago." Yet, she had no idea of what was given to the patient already and the reason certain medications are given. I think some people just want patients to go to sleep for their convenience - sad but true. You will get more comfortable with time and experience. If the patient was acting up or very anxious or agitated, then I'd have considered the IM injection.

Many of my patients on the unit like me and consider me one of their favorite nurses. I am not tough skinned or loud or hard. I'd probably consider myself soft, too. But, that is not always a bad thing in psych nursing. Some patients may be more apt to take medication from you or turn to you because they feel comfortable with your demeanor. I think a balance of 'hard' and 'soft' in a work environment is a good thing. So be proud of what you bring to the unit.

I need to work on being more firm and assertive. I have taken strides in that and will continue to work on it. Just think back to when you started on the med-surg floor. I bet you were uncomfortable with some things when you started off there, but got better with time. You are in a new specialty now so you have to grow into it as well.

There are times when I don't know what to say to patients and all that psychiatric communication I learned in nursing school goes right pass me. It is different when you are interacting with real patients, but you will get the hang of it.

[falcon123]

Like others have said, keep up your positive outlook, empathy, and authenticity in your work. Studies have shown the importance of self-care in burnout, especially with psyc. What they have found is it is not what we DO necessarily that prevents burnout (ie. have a hobby after work) but rather it is how we THINK about the work itself. Your passion and empathy for those you serve will carry through, and as others have said you will find your niche. The field needs good psyc nurses like that!

[Dying2nurse]

Hi,

I recently had a similar experience. I'm also a new grad in Psych. I think it is important for you to stick to what you know is correct. They have all said " if it were them they would have given the haldol". Well, it's not them, it's you. You do what you know is best for your patient with the understanding that if anything goes wrong, you will be held responsible. Nurses are patient advocates. You don't need them to agree with your nursing judgement. I think if you hang in there you will be fine. Over time you will learn more and grow from your experiences. Let them know you respect their experience because there will be times where you will need that experience to help you. However, they don't get to tell you what to do. You have to do what is within your scope and what's best for your patient. Find a more experienced nurse that you trust and hang on to her. Try to learn as much as you can from her. Don't let anyone intimidate you into doing something you know is wrong. You can inbox me anytime you want to talk. God bless.