Psych Nurse ="not a REAL nurse"?

StuPer · Mar 23, 2006

Hi All,

I am grateful to see many non-mental health nurses acknowledging our practice. But I need to tell you this is reciprocated, I work in C/L psych in an ER mainly, and when I see the nurses in there dealing with major trauma I am amazed and impressed at the skill and teamwork involved, this equally applies to the med/surg nurses too. In all area's of nursing we are skilled and should be valued.

One of my 1st introductions to the skills of psych nurses was my 1st rotation on an acute admissions ward, I was doing the right thing I thought as a student and takling to a patient and trying to help. Scattered around the room were psych nurses engaging other patients. Then as 1 they all got up and headed for one part of the room, they had all picked up on increasing tension with one patient and they responded to deal with it.. crisis averted. Ohh and for anyone wondering the response was a quiet chat and some ventilation, rather than meds.

I never forgot that and although I was already goign to do psych, that was a cementing moment.

regards StuPer

karynfrances · Mar 24, 2006

I work in psych and I'm sure I'm a nurse!

medpsychRN · Mar 24, 2006

I've heard this many times. It also goes along with "the night nurses don't do anything". I work nights...LOL. I really don't know what prompts people to say such awful things. I just remind folks where and when you work is a choice and they are welcome to join me anytime!

leslie :-D · Mar 24, 2006

when i was in nsg school, i was removed from the locked unit in my psyche rotation. we were to select 1 pt. to be the focus of our case presentation. the pt. i selected made the staff nurses leary, as his acuity was high and poorly controlled. he was a paranoid schizophrenic....i sat next to him. he turned to me and said, "you're one of the good guys." i responded, "yes i am".

out of nowhere, my psyche instructor yanks me away from this pt., and reads me the riot act; that i should have told him my name, that i was a student nurse and was going to school. :uhoh3: she said i had been enabling him which was a major faux pas.

another male pt. (end stage AIDs w/dementia) was crying frantically, yelling 'they' wanted to take his baby. i promised him that i would ensure his baby would stay safe. AGAIN, another faux pas as i was enabling...i should have told him my name and the student nurse thing. good Lord! obviously i would never succeed as a psyche nurse. what i considered to be reassuring and therapeutic, my instructor was always reminding me to orient them to reality. all you psyche nurses have 100% of my admiration and respect. i ended up being transferred to the substance abuse unit. i still wouldn't change the way i communicated with these patients. orient them to reality?????? good grief.

leslie

JeanettePNP, MSN, RN, NP · Mar 24, 2006

Leslie, I'm not sure that "orienting to reality" is an approach that's carved in stone. At least I hope it's not and will be put to the research test. I think it can be unnecessarily frustrating on both sides to be "oriented to reality" when the patient is unready or unwilling to do so. Maybe by you making them feel "safe" even within the boundaries of their delusion they will come out of it sooner.

Not that I have any training or experience in the field, just the way I see it.

MadRedneckRN · Mar 24, 2006

Leslie

If "orienting a patient to reality" will agitate them, I won't do it. While playing into the delusions isn't a good thing either, I think your response as "one of the good guys" is appropriate. It's important to gain the trust and establish a relationship early. You could follow your comment with "all the nurses are good guys". Patient safety is first and if being one of the good guys makes the patient feel safe, that's what it's all about. IMHO, your instructor needed to put down the book and talk to the patients. Every patient is unique. Your approach needs to be unique.

leslie :-D · Mar 24, 2006

thanks lori and chaya!

you know lori, being a student so many yrs ago, i would have never thought to respond with "all nurses are good guys" even though that's THE response to give. but sev'l yrs of experience later, yes i would give the same response or very similiar.

i'm a hospice nurse and MANY of my pts present with confusion, delusions, hallucinations, psychosis. it's just the nature of the beast when ca, high temps, dehydration, and a variety of terminal dxs can and does result in cognitive deficits.....add to that, the fear, anxiety of dying; i use alot of psyche interventions and sometimes feel inadequate in dealing w/the families. those are the times i wish i had more of a psyche background. that's why i genuinely salute all nsg staff within the psychiatric population. it's hard and draining. and you people should be darned proud of who you are.:balloons:

leslie

lvs2nrs3535 · Mar 24, 2006

So funny that I came across this thread tonight, cuz today I insulted one of my best friends, (unintentionally), because in our first day of our psych rotation we were discussing having to take care of patient needs when CNAs were not available, and I (being SO very good at sticking my foot in my big fat mouth), said,

"Well, dont psych nurses start because they dont want to deal with that kind of stuff?" Needless to say, I insulted my friend (who wants to be a psych nurse, and felt that I was calling her lazy), I felt like an a**, and lucky for me, my instructor did not take offense. I think that there is a general opinion that psych nurses dont work as hard, or want to, and I have to say, this is SO wrong. I did NOT mean it the way it came out, yet, it was the bias I have heard, and I guess, assimilated without realizing it. How awful.

After my first day in psych, I saw how very much psych nurses care, evaluate, deal with people who need someone to care and can also stay professional while dealing with the hardest job of all. All I can say is, this has to be the hardest job in nursing, and it takes a very strong and professional person to be able to deal with this. I have nothing but respect for the job these men and women do every day. I apologized to my friend today, and I have to apologize in general for my ignorance. I cant wait to continue my pysch rotation and learn more. :bow: :bow: :bow: To the psych nurses. I do not think I am strong enough to do the job they do. All I can do is STRONGLY advocate for a different attitude if the subject comes up.

Thanks for letting me get this off my heart.

:scrying:

mhull · Mar 24, 2006

I've heard this twice this week and being a psych nurse, it's very annoying.
Do you nurses in traditional fields feel this way about psych nurses too? Please be candid, I would just really like to know. Thanks!

I do not blame you for being upset. That would really p**s me off. I think all nurses (RN and LPN) are nurses. I have seen a few I thought the bought their licenses at walmart, but in real life they are still nurses.

JeanettePNP, MSN, RN, NP · Mar 24, 2006

I've been thinking about this a little more and I realize what bothers me about "orienting to reality". Mental health is about functioning, not mind control. A person can have all sorts of bizarre beliefs or fixations, but it's only a mental health issue when their functioning is impaired. If someone can get up in the morning, brush their teeth, go to work and get through their day without harming themselves or anyone else, they are mentally healthy, regardless of what weird beliefs they have. If the job of the mental health professional was to "orient" them to reality, we could go around institutionalizing people for praying to God (hey who are you mumbling to?) running for political office when they have no chance, etc.

If someone is an inpatient that means that their functioning is impaired somehow, and that should be the focus of treatment. Psychotics can be more in touch with reality than you realize - maybe they're choosing an alternate reality because they've had enough with the one they were in. So trying to orient them to a reality they don't *want* to be in will be a frustrating battle on both sides.

I think that if a patient said something like that to me (are you one of the good guys?) my response would be to explore what the patient is feeling - (do you feel unsafe here?) rather than try to superimpose my view on his (For the thousandth time, no one is out to get you! Snap out of it!) People in psychotic states don't snap out of it because someone told them to = they'll come out of it when they feel validated, accepted and comfortable.

I did a little googling and found that there's research support for my view:

If the client is delusional or hallucinating, do not confront him or her with reality. Use validation therapy to verbally reflect back the emotions that the client appears to be feeling. Use statements such as, "It must be frightening to see a fire at the end of your bed," "I can see you are afraid," "I will stay with you," or "Can you tell me more about what is going on right now?" Clinical and Nursing Research: Orienting the client to reality can increase agitation; validation therapy conveys empathy and understanding and can help determine the internal stimulus that is creating the change in behavior (Feil, 1993). Staff training in validation therapy resulted in a decrease in the doses of psychotherapeutic medications used and in incidences of behavior problems in one study (Fine and Rouse-Bane, 1995).

bahamabread · Mar 24, 2006

that is the most ridiculous statement. :angryfire nurses always complain of patients and doctors bringing nurses down and insulting them. but it's us who do it to each other. each of us have different skills and is proficient in different areas. let's build each other up. maybe you wont want a psych nurse putting an iv on your baby............but you will worship the ground she walked on if she helped your sister with post partum depression get well.........or your baby with autism. come on nurses..............build up each other. none of us is more important than the other.

TamIam · Mar 25, 2006

Of course, they're "Real Nurses"! But, then I am one. I just don't listen to others' comments, because I know what I do. Like the time a woman came in w/ the c/o extreme anxiety and aggitation: we discovered she was having hypoglycemic episodes. And there was depressed woman who had an MI. Or the schizophrenic man with a staph infection. There's LOTS of diabetes and drug-enduced conditions that truly require a skilled profession NURSE to recognize, treat, and educate. Furthermore, we usually work w/ a population that has difficutly communicating, has limited insight and/or ability to comprehend the extent of their condition, so the ability to pick up on subtle clues is absolutely essential. Furthermore, we detox drug/alcohol patients, and if that's not medical, I don't know what is! I should add, I've been a med-surg nurse. Others I work with have worked ICU, CCU, Obstetrics, and Emergency prior to coming to our unit. Real Nurses? You bet we are!!!