Psych nursing...don't know if I can do this

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Specializes in ICU/CCU, Med Surg.

Okaaaayyyy, so I started working on a psych unit at the state hospital. I knew it wouldn't be easy. I just didn't know it would be this hard, if that makes any sense...

Psych wasn't my interest, but I didn't really know what area of nursing I wanted to do...and since this was the only job offer I had in 8 months (I graduated nursing school in June) I had no choice but to take it. And I'm going into this with an open mind...after all, ALL nurses should be psych nurses to some degree.

I just finished my third shift and I'm still in orientation. I cried today because I felt like I didn't know how to handle a patient. I didn't know what to say, what to do...and it made her angry. I don't want to give away too many details here, but basically she has some schizophrenic qualities and borderline characteristics - as another nurse on my unit said, "Total Axis II..."

What am I doing?? I didn't go into nursing for the glory or the "thanks" but I certainly didn't get into it for the abuse - both verbal and physical. Today we put two people in seclusion (and one of those went into restraints). It was a bad day.

Thanks for listening...I think I just needed to vent.

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Well first I want to say.......relax. You are not going to learn how to be a good psych nurse in 3 shifts. Knowing how to handle situations and what to say and that kind of thing will come. I would say to watch for other nurses who seem to have a good repore with the patients and watch her/him. Watch how they react and what kinds of things they say. Did they give you any kind of training before you started on the unit? Curious as with my first psych job they had us in a room with a Psych Clinical Nurse Specialist doing education on the various dx and what to expect and ways to handle things. Ways not to handle things and what not. Yes you can never be preparred for every different conversation that comes your way but that is what you will learn just practicing. With every encounter you will come away learning--what went well and what didn't go so well and you take that with you for the next situation. We all had to learn and it takes time so be patient with yourself. Maybe psych nursing isn't your thing and that is okay if you find it is not, but maybe it could be so just give it a chance. The other thing I might suggest is to do some reading on your own. There are a lot of resources out there. And have you know that I have come across many seasoned psych nurses who are still challenged by those pts with Axis II Dx. Me personally, yeah I have taken care of a few who made me want to scream but for the most part I actually learned to enjoy most of them. But really give it a chance and see what happens. I came out of nursing school boud and determined to be an L&D nurse and hated my psych rotation in school. Now I love psych and will be beginning my masters in Mental Health Counseling soon. So you never know! lol

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Specializes in Psych (25 years), Medical (15 years).

Oh, who knows? Once you Find your Groove, you just might find Psych Nursing is Your Calling.

It does happen. I won't bore you with My Story (as much as I like to tell My Story), but I eventually resolved to Bloom where I was Planted.

In all sincerity, it's important to feel like you are a Contributing Member of the Treatment Team. Please try and remember that Your Work, like Life in General, is a Learning Process. And The Work that you do is both necessary and worthwhile.

Unless we're Naturals, we just have to struggle along and Learn As We Go.

Being a Concerned Individual as you are, seeking Advice and Guidance, is aWorthy Endeavor. It speaks Volumes on the Kind of Individual that you are.

Good luck and the best to you, opossum.

Dave

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Right now I am just a student PCT on a psych unit 2 1/2 more semester to go), but I find that a smile and respect go a long way. I've been cussed out and threatened, but never actually swung on.

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Specializes in Family Nurse Practitioner.
Right now I am just a student PCT on a psych unit 2 1/2 more semester to go), but I find that a smile and respect go a long way. I've been cussed out and threatened, but never actually swung on.

This is excellent advice, being friendly, showing concern and respect goes a long way with all people especially psych patients who are often misunderstood and treated poorly in our society.

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This is all interesting to me as I am considering a change from the OR tp a psych area... I have 36 yrs nursing exp but so ready for a change. I have worked most areas of nursing and the last in the OR for 12 - 14 yrs..

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May I ask why you are leaving the OR? I'm trying to get a summer internship there but have not been able to get an observation day there yet. I was able to watch a PEG insertion and that was one of the coolest things ever.

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Sure, just worn out....

I got real tired of working long days and Management letting the doc's add on till there is no tomorrow...you work it if you are the call person, usually not a late shift so you are it. you think those shoes are great till you work on cement all day and no, no sitting stools in most OR's.. you don't have the time anyway. Then call, so tired of being called in at night for some doc because he doesn't want to mess his office schedule up...and then having to work the next day anyway.

There's lot's to learn but remember, you are in a totally different area. As an OR nurse you don't give drugs or do very little patient care. I enjoyed my time there and learned so much but time for me to find something else.

OR nurse's can be pretty rough...if you go there, get a thick skin..

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Specializes in ICU/CCU, Med Surg.
Did they give you any kind of training before you started on the unit? Curious as with my first psych job they had us in a room with a Psych Clinical Nurse Specialist doing education on the various dx and what to expect and ways to handle things. Ways not to handle things and what not.

We did have to go through a week long orientation to the hospital and get certified in a behavioral management training. I found it to be very useful thus far, I'm just not used to anything yet. Starting a job is hard enough, but trying to learn the flow of the unit while a pt is throwing food and screaming, and another is being put into restraints, etc. :uhoh3:

I know...I'm sure I haven't seen it at its worst, although everyone is saying the unit has been "high" lately. I just feel so beaten already. I feel like these patients rule the roost.

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Try to keep in mind that honing your skills to notice signs of agitation early. It's a lot easier to be pro-active. To medicate while a pt is just at the start of escalating and hopefully willing to take meds PO.....instead of waiting unitl the violence has begun and restraints and IMs are needed. So really paying attention to the little signs and acting quickly is a great skill. Pacing, rings of the hands, noticable changes in behavior, speech changes like increase in volume and rate, etc. You can probably find lists of these early signs of agitation for each diagnosis somewhere on-line. And second the better you get at verbally de-escalating situations they less you will be doing restraints. And last remember that for some pts talking to them can make them worse. For some keeping things short and sweet and giving some space and decrease in stimulation is more helpful.

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