Psych rotation coming up.. not excited about it, should I be?

Nurse Kyles, BSN, RN · Mar 11, 2011

I wouldn't sweat it. I just finished my psych clinical yesterday, and I really liked it. It is an area where you really get a good chance to practice your therapeutic communication skills. I had a PM rotation, which was really laid back. Depending whether we were on the

Adult or adolescent unit, things were a little different. The adolescent unit was very structured, whereas the adult unit had more free time. We often got to play games with the patients (which often was the best time to communicate with them, because they weren't so guarded). One time we even got to make cookies. The adolescents had group at night, which was very, very interesting. Unfortunately the adults had most of their groups during the day, so we didn't get to participate. Overall, I thought that psych wasn't what i thought it would be. It was much better! Perhaps you won't like it, but just try to have an open mind about it! ( i say this because i just now read your username and notice you are futureobnurse. I felt the same way about OB as you feel about psych. I have to say after my OB rotation I knew for sure i would NEVER EVER want to be an OB nurse. Lol! I am happy that i had that experience, though.). Good luck to you! :nurse:

CBsMommy · Mar 11, 2011

I was SURE that I wouldn't like my psych rotation and felt SURE there was no way that I could make it through either. I had dreaded the class and the clinical from the onset of school. Both the class and clinical were so laid back, it felt like a little mini vacation. I was on an acute unit, which I was scared to death to go to, but I got to see the most interesting situations and meet some great patients and staff. And while I thought that therapeutic communication was ridiculous before the start of class, while actually trying it out with some patients, it really does work. Just try to go in with a clear mind and try to think of it as learning how to communicate with patients and you will get through it, and may actually enjoy it. I did! Good luck!

FutureOBNurse2118 · Mar 11, 2011

I was SURE that I wouldn't like my psych rotation and felt SURE there was no way that I could make it through either. I had dreaded the class and the clinical from the onset of school. Both the class and clinical were so laid back, it felt like a little mini vacation. I was on an acute unit, which I was scared to death to go to, but I got to see the most interesting situations and meet some great patients and staff. And while I thought that therapeutic communication was ridiculous before the start of class, while actually trying it out with some patients, it really does work. Just try to go in with a clear mind and try to think of it as learning how to communicate with patients and you will get through it, and may actually enjoy it. I did! Good luck!

I think my feelings come more out of a "not knowing what to expect, and fear of being uncomfortable" kind of place.. What types of patients were you exposed to?? I've just heard stories from other people that were in my program previously and the clinical experiences that they've had with their psych rotations in the same clinical sites. I was told that a girl who was in my program before had to go in and do an interview with a man before looking at his chart or knowing anything, and turns out he was a pedophile.. wow.. don't know how i would handle that one.

sandyfeet · Mar 11, 2011

You are exposed to all types of patients on a psych unit, but I want to point out that you are exposed to all types of patients in regular settings too. Just because they are not wearing their psychosocial problems on their sleeves doesn't mean they don't have them! (I just had a psych patient in Med-Surg yesterday.) So you treat them just like normal people and you work at their level. And you are safe.

The stories...don't listen to the stories. The most horrible ones are passed around, and the stories about how it was just a normal day or even that nothing exciting at all happened never get passed around, so it's not an accurate view. I had psych last semester and I wasted a lot of time worrying about being with certain patients. It was just a waste, really!

On my rotation, most of the patients were there for drug/alcohol problems, anxiety, or suicide attempts. There was one patient that was there for threatening to kill her parents, and it just so happened that I got to watch her progress (through our rotation) from that state, through inpatient treatment in a locked unit, to outpatient treatment where she was making goals and doing great things with her life. It was amazing to watch her transformation. I talked to her many times and even though I was afraid at first, once I got to know her history and story she was just a person with problems, trying to work them out.

Just go in with an open mind and practice your therapeutic communication!

CBsMommy · Mar 11, 2011

I think my feelings come more out of a "not knowing what to expect, and fear of being uncomfortable" kind of place.. What types of patients were you exposed to?? I've just heard stories from other people that were in my program previously and the clinical experiences that they've had with their psych rotations in the same clinical sites. I was told that a girl who was in my program before had to go in and do an interview with a man before looking at his chart or knowing anything, and turns out he was a pedophile.. wow.. don't know how i would handle that one.

I got to see a lot of different patients from patients just coming in off the streets with severe cases of schizophrenia or mania to patients that were fully medicated for months/years. Before I started psych I was also really scared of the unknown, exactly like you are now. And my first couple of interviews, I did sit down with the patients without reading the charts and didn't know what they were there for.

As for pedophiles, just remember that some of these people have walked a very hard line in life and some have previous abuse. I know that it's hard not to judge, but really, we can't as nurses. It's not easy but it can be done. You will be fine. Just go in with an open mind and know that anyone can do anything for a few weeks. If nothing else, you will learn a lot about YOU. Keep us updated!

pitaya · Mar 11, 2011

I think my feelings come more out of a "not knowing what to expect, and fear of being uncomfortable" kind of place.. What types of patients were you exposed to?? I've just heard stories from other people that were in my program previously and the clinical experiences that they've had with their psych rotations in the same clinical sites. I was told that a girl who was in my program before had to go in and do an interview with a man before looking at his chart or knowing anything, and turns out he was a pedophile.. wow.. don't know how i would handle that one.

You handle them just like you would any other person - with respect. You don't bring up their past issues, don't ask them directly about it. Just find out where they are now - how was their week, how are they today, what are they working on? On some units, all of the patients may have a criminal record, but if you let that affect how you see them when you are talking to them, you won't be able to build trust with them and your fear will overtake you. You can learn a lot from the patients by talking to them. Mental patients on meds and receptive to treatment are different people than they were without their meds and before their treatments. Think about how they feel...it can be scary for them to talk to you, a stranger, who may possibly have read their whole chart already and have preconceived notions about them when they don't know a single thing about you!

ImThatGuy, BSN, RN · Mar 12, 2011

I'm starting to think psych is going to be my area. I really enjoy pathophysiology and pharmacology material (used to teach biology and chemistry) so that type of thing appeals to me. I like learning about it and applying it, but it more or less stops there. The whole hands on treatment thing isn't so much of a reward for me. Psychology was an interesting class with my first degree. I actually took seven psych classes back then and started to major in it. At any rate, I'm in my psychiatric nursing course now. I enjoy reading the book, and I think working in a psych setting would be kind of neat. I'm not positive about that because I think being the psych NP would be neater, but like you I dreaded the idea of a psych clinial - just sitting and talking to blabbering people. At any rate, we don't have psych rotations, but we had to do a self-initiated "observation" in a psych related setting. I chose a detox/addiction rehab location. I actually enjoyed it. I saw addicts from a different angle than I'm used to. (Most of my career has been in police work.) At least I believe I'd enjoy working as an RN in that environment. My past work experience has taught me to calm people, de-escalate emotional situations, and be perhaps not "comfortable" but likely more prepared in handling a potentially hostile or physical encounter. That intimidated some of my classmates in respect to their observation experiences, but to me that kind of thing just adds diversity to a day, lol.

You've had mental health lecture so you've had the statistics, but in reality it's surprising at the number of people you run into everyday with mental health disorders or outright psychiatric diseases. Most of them are medicated or in enough therapy to appear "normal." Trust me, I've run into them in their homes, on the streets, and places of work. They're out there. You see them everyday.

With respect to therapeutic communication most of it still seems kind of silly. I say that meaning that a lot of what nursing school teaches, particularly the psychosocial material, seems to be total common sense; only nursing school applies a label to it. The more opportunities you have in life to interact with diverse people in diverse settings in diverse circumstances the more you'll be able to communicate, and you won't be thinking up those nice labels such as "exploring or reflecting" in your mind while you do it. You'll just know what that person needs.

To summarize, keep an open mind. I did it just go get points, but I ended up really liking it. I didn't think I'd have a problem with it. I just didn't think I'd enjoy it. I was wrong. I can't speak anything but positive about it. I found it to be rewarding.

decembergrad2011, BSN, RN · Mar 12, 2011

I love psych.

I saw people with schizophrenia, bipolar disorder in manic and depressive states, psychosis, lots of substance abuse, suicide attempts, some personality disorders, PTSD, and abuse cases.

The stories are sad sometimes. We were required to ask about past history of abuse and addiction, so that would open up a can of worms sometimes. I was on an acute unit so it was difficult to get corroborating information and you have to take everything the patient says at face value.

Yes, you might come across individuals with anger problems, who have abused themselves or others, or who are highly impaired with a mental illness if you are on an acute unit. But it is extremely interesting, and if you can learn to communicate with those with mental illness, you will have an easier time doing it with those without. And as others have stated, working in med-surg, OB, or peds won't keep you from seeing psych patients or having a need to communicate with them.

AOX4RN, MSN, RN, NP · Mar 13, 2011

Well think of it terms of your future goal as an OB nurse: lots of pregnant women and their families have psychiatric disorders (mood disorders of pregnancy for one) and you need basic exposure. Birth isn't all rosy like on TV... you have addicts and schizophrenics who are pregnant with the babies of bipolars and antisocials... or will have PPD or PPS... or they have a history of abuse... and they are going to end up on your floor someday. Enjoy it :)

I'm a midwife and thinking strongly of getting my continuing education in psychiatric nursing. I hear from a lot of my birth professional friends they have a pull toward psych too. It's all about communication and this is the perfect place to learn about it in depth without worrying about med schedules and morning assessments.

Natkat, BSN, MSN, RN · Mar 13, 2011

. I was told that a girl who was in my program before had to go in and do an interview with a man before looking at his chart or knowing anything, and turns out he was a pedophile.. wow.. don't know how i would handle that one.

You would handle it professionally and give him the care he needs. Wen I deal with prisoners I have the attitude that whatever they did is not my dillema. If it was I would have gone to law school. I focus on my job and let the justice system do theirs.

Try and get the most from your psuch rotation. No matter where you end up working you will have to deal with mental illness. It will be in your best interest to learn how to work with them. Mental illness is an illness. They can't help it and would gladly trade it for something else. They need our compassion and our best communication skills. Its also good practice to learn boundaries. These are valuable skills and someday you will be very glad rhat you have them. Have fun and best of luck.