Psychiatric emergency nursing

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Hi all. I just recently got hired to my first hospital position working in the Behavioral health emergency department. I am excited and nervous. I have no experience as a psy nurse or emergency room nursing. Any pointers on what to expect would be truly appreciated. Thanks.

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First off, congratulations on your new job! :)

I have worked as a psychiatric nurse since I graduated nursing school in 2012. I first worked in an adult inpatient psych ward and after a year and half I got a job in a busy psychiatric emergency room. I have been working in the psych ER for 2 1/2 years now. It depends on where you're at I would assume, but here are some pointers I can think of from a perspective of a busy psych ER in the city.

The layout of the psych ER I work in is set up in two rows in what used to be an old gymnasium at the hospital. There are recliner chairs on both a female and male side and we have three quiet rooms used for restraints/to help a patient calm down/patients who can't leave other patients alone or are aggressive and need to be away from others. We have 40 patients, constantly admitting people and moving people to inpatient units, discharges, transfers, etc. Oh, and btw I work night shift.

-Our "code purple" is code for aggressive patient and we have them multiple times a shift majority of the time (happens in the ER and inpatient units) and this means that multiple staff members from other units (there are multiple adult inpatient units at my hospital as well) respond to deal with the aggressive patient. We use 4 point restraints frequently and if the patient begins to head bang or thrashes, we use both upper and lower torso belts for further restraint to keep the patient as safe as possible during their behavioral crisis. We do have patients that assault one another as well,

-You will be constantly "putting out fires", if you will. You will get frequent fliers and some of them might be demanding. Others will be coming in intoxicated on drugs and amped up to the point of needing emergent medications and restraints (meth, PCP, cocaine, ETOH sometimes if they can't calm themselves, etc). You will have extremely suicidal patients that can't be left by themselves or they will try to hurt themselves. You will have your borderline personality patients that will act out when chaos is occurring. Also, a word of advice, do not EVER be in a room with a patient alone. Always take another staff member with you JUST in case. It is always better to be safe than sorry and psych patients are unpredictable and based on personal experience, I never trust them because I have seen SOME the nicest, calmest patients flip out and assault staff. Of course your gut instinct can tell you a lot about patients and definitely not all nice, calm patients will assault staff, but I would rather be safe with another staff member then get punched while no one else is around to help me. I don't mean to scare you, but it is a reality that I want you to be aware of. Always be aware of your surroundings and always consider what is the safest thing to do for you and your patients. Verbal de-escalation doesn't always work but it is best to give it a try to help build a rapport with the patients.

-As corny/cliche as this might sound, please don't be afraid to ask questions! I have been working here for 2 1/2 years and I still ask questions if I am unsure of something. It is in your best interest and the patients best interest for you to educate yourself on something you are unfamiliar with. It only ends up benefiting you and the patients you care for.

-You might feel overwhelmed quickly after you start your new job but don't let the newness of it all ruin your outlook on psych ER nursing. It is a totally different world and despite sometimes feeling like I don't make a difference, it seems a patient comes along and reminds me why I do what I do when I really need it the most. It is humbling to have that one patient that thanks you for what you

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do and is truly sincere and wants to get better.

In all honesty, this job is very draining emotionally, mentally, and physically. But give yourself a chance to get acclimated to the craziness (pun intended :)) of it all. You will learn a LOT about yourself, your coworkers, and everyone else around you. I find it to be invaluable experience and it will aide you wherever you decide to go in nursing because psychiatric patients are in every unit of every hospital, I can promise you that.

Hope that helps, even if only a little bit! Best of luck to you.

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Thank you very much! It definitely does give me a better prospective on what I'm going to be getting myself into. I intend to learn as much as I can and hopefully gain a passion for it. Thanks again.

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