Psychiatric/ER nursing advice!

Sour Lemon · Aug 30, 2018

Hello colleagues,
I am an accelerated nursing student at Creighton University in Omaha, NE who will be graduating this December. I've developed a deep interest in psychiatric nursing after finishing my mental health rotation, but I also have always been very interested in ER nursing. I just recently joined the APNA so I have not posted before, but I am looking for some advice/guidance from all the experts out there on career options I should pursue with these interests.
If you have been in my shoes, if you have any experience/interest in both fields, or even if you just have some knowledge about the field and potential careers that I may lack (as I am still new to the healthcare world), please feel free to share! I love mental health nursing and performing behavioral health assessments, but I also love the rush and excitement of emergency nursing and the technical skills that accompany the position. I've heard of float pool nursing, but it seems rare to be able to float between psychiatric and emergency nursing. I'm also aware of the fact that the ER sees several psychiatric patients every day, but I don't have enough clinical experience to really see how a nurse can care for both a patient's admitting diagnoses, as well as their mental health.
Any advice is welcome, and thank you so much for your time!
Thank you,
Riley

Telemetry might actually be a good start for you and would be useful as a stepping stone to ER. Psych patients are absolutely everywhere, so you'll get experience with them no matter where you start. If you're not 100% sure about psych as a long term thing, I'd advise not starting in a straight psych unit that only deals with medically cleared patients.

Carpediem1012, BSN, RN · Aug 31, 2018

Have you thought of prison nursing? Both areas are covered quite easily there!

AnnieOaklyRN, BSN, RN, EMT-P · Aug 31, 2018

I say go into the ER, as most are beyond overloaded with psychiatric patients now. Most ER nurses would LOVE to have another nurse who actually enjoys caring for those patients, so that they don't have too. There is a ton of burnout in ERs now because of this.

Annie

verene, MSN · Aug 31, 2018

They aren't super common but dedicated psychiatric emergency departments exist - we have one in my city. It might combine the best of both worlds for you. It's mental health focus and getting to use solid psych nursing skills + the rush of an emergency department with lots of triage and assessment and never knowing who/what is going to walk in the door next.

You might also look around for a medical-psych unit, which is a combo of med-surg and psych and could set you up well for going a number of different directions down the road.

RNperdiem, RN · Aug 31, 2018

I was just reading some articles about the long waits in ED for psych inpatient admission. There is a dedicated section in my hospital's ED for mental health needs. There is a big shortage in my state for inpatient beds, so ED is a big overflow area. If this is what you want, you get to combine your interests.

rmjones003 · Aug 31, 2018

I was actually just introduced to corrections/prison nursing today, when talking to a professor! I like the idea, it sounds exciting. However, she did mention the pay is relatively low for that field of nursing.. is that correct? Thank you all for your replies! I will definitely be on the lookout for dedicated psychiatric EDs. I will likely apply to both fields, try and float, or at least start in the ER and go from there.

rmjones003 · Aug 31, 2018

I say go into the ER, as most are beyond overloaded with psychiatric patients now. Most ER nurses would LOVE to have another nurse who actually enjoys caring for those patients, so that they don't have too. There is a ton of burnout in ERs now because of this.
Annie

Thank you for this comment! That's good to hear, and I would love to keep my skills up in the ER and would gladly take psych patients off other ER nurses' hands.

FolksBtrippin, BSN, RN · Sep 1, 2018

You sound like me!

I went to nursing school with the idea of going into psych, then got interested in the ED. I also was in an accelerated program.

Now I work on a community mental health team. We care for seriously mentally ill people who are refusing tradtional outpatient treatment. Google ACT team mental health if you want to learn about that job.

Does your school have a leadership/capstone class last semester where you get to choose an environment for your last clinical? If so, choose the ED.

Where I live corrections nurses are not paid less. So this may vary based on geographical location. I make a little less money working in the community, but I am salaried and I don't work weekends or holidays. I also love the work I do as compared to how I felt in the hospital. There is a lot of crossover between psych and corrections, so I know a lot of nurses who do both. In general the nurses I know who work in the prison love it.

Some other jobs that combine your interests:

1. Crisis nurse. Crisis screening is generally done in the ED. Some EDs are split with a psych ED and general ED. The crisis nurse may also be a licensed mental health screener. The mental health screener collects all the info related to the patient's visit and determines whether an inpatient admission is warranted or not. Very cool job and very exciting.

2. SANE nurse. Stands for sexual assault nurse examiner. In my state, sane nurses work for the county. They work on call. When a patient presents to the ed with a sexual assault, the doc medically clears the patient and then the sane nurse does everything else. She collects and processes all the evidence; both physical evidence and the personal account of the patient.

Either inpatient psych experience or ed experience would be a good start to your career path. It would be somewhat easier to go from ed to psych, but I personally know nurses who have gone the other way. Not impossible. Inpatient experience is the gold experience in nursing.

I really think getting some clinical experience in an ed will help you get a better idea about where you want to be.

Feel free to PM me.

rmjones003 · Sep 1, 2018

You sound like me!
I went to nursing school with the idea of going into psych, then got interested in the ED. I also was in an accelerated program.
Now I work on a community mental health team. We care for seriously mentally ill people who are refusing tradtional outpatient treatment. Google ACT team mental health if you want to learn about that job.
Does your school have a leadership/capstone class last semester where you get to choose an environment for your last clinical? If so, choose the ED.
Where I live corrections nurses are not paid less. So this may vary based on geographical location. I make a little less money working in the community, but I am salaried and I don't work weekends or holidays. I also love the work I do as compared to how I felt in the hospital. There is a lot of crossover between psych and corrections, so I know a lot of nurses who do both. In general the nurses I know who work in the prison love it.
Some other jobs that combine your interests:
1. Crisis nurse. Crisis screening is generally done in the ED. Some EDs are split with a psych ED and general ED. The crisis nurse may also be a licensed mental health screener. The mental health screener collects all the info related to the patient's visit and determines whether an inpatient admission is warranted or not. Very cool job and very exciting.
2. SANE nurse. Stands for sexual assault nurse examiner. In my state, sane nurses work for the county. They work on call. When a patient presents to the ed with a sexual assault, the doc medically clears the patient and then the sane nurse does everything else. She collects and processes all the evidence; both physical evidence and the personal account of the patient.
Either inpatient psych experience or ed experience would be a good start to your career path. It would be somewhat easier to go from ed to psych, but I personally know nurses who have gone the other way. Not impossible. Inpatient experience is the gold experience in nursing.
I really think getting some clinical experience in an ed will help you get a better idea about where you want to be.
Feel free to PM me.

Hi FolksBtrippin,

Thank you so much for all your advice, I am glad to hear someone who has gone down a similar path as me! I will definitely look into corrections nursing and outpatient mental health jobs. I agree, I think as of now, I will opt for my capstone to be in ER and then if I want to switch or look elsewhere, it won't be too difficult to do that.