Psychiatric Nurses and Safety

Zelda, RN · May 7, 2016

I worked on a child psych unit for 6 months. I loved the work, and left due to administration and short staffing rather than due to my patients. We actually had far more violence on the kids side than the adults - I've been bit, hit, etc. De-escalation techniques saved my butt so many times.

I prefer psych patients in a psych unit vs psych patients in an acute medical setting... Quiet rooms, standing PRNs of Seroquel and Zyprexa, physicians not afraid to give Ativan or Haldol, security ready to respond at a second's notice, coworkers who are also skilled at de-escalation and holds are all reasons I feel far safer on an acute psych unit.

In psych, you have to be tough but fair. You have to know when to push and when to give. Some nurses struggle with this. Identify your triggers - we had one boy who was upset about something trivial. Someone asked him to go to his room for a "time out" (meaning a break). He took that to mean he was in trouble and became even more agitated. I stepped in and backtracked quickly, telling him it was not a time out, just a break. We got him to bed with only his HS melatonin and no restraints. It doesn't always turn out that well, of course. Some days there are seven people holding down a 250 lb 15 y/o girl so you can give IM Benadryl.

I miss my psych job dearly, even though I love my job I'm currently at (peds med/surg). The hardest part of psych for me is that nurses are treated almost as an afterthought to social workers.

My coworkers were unlike any I've ever had. Psych requires a certain cynicism, a dark sense of humor, and an ability to read between the lines and think quickly. You also forge a sense of camaraderie that is not easily broken, since it's hard to break a friendship that is forged on the tense bonds of "is he going to throw that chair at us or...?" (he didn't, by the way, thanks to some quick talking and some quick security guards).

RebecaRN · May 13, 2016

I've worked inpatient psych for five years. Of course I've had some bad experiences but also many rewarding ones. I don't believe that there is much difference in psych vs other inpatient units except you are more aware of potential situations thus pay better attention to cues provided by the patients when working psych. If psych is your dream go for it!