Psychiatric nursing... do you really lose all your nursing skills?

Dragonnurse1, ASN, RN · Aug 22, 2012

In my 9+ years in the one of the three local ER's here only once did a nurse from our psych unit try to transfer to the ER - she stayed for 1 hour and requested to go home, she stated to us that the ER was too hectic and she was not comfortable with our medical protocols. We had sets of protocols to follow for say kidney stone patients, shortness of breath, chest pain and so on. The nurses often had to start treatments prior to the physician seeing the patient.

When I was in nursing school after my psych rotation I was asked to specialize in that area because I had such a good bead on PTSD, the topic I chose for my paper. I was able to get Vietnam Vets to open up about experiences they had during the war they had never opened up about before. I declined. However that ability served me well in the ER.

I went straight to the ER after graduation, had a 3 week orientation on days and then went to nights and there I stayed. I was sent to the psych unit several times for "emergency" situations - they did not keep a crash cart in the unit we had to bring it from the ER. I and others from nights routinely went to start IV's and to transfer patients back to the ER if they needed advanced care.

All that being said, depending on you and your interests and strengths, try to get into the area of nursing you want to do for a long spell of time. Perhaps you can "float" to the ER or to another unit? But I will say this - nurses that came to the ER from other units in the hospital I worked in never stayed - their biggest complaint was - too busy! (Had I not developed a severe latex allergy I would still be in the ER).

P_RN, ADN, RN · Aug 22, 2012

Not much left to add. Good advice especially the NO EXPERIENCE IS WASTED!! I've wanted to tat something like that on some co-workers who made fun of my unit (Adult total joint) not being real Nursing.

tyvin, BSN, RN · Aug 22, 2012

The inpatient psych ward I worked on had yearly skill checks for all staff that matched the med-surg area (that's where we had to do our check list). We were required to stay IV certified and attend all in-services that the other RNs had. I mean seriously...how hard is it to put in a foley.

I think it all boils down to the psych unit itself and how well educated the RN is.

Wild Irish LPN, LPN · Aug 22, 2012

I am excited for you...I am starting my trek from LPN to BSN and have been pondering what I would like to focus in on, and it always came back to Mental Health/Psychiatric nursing....that is where my true passion is....I have lived a lifetime with friends and family that have been affected by mental illness so my heart has always been there....I currently work in corrections nursing and enjoy the balance of some acute care along with obvious mental health issues, I simply want to do more for these folks but doing so is out of my scope of practice (at least for now)....I am rooting for you and wish you nothing but success!, please keep us informed of your progress....I will be eager to see how it is going.... :up:

Hallows_Eve · Aug 24, 2012

Our BH units include a fair amount of detox and rehab areas- the former especially keeps up my med surg skills as all types and conditions go through various withdrawals, from alcohol, pain meds, crack, street rx drugs, etc.

I do stoma cares, trach cares, wound care, incontinence care, foleys, IV checks and blood draws. We also look out for DTs and seizures- all told an excellent combo of medicine and psych. Whether your workplace includes detox in behavior health or not can vary, but even on the psych units we find ourselves doing a fair amount of wound care and foleys, just not as often as on a med surg floor, but to me not seldom enough to completely lose the skills, and we get the added bonus of the patients not staying in their beds :)

Elladora · Sep 5, 2012

I think one of the biggest misconceptions in psych nursing is that there is no medical care given. Psych patients have medical conditions too. You will be surprised at how many medical cares you actually perform in psych.

Feistn · Sep 19, 2012

Okay, I'm just a little ol' nursing student, but I do work at a psychiatric facility. I've taken more than plenty of residents to the emergency room for a variety of things. The emergency room isn't like TV; people come in for the mundane and the seriously life threatening. One of the things people come to the emergency room for is suicide ideation, delusions, or otherwise being unsafe. Furthermore, people with mental illness get other diseases and disorders that require treatment. They too, have heart attacks, cancer, diabetes, COPD and many other issues. In fact, they may have more than the general public, as the life expectancy of someone with a severe and pervasive mental illness is like 65. Last time I took a psych patient to the ER, they had me, a non-employee, lead her back into the "secured" ER because the medical staff was literally deer in the headlights. I don't know anything about transferring, but telling someone that they might lose their Foley and IV skills kinda sounds like some people don't think you're a "real" nurse unless you do these things all the time.

OneDNP · Sep 20, 2012

@Feistn - awesome points. A large percent of ER visits are related to mental health disorders, domestic violence, and intoxication of some form. These patients encounter a lot of stigma and are often labeled by their disease and their complaints neglected as a result (yes, people with bipolar actually can have a stroke!). Admittedly, psych is not the best place to start if the ER is where you want to be, but it is not because of losing your familiarity with physical tasks, but with the differences in prioritization and time management. If there is any way you can float to a med-surg unit with monitored beds or to a step-down unit, you would have the most comprehensive foundation for an ER career. Or, you may like mental health so much that you will want to work in the psych-ER!

natasham11 · Mar 7, 2013

I agree with the last 2 comments above. I have worked at the State Hospital (obviously psych) for 5+ years and graduated in Dec. 11' with my ADN. At first, it was difficult for anyone to call me for an interview in a medical field, and I was getting frustrated, cuz let's face it, if you work psych for a period of time you will get easily irritable and burn out! Finally, after 6 months I stared getting calls for ER positions, L & D positions, and Med Surg positions I applied for. They were offering me jobs left and right. ( Keep in mind I've been in psych for 5 yrs and a CNA before then) I was a total believer that if I didn't get out of the psych field I would lose everything I dreamed of going to school for. ER gets SOOOO many psych cases, they actually benefit from someone with experience since a seasoned psych nurse knows how to handle a manic, grandiose pt that comes to the ER thinking he's Obama and recites the Bible with his eyes closed. Every field has psych related somehow. Depression, anxiety, you name it. I decided to stay in psych and I absolutely love it. Just remember, anyone can say they worked in ICU, Med/Surg, Neuro, ER, OR, or whatever field, but how many can say they survived years in psych? Not many. It takes a special person to work in this field. PLUS, the pay is so much nicer, and working for the State offers way better benefits.

For the " you don't use it you lose it" part: I've removed countless sutures and staples, removed IV's that "medical nurses" forgot to take out, responded to many codes for cardiac arrests, seizures, anaphylactic reactions, you name it, I've pretty much done it. The only lacking part is IV's. I am not trying to talk down about any other field, but no one single person can say they've handled a day in psych AND survived until they dealt with a borderline pt cutting themself and leaving a blood trail up the hall, a person detoxing off whatever drug they were using with a CIWA score of over 20 and b/p thru the roof among other withdraw symptoms, 4 admissions, a man who thinks he is Jesus and "saving" all the other pts for their sins, a pt whose blood sugar dropped thru the basement and gotta get it back up ASAP, and then convincing the old man that the person whom he is speaking with is just his reflection in the window, and not his boss. ( these are all examples btw...)

So if you wanna try psych, go for it. Don't let anyone elses opinion make you choose otherwise. You won't if you like it til you try it! Every day is unpredictable in psych. Mental health is just as important as medical health!

lilmoongoddess · Jun 27, 2013

I want to give an update on my earlier post. I was initially scared about losing all my 'clinical skills' and I must say that the first mental health unit I got hired on was not an overall positive experience. The older nurses were mean to the younger nurses, as well as the patients. Nurses on the unit were not allowed to start IVs or take blood. I am happy to say that I have since moved on to a different mental health unit in another hospital and since the unit takes patients even before they are 'medically cleared,' nurses have many opportunities to practice their 'clinical skills'. :) I will be IV certified, I will take my own blood samples, I will perform blood transfusions, etc... so things are looking good and I have fallen in love with psychiatric nursing :) now my long-term goal is to work in the psych ER or in the community :)

Meriwhen, ASN, BSN, MSN, RN · Jun 29, 2013

so things are looking good and I have fallen in love with psychiatric nursing :) now my long-term goal is to work in the psych ER or in the community :)

Another one joins the dark side :)

Psych ER is fun, you'd like it. But it's not as medical as the name makes it seem. In the psych ER, you're dealing with patients who are in acute psychiatric crisis--a majority of them are/will be under holds when they arrive, but there's a fair number of voluntaries. There's also lots of intoxicated/stoned/high patients coming in too. But if the patient is medically unstable (e.g., unresponsive, MI), they're going over to a medical ER.

Monica H. RN · Sep 1, 2013

I am so glad to hear this, as I too am getting ready to start a new position in a state facility. I graduated in may this year and at first I was disappointed that I did not land the "new grad" med surg job at a local hospital; however, I have always liked psych and feel like this will be the place for me. I have heard hat it's good to start in med surg but now I believe psych is where it's at. My facility does med surg skills as well as long term psych and I am excited to be a part of their team! Congrats to you on hanging in there, I hope I will be the next to post a good experience :)