Psychiatric Nursing

[lheinzelmann]

I am currently enrolled in an ADN program possibly interested in Psych ED nursing, as I am going through that rotation right now in school. Just wondering if I could get some more information from experienced psych nurses...Is there any market for new grad nurses in a psych ED? What kinds of skills/competencies do you need to have? I have heard medical skills are not really used on a psych ED? What is the orientation period like/how long? Do you need any additional certificates (like acls?)? Thanks!!

[chevyv, BSN, RN]

I'm in WI and landed my first RN job working psych so yes, there are openings. I am also a graduate of an ADN program. My employer is expecting 60+ nurses to retire at the end of the year d/t changes with union contracts. I would bet they will be hiring all new nurses as we are on a pay freeze so have faith and good luck!

[Meriwhen, ASN, BSN, MSN, RN]

Psych ED isn't quite like a medical ED. You are dealing with patients in acute psychiatric crisis--medical problems may or may not be part of the package. Depending on your facility, you may ship your psych patients to a medical ED for treatment first, or you may be able to provide both.

You will see a wide variety of patients, just like in a medical ED: you have the patients coming in with the psych equivalent of a STEMI, and then there's the ones that are there for the psych equivalent of an earache or who are just seeking meds. Most patients are often brought into psych EDs on an involuntary status and aren't happy to be there, but once law enforcement leaves they are now YOUR problem--unlike voluntary patients who can walk out AMA, involuntaries can't. In addition, depending on your facility, you may be dealing with indigent patients as well, those with low income and/or without insurance...these patients tend to see the psych ED as their personal outpatient clinic.

Can new grads get hired in a psych ED? Sure. Like medical EDs, it's a steeper learning curve but not impossible. They do prefer nurses with prior psych experience though, because you need to have your assessment, communication and medication administration skills down pat...especially when you're dealing with a high volume of patients that aren't always AOx4 and/or cooperative.

So definitely look at psych EDs when you graduate, but don't count out any psych job you see--instead, think of it as a way of gaining experience and a stepping stone towards the ED. I work part-time in a psych ED. Having a couple of years' of inpatient psych experience before getting there helped me tremendously. I started alongside some new grads who had a tough struggle for the first few months (most made it though so there's hope!) while I had few problems getting into the environment.