Changing Attitudes of a Psych Nurse

Meriwhen, ASN, BSN, MSN, RN · Oct 7, 2014

Unfortunately, a lot of psych patients don't want to participate in their treatment, and you (general) have to get used to hearing "NO!" from them. This attitude is even more prevalent in detox/recovery settings, usually because the patient doesn't feel they have a problem and were often coerced/pressured/forced into seeking treatment. And as long as there's no court order in place indicating otherwise, you need to accept their refusals. And learn not to take anything personally.

This doesn't mean you have to take all of their verbal abuse willingly...in fact, you can and should set boundaries for their behavior, and refuse to tolerate rudeness. More than once I've told a patient that I will come back to talk to them when they stop being abusive and calm down, and then walked out of the room. When they see that I'm not going to tolerate it, they usually dial it back. If they persist, I'll bring the MD in, and I've worked with doctors who have not hesitated to discharge CD patients that are being abusive to the staff. And the threat of THAT from the MD usually fixes things because discharge means no meds :)

Now, I've had more than my share of frustrations, but I can't say I've ever wished for a patient to act out so I could go all Bruce Lee on them...and I've been doing this for a few years.

Do I think you're a bad person/nurse for feeling the way you do? Not at all. But the fact that you feel like this isn't a normal part of the psych nursing culture IMO. It sounds like you might be burnt out and need a new patient population to work with, or even a break from the specialty.

wingding · Oct 7, 2014

Thanks to the input - I do think I am burning out some. After looking at this & having my weekend time way from work, I know there was a trigger from this one particular patient - will need to address that in myself. Also, I am guessing that no vacation time in 2 years may be a contributing factor of burn out. Not ready to change jobs, I do believe in our process - but will have to re-evaluate how I will go forward handling young abusive men so I handle appropriately.

vegnurse21 · Oct 7, 2014

I had to leave bedside psych nursing for the exact reasons you mentioned in your original post. I was having nightmares about knocking a patient out cold because they can just be such jerks. I DO still have all the empathy and caring in the world for psychotic, depressed, and demented patients. They are not included in the nightmares part lol. I'm talking about all of the addicts who do this nonsense and keep getting away with it. And with heroin being so huge right now we have so many of those. I saw a lot of patients who genuinely needed care get pushed out of the way by drug addicts who knew exactly what to say for three hots and a cot for a few days.

I still love psych but I had to move on. I miss my coworkers and genuine patients but I am so glad I left.

Davey Do · Oct 9, 2014

It sounds as though what you're experiencing is a normal progression of some desensitation and acceptance of your own and others' abilities and limitations, wingding.

This progression as a Psych Nurse can be a healthy transition, albeit a tough one. Realizing the reality of a situation and accepting that reality can be ardorously deflating to our old starry-eyed selves. However, that realization can also be illuminating and revelatory in changing our consciousness and expenditure of energy.

Point in fact:

I seem to still have the compassion for truly psychotic or depressed patients

means you are able to spend energy on those who will utilize your expenditure of positive energy.

Currently, it appears that you are experiencing a broad spectrum of reactions:

almost looking forward to trying some CPI skills on the squirrely jerks (just drug addict jerks who bully, not really psychotic) & holding down to put into restraints.

This sounds almost like you have a need to punish others for your pain and take it out on those you deem need to suffer.

This is not good. However, this also does not mean you are "broken", wingding. This merely means you have a need to deal with your pain in a more therapeutic manner.

Venting and processing with a Therapist, exercise, mediatation, yoga, art, etc. etc. are more therapeutic ways of dealing with pain than merely being sadistical.

Check out an EAP (Employee Assistance Program) that may be offered by your Employer.

I speak with the voice of experience.

The very best to you, wingding!

wingding · Oct 9, 2014

Thanks, good advice. Sometimes I don't realize exactly what's getting to me until I voice it -- like this experience. It was eating me why just this one & was it going to continue? Couldn't put my finger on it until I put this up for discussion & started reading. A little bit of everything -- meaning, he reminded me of someone from my long ago past(not wanting to punish others, just this one); I am getting desensitized & not afraid so much; Working on developing boundaries with these types of patients - without the fear; and lastly, I am in dire need of a vacation - seems after 2 days off, I don't have those feelings anymore. I believe it is up to me to figure out myself & non therapeutic feelings so I can work with these patients effectively & learn, learn, learn, from the nurses with much more experience at this than myself. Hopefully my emotional pendulum will settle in the middle quickly & I can have better 36hr. weekends & with a little luck, approved time off!

MSNce1 · Oct 10, 2014

Wingding,

I agree with Silver 4 and 2. Breaks and emotional support are mandatory for all nurses. I have heard that psychiatrists have to go see other psychiatrists to help them stay balanced. Did you ever see the movie 'What about Bob'? the psychiatrist in that movie was very pragmatic and wound up tighter than a drum. If we think of our clients and ourselves as victims rather than survivors, then we will always be as such.

Long Term Care Columnist / Guide · Oct 11, 2014

I'll be honest with y'all---I don't know how you do this work. As a patient I know I'm no picnic, but you deal with a lot harder cases than mine every day and I admire you for doing it so well in most cases. In another life I would have liked to work in psych, but I think I'd be too much of a softie to be effective. There are times I actually feel sorry for my own psychiatrist, who is very much an empath himself and sometimes he's almost as distressed by my circumstances as I am. But he knows where to draw the line, where I would have trouble with over-identifying with the patient. Which is why I'm not a psych nurse. :yes:

wingding · Oct 11, 2014

Viva - psych actually keeps me grounded. Working with those who need help & can't help their condition, those that could help their condition & those that won't help themselves & are waiting for rescue reminds me how real life is. Luckily I am able to recognize when my thoughts start going askew (obviously too much stress) & that I will still have that learning curve as I figure out where I stand & how I stand. Thought I'd be there by now, but apparently, I learn slow. Being able to reach out to peers in the same field is invaluable to me when I have no one to talk to. Sure I could get a therapist (see $3,000 deductible for OON providers), however, what I really need is to double check with an "is this normal" question every now & then. I re-evaluate myself & my nursing every shift, every weekend & try to find what was done right, what was wrong, what I could have done & how it will be done in future. Sometimes the bump in the road is just a bump, but I am always stopping to make sure it isn't a person. The honesty of those responding is appreciated & not bashing me for having darker thoughts on occasion is greatly appreciated.

psychRNmom2 · Oct 12, 2014

Thanks, good advice. Sometimes I don't realize exactly what's getting to me until I voice it -- like this experience. It was eating me why just this one & was it going to continue? Couldn't put my finger on it until I put this up for discussion & started reading. A little bit of everything -- meaning, he reminded me of someone from my long ago past(not wanting to punish others, just this one); I am getting desensitized & not afraid so much; Working on developing boundaries with these types of patients - without the fear; and lastly, I am in dire need of a vacation - seems after 2 days off, I don't have those feelings anymore. I believe it is up to me to figure out myself & non therapeutic feelings so I can work with these patients effectively & learn, learn, learn, from the nurses with much more experience at this than myself. Hopefully my emotional pendulum will settle in the middle quickly & I can have better 36hr. weekends & with a little luck, approved time off!

This is called countertransference. Something we need to be aware of especially in psych nursing. When you are experiencing this, I suggest to talk about it with your colleagues and ask for them to take over care for the patient. You will not be doing anyone any good if you can't be therapeutic.

nickfitz1969 · Jan 13, 2016

Thanks to the input - I do think I am burning out some. After looking at this & having my weekend time way from work, I know there was a trigger from this one particular patient - will need to address that in myself. Also, I am guessing that no vacation time in 2 years may be a contributing factor of burn out. Not ready to change jobs, I do believe in our process - but will have to re-evaluate how I will go forward handling young abusive men so I handle appropriately.

You have answered your own question!