Do I NEED Med-Surg training to be a psych nurse?

CharlieRN · Aug 22, 2004

I don't think its your imagination. Insurance companies are applying constant pressure to only admit the sickest patients. They would like to have only duel diagnosed patients on inpatient units. In the fantasy world they live in there are no single dx psych pts who can't be managed outpt. So we get sicker and sicker patients.

Also there is the turf thing, med hospitals find psych pts a problem to manage so they want to place them somewhere else. They don't realize that just cause it says "hospital" in our name does not mean we are prepared to handle physical illness. Since I have worked both sides of the street I have some insight into this. I can remember being irrate when the psych unit refused to accept one of our pts because she was bed ridden. I actually said, "What's the problem, they have beds don't they?" Later I worked on that psych unit and found out that infact they did not have beds! The clients slept on day-beds that became couches during the day.

CHATSDALE · Aug 23, 2004

I work psych and i would say that over 90% of our residents have a chronic physical ailment....whether cause, result, irrelevant to issue who can say....but you need to know what to look for...esp in dealing with pts who are confused and unable to articulate their needs and/or pains....if you choose to go into psy ch you may not need a lot of M-S internship but you must be observant to the needs of those who depend on you for care

Thunderwolf, MSN, RN · Oct 6, 2004

Do you "have" to have Med Surg experience?....the answer is NO. However, the best psych nurses that I have had the pleasure to work with have had previous medical or med-surg or critical care experience under their belt. Psych patients rarely are "just" psych patients. Many have genuine physical health care problems that need addressed concurrently with their mental health problems. Often, you will see an overlap between the two. Nothing is more disheartening than to work with a fellow psych RN who has a very poor knowledge base on assessment and interventional skills with regard to common physical ailments...such as CHF, asthma/COPD, sepsis, diabetes, dehydration, anemia, TB, liver disease, substance abuse, head injury, stroke, pneumonia, etc. No, you don't "have" to have med surg to be a psych nurse. But, at least, consider broadening your skills beyond just psych. Your patients are more than just psych patients. I've met my fair share of psych nurses who treated the psych needs but the patient crashed and burned physically because of not assessing or knowing how to assess the tell tell signs of physical problems for days. To my shock as well, I've had the poor pleasure of having some psych RNs tell me that "If I wanted to be a medical/med-surg nurse, I would have been one". Personally, I think all psych nurses need to have a good working knowledge base on physical assessment skills, critical thinking skills that if patient "A" has CHF...I need to assess for such and such, blood lab skills regarding chemistry and other blood lab value normals, ABG ranges and does that patient require some Oxygen?, basic understanding of EKG results (due to cardiogenic effects of key psychotropic meds), and so on. Education is an ongoing process. I've worked both sides of the fence. Some of the better med surg nurses have been previous psych nurses. Some of the better psych nurses have been med surg nurses or such. What counts is that you are well rounded. Sometimes, having the knowledge base of physical health problems, how to assess, and how to intervene, may help a psych nurse to better understand why that patient has had a change in mental status in the first place.

EarthChild1130 · Oct 7, 2004

Well, that makes a lot of sense to me...I'll be honest with you...I think the reason I'm feeling intimidated by med/surg so much is that this clinical has been nothing but endless paperwork!! I actually love doing the 'technical' stuff but the paperwork is altering my view of med/surg in general LOL...

My teacher told me something very interesting today...she said 'You know, 2 areas of nursing that you'll NEVER get away from are med/surg and psych...You'll always have med/surg issues with your psych patients and you'll always have psych issues with your med/surg patients'...

I think I would like to do at least a little med/surg, for the experience...My psych teacher from last semester also suggested that I work primarily as a psych nurse to begin with and also prn as a med/surg nurse...she suggested that I talk to potential employers about that...We'll see!

Thanks for a great post...I appreciate it!

normj · Oct 7, 2004

I just started my first RN job on a med/surg floor ... and spent all of last night dealing with the typical shenanigans of a galloping borderline who has a multitude of medical issues.

Orginally got into this because I want to be psych nurse ... and I am already glad I have chosen to do med/surg first. I'll probably do no more than a year because I am not happy with my current unit, then switch to psych.

I think I would like to do at least a little med/surg, for the experience...

Thunderwolf, MSN, RN · Oct 7, 2004

Normj, hang in there. Your med surg experience will come in handy. Borderlines, they are like the bread and butter of acute psych. Just be grateful that you have your limited exposure to one now on a med surg unit. When you become a psych nurse, imagine having several on your unit every day, planning to make your daily life interesting. But, in all seriousness, Borderlines can be great teachers. They show you what skills you still lack because that is their job to expose them...with great relish.

Gompers, BSN, RN · Oct 7, 2004

I would say yes. Some hospitals I've worked at not only had regular psych units, but also detox or med-surg psych units. Having some basic med-surg experience in your pocket will help down the road because you ARE going to be responsible for these patients and if they have other medical problems, it's up to you to find them. Don't forget that in general we have an aging population with multiple medical problems, and that there are psych patients of all ages that do not take care of themselves...

Now, I ran into so many great nurses during my nursing school clinicals, especially in psych - they were awesome psych nurses!!! BUT the only time I was "that annoying know-it-all student" was one day during my psych rotation. This was a regular psych unit, and one of my patients was an older man who was scheduled for once a day vital signs - and on paper, they looked fine for the two whole weeks he'd been on the unit. But when I checked him out, I immediately noted a heart murmur and wildly irregular pulse. I told the nurses and they seemed surprised and annoyed, saying "everyone else has reported his vitals as normal," and trying to brush me off. Well, by the end of my short clinical day this guy was transferred to CCU, and the cardiologist who came up to check him out told me this wasn't an acute problem, but something chronic that had been going on and he couldn't believe it took a nursing student to notice something. :uhoh3:

Again, this was just ONE incident, but it always sticks in my head.

Thunderwolf, MSN, RN · Oct 7, 2004

Gompers, you provide an excellent example as to why physical assessment skills are important on a psych floor. Probably why the cardiologist couldn't believe it took a nursing student was because seasoned nurses should have picked this up and documented it. Your intellectual curiosity is what sharpened your skills. Don't lose it. Intellectual curiosity is the beginning of critical thinking. Good job. Like any muscle, if you do not use it...it atrophies. Unfortunately, in psych, you may find a lot of weak, flabby muscles on staff.

lcsw2aprn · Oct 16, 2004

Our DON will not consider anybody without 1 to 2 years general nsg experience. That having been said, we are understaffed and have a lot of dead weight, because she can not afford to train anybody. Then if and when anything medical turns up all the nurses panic and ship the patient off to a "real hospital."

I was hired at another hospital on a PRN basis the day after I passed the NCLEX. Some of the older nurses gave me ****, excuse me... all of the older nurses give me...... but I understood that they were just eating their own and in time they would come to love me,.... they were and they did!

In my opinion, give me a new grad and I would train him/her.

Al

Hukilau · Oct 27, 2004

I never did a day of med/surg nursing after school. But I have been fortunate in working on psych units with a good mix of nurses who have always done psych and those who have a lot of experience in other areas and have come to psych recently. When teamwork and trust are working properly the combination of skills of 3 or 4 nurses can handle just about anything.

LOL, but if I were forced to answer the question, I would say YES, get a year of med/surg if you can stand it! For one thing, I have always envied the nurses who could, if they wanted to, float to a medical floor during low census on the psych unit. It would be dangerous for everyone if I did that!

Hukilau · Oct 27, 2004

I never did a day of med/surg nursing after school. But I have been fortunate in working on psych units with a good mix of nurses who have always done psych and those who have a lot of experience in other areas and have come to psych recently. When teamwork and trust are working properly the combination of skills of 3 or 4 nurses can handle just about anything.

LOL, but if I were forced to answer the question, I would say YES, get a year of med/surg if you can stand it! For one thing, I have always envied the nurses who could, if they wanted to, float to a medical floor during low census on the psych unit. It would be dangerous for everyone if I did that!

Birdie RN · Nov 13, 2004

That one year med-surg exprience has helped me- trust me -I only did one year and really hated it, I am glad I did. I wish I could of done more but iIthink I would have required hospitalization myself if I had!