New RN and stressed out!

  1. I work in a 23 bed psych unit at a hospital. This is my first job as an RN, however, I've worked in the psych field for about 5 years doing other things. I am still on orientation until the beginning of October. Due to staff issues, I have already worked without a preceptor many times. My patient load increases daily it seems and my pt's seem to have higher levels of acuity. For some reason right now, most of these pt's are all axis II and are very demanding, needy, cutters, constant suicidal thoughts, swallowing things for attention, etc. I am constantly sending down pt's to have things fished out of their stomachs. We have more pt's than we can handle and they still seem to find a way to squeeze even more in. We have been getting pt's that are admitted to us who are elderly and depressed because they have been diagnosed with terminal cancer....duh! I'd be depressed too. Some of these pt's medical conditions far outweigh their mental illness. We have tons of pt's on coumadin, tons of IV's, people on oxygen, etc. We have had 3 deaths on our unit in the last couple of months because they send three elderly pt's there to basically die since they were depressed. I wanted to be a psych nurse and now I am a med surg nurse anyway. I have been going home and crying in the last few weeks after work. I am so stressed out. There is so much to learn. There is so much paperwork. I don't know if I'll ever learn how to do it all and manage it all. I am going home depressed. I really love the counseling end of psych nursing, which we do as well, but rarely because we are always calling doctors and giving meds and running around crazy. I love the quality time with the pt's and I have no more quality time than any other nurse. I thought this was what I wanted. I just feel like a bad nurse because I feel that I can't possibly do my best under the stress I'm in. I don't know what to do. I didn't sign my contract yet. It was supposed to be for 3 years. I really hate being a staff nurse. I would love to do outpatient behavioral health counseling or even home health at this point. I just don't know how long I can keep this up. I am not happy and I'm starting to feel like not even getting out of bed. Does anyone feel like this? Can I work in home health or something without working as an RN for a long time? Ugh!
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    About alambert603

    Joined: Feb '06; Posts: 22

    10 Comments

  3. by   JentheRN05
    I've been where you are. I know alot of us can say that. But where I'm at, the hospital psych ward will NOT accept any patients on IV's! That's just crazy, that means having IV supplies on the floor and numerous possibilities for things to cut/swallow/gouge whatever with! Thats nuts! I would consider looking for an ACTUAL psych position where these things are taken into account. There's no shame in quitting as long as you give 2 weeks notice and if your early in you don't even have to put it in your resume. Remember, while you don't have a preceptor it is YOUR license on the line.
  4. by   RNinSoCal
    I know how you feel-from the opposite side of the fence. I used to work on a med/surg floor that admitted any psych pt to med/surg if they needed IV access. It was unsafe for the pts and for the nurses. It was an open ward with 4 different ways to leave the unit and an elevator that went straight to a parking garage. Only 1/4 of the rooms were visible from the nurses station. I actually had to leave that facility to relocate to another city but I had been complaining to management about the psych pt issue for 6 months before I left. It is a very difficult assignment to care for someone who is not reality oriented, noncompliant with medications, combative, abusive and who needs IV antibiotics and/or dressing changes. Even with my ratio of 1:5 it was hard. If I had 2 psych pts, 1-2 detoxes and 1-2 dementia pts with a G tube it was hell on Earth.
    The things you like to do with pts-counseling etc-are exactly the things that you have no time for on med/surg or psych med.
    I hope you have a manager that will hear and respond to your concerns. If your management continues to give you unsafe/unrealistic pt assignments you could always try to find a facility where psych is separated from psych med. I am sure there are facilities out there that would love to hire someone with your interests and experience. It is always better to find a job that fits your needs rather than one that will ignore your needs and break you.
    As far as home health you need a solid med/surg base because you will be providing treatments ALONE. It is a lot of responsibility with no one there to help or answer questions during home visits.
    I hope you find your ideal job.
  5. by   StuPer
    Hey guys,
    This is an issue every where it seems, and there is no easy answer, however admiting terminally ill people to a psych ward because they are depressed is just in one word a 'dump'. Good god have they not heard of palliative care, that is their field, being depressed in that scenario is a 'normal' function of the grieving process, pally care assist individuals and families to come to terms with this and to help them prepare for 'the end'.
    Putting people like this in a psych ward is an absolute injustice, no wonder you are struggling to cope.
    Frankly if your administration see's no problem with this practice I'd be looking for alternate employment. Take care of yourself because under that kind of stress your own mental health could suffer.
    Ohh and we to do not admit people with IV's for the same reasons JentheRN05 stated, no mental health facility I know does.
    regards StuPer
  6. by   Sistermoon
    Listen to yourself, and honor yourself. Sounds like you are miserable there for a very good reason...you describe a place that employs unsafe practices that puts people who are already at risk in even greater risk. As a new RN, you're not in a position to make some drastically needed changes, or influence upper management to consider creating a manageable milieu. And what you really need is a supportive, sound place to learn and grow as a nurse. If a health care facility can't provide proper support to the patients it proposes to serve, what chance does a nurse have of finding anything good to draw from there?!?

    Honor yourself. Good luck! There are places out there that will challenge you AND meet your needs for a safe environment in which to practice.
  7. by   Ayonti
    I quit a med surg position after 3 months. It was my first nursing job. Do I have to put it on my resume?

    Thanks
  8. by   maesam1
    I would not put it on my resume, I have friends who advised me not to, just keep yourself as a new grad.
  9. by   TrudyRN
    How about working for a hospital that does only Psych? One that sends Psych patients to a general hospital if they need med/surg care.
    You could find a Psych-only hospital if you work for state government probably.

    Good luck, let us know.
  10. by   RN4life74
    I completely understand what you are going through. I have done this for 20+ years and I'm sorry to say that it doesn't get better. Please get out while you can. I am very serious about this.

    My unit is the "dumping ground " of the city. The name of the game here is "keep the beds full". If our census gets low they cancel staff without regard to acuity or incoming admissions. On my last shift our census was 17. They canceled staff and left 3 of us- 2 RN's and a tech. We had 1 out of control acutely psychotic pt who screamed all night long. We had 3 admissions, 2 of whom didn't want to be admitted but were coerced into it, several detox pts in withdrawal, a couple of manics who were all over the place, 2 total care nursing home patients, drug-seekers, and needy borderlines. We had to give up our tech to do 1:1. No sevretary. No breaks. Lucky to be able to get to the bathroom. I started fantacizing about walking the heck out of there in the middle of it all. And this is not the exceptional night. More and more it is becoming the norm. NO support from management, only reminding us about a "T" we forgot to cross.

    We admit patients whose families want to go on vacation. Alzheimer pts whose nursing home needs a break from them. Homeless people who need their 3 hots and a cot. etohics who need to sober up just to binge again and come on back in our revolving door. Crisis counselors who send inappropriate admissions just because it's the easiest thing to do. This is a voluntary unit. We are sent psychotics who couldn't possibly have signed themselves in. The admission process and paperwork is arduous. Checking through belongings and recording every stick of gum they have with them, recording, counting storing the bottles and bottles of meds they bring in. To do all the work required to admit a patient only to have them discharged hours later because they didn't want to be there in the first place makes me want to puke. Ran out of space..sorry fior the rant. GET OUT ASAP!
  11. by   RN1263
    Hi,
    I'm a new grad RN also so I simpathize and I work at a psychiatric hospital (pt.'s MUST be medically stable...period!). Anyway, even though it can get hectic/crazy... I love my job!!! I always hated med-surg since my first med-surg clinical but psych nursing so far seems like a good fit. My orientation has been alittle under par, but I've been holding my own w/ 6 pts. for the past 3 days after only getting 3 days of shadowing/orienting as a new grad.

    Anyway, I now know I'm ment to be a psych nurse. I wasn't sure when I was in school, but so far I LOVE IT!!!!! The facility on the other hand is going through a ton of changes and that can get frustrating, but still not enough for me to leave and really explaining the situation would take another post all together.....LOL

    My advice though......find a private psychiatric hospital, they understand how important it is that patients are medically stable and are not on any IV's, ect. OOHHH, and another plus so far in psych is the doc's are nice .....on med-surg they were anything but nice usually.


    good luck
  12. by   flpsychnurse
    I have been a "psych" nurse for 25 years. It is not going to get any better. The US has no mental health system. A great deal of admits are about money...insurance. Please, until you realize that reality and theory are 2 different things, you will be miserable in any field of nursing. Yes, medical issues should take precedence, but it is not reality. You have to have some medical training or intuition nowadays. There are few "psych only" units. Research is one possibility. Hospitals can talk all they want about patient safety etc.--but they are asking more and more from less and less staff. They are a business you know. I would try CA--they have nurse-patient ratios, and /or find a hospital that is unionized, like Kaiser.

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