Please help!

  1. I posted this on the general discussion as well; please help!!!

    Hi, ya'll.......

    I'm getting ready to graduate with an ADN in a few short months, and I've found myself really stuck when thinking about what aspect/area of nursing I want to work in. I am passionately leaning towards psych/mental health nursing, but am unsure of my career options. I won't be able to return to college for an advanced degree right away (hubby's turn to go to school!), but that is in my long-term future. In our program, we did a rotation on an acute psych unit at a local hospital. I LOVED it, although I'm not sure what I was doing then would be what I would be doing as an actual, real-life nurse. Mostly, we talked to the patients, learned about their meds (didn't actually pass them, for some reason), ran groups, etc. I learned a whole lot there, and I seemed to have a real knack for what we were doing. The patients on that unit were mostly schizophrenic or manic/bipolar patients (probably 80%/10% with the rest made up of various other illnesses). Now, here's the problem. I'm sitting here, trying to evaluate my job options and figure out a long-term career plan, and I really don't know what that will be! What are my options in this field? What do actual psych nurses DO? At this particular facility, they didn't seem to be doing what we were doing; as a matter of fact, we barely had contact with the nursing staff- if they weren't sitting at the nurses' station, they were god knows where. I'm not suggesting that they were not working, it's just that we never really saw them around the unit. Furthermore, I'm not sure that I want to work with a mostly schizophrenic population; I'm considering something a bit different, like adolescent psych or something like that. I just don't know exactly what!! I'm beginning to think that I should have become a therapist instead of a nurse. Someone help me! I think I would be better at a long-term facility, rather than an acute unit; it seemed like all we were doing there was medicating and shipping them off to day programs/partial hospitalization/group homes. I know that that is necessary, but it's not really where I feel I would do best...anyone know what I mean? Another problem I'm discovering is that my fellow nursing students don't seem to appreciate psych/mh nursing as a REAL nursing career! How disappointing! Most of them absolutely hated our psych rotation, and when I'm asked which area I want to work in after graduation, I'm given anything from looks to actual comments like, 'Oh, that's not real nursing' or 'You're going to lose all your skills!' or 'Hmm..psych is horrible. Why would you want to go into psych?' or such things. It's so frustrating! For the first time, after class that semester, I would come home to my husband and RAVE about my day, so much in fact that he is now preparing to go to college to become a psychologist or something in that field. I'm looking at job opportunities in our area, and I"m seeing lots of openings for ICU/Critical units (which I DO NOT want to do), but not so many for psych/behavioral health. Furthermore, I'm not sure that I want to work in a hospital setting; I'm more the type of person who does best in a community setting or something similar. I'm so LOST! Someone give me some advice, please, before I drive myself crazy!! I feel very confused and unsure right now...I always felt drawn to nursing, and ever since my psych rotation, I've felt drawn to that area, but what can I DO there? Where can I work? What will I be doing? Anyone with experience here, feel free to email me or respond. I feel like I'm hitting brick walls. Thanks.
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    About NICU_Nurse, BSN

    Joined: Jul '01; Posts: 2,151; Likes: 85


  3. by   MollyJ
    Hi Kristi,
    I think their are alot of frequenters of this site, but it seems the psych nurses don't come here too consistently. Look to some of the past posters that are bonified psych nurses like waynesoo4, bjo and Pat RN. You might even directly email your questions to them.

    I'm an 23 year nurse who has never worked psych, but now I do drug prevention in a school, so I cannot be very wise for you. But I always have an opinion.

    Anyhow, if psych is where you are being called, don't wait for a popularity consensus vote to go there. They don't have to live with your decision; you do.

    As for psych as a first area of practice. I think it would be a challenging first area of practice, as they all are any more. One of my nursing school colleagues went to psych first but then ended up as an ED supervisor. Her skills don't seem to have suffered. The truth is that nursing has many skills and you won't be able to maintain them all equally. I haven't started an IV in 5 years; haven't given a shot in that many years but if I feel called to it, I'll be able to remaster it. However, in this job, my therapeutic communication skills have really grown and my knowledge base about chemicals is better than it used to be. When I was in the ICU, I felt good about my lung ausculatation skills and my EKG interp skills. Certainly if I had to use those skills tomorrow, I wouldn't be great at it, but neither would I be starting at "zero". Nursing school turns out "nurse generalists" but we all automatically start to become, in small ways, nurse specialists. I had a friend ask me about prostate cancer staging not too long ago. What I know about prostate cancer staging fits in a small thimble. That's what I told her. I let her educate me (her hubby has it). I recognize that when someone talks to me because "you're a nurse", more than knowledge, they want attentive listening and support. If I happen to have speciality knowledge in their problem area, I will offer it realizing they are free to take it or leave it.

    I think you also asked about your student experience vs what you saw RN's doing in practice. I think some psych and other nurses do turn their jobs into a pill dispensing job and certainly psychiatry right now seems really taken by the conviction that all psychiatric illness can be alleviated with a pill, but the need for therapeutic communication is really never passe; it just takes more work and the out put is often not readily apparent. Focus on psych nurses you want for your role models. If you interview for a psych position, ask about how psych nurses are used and then, when you are on the unit, notice what you see. Pill admin and charting is often part of the job, but it can be amazing how being the person that gives those meds daily can give you some opportunity to know people.

    Good luck.
  4. by   Mike-CPN-UK
    Hi Kristi,

    I'm not sure how it works in the USA but in England being a Community Psychiatric Nurse (CPN) is great. You get so much autonomy and choice in the way you want to do things. I've been a senior in community for eleven years and have worked in old age psychiatry and younger adults. There is so much veriety. I still have to try out drugs and alcohol, forensic, child and perinatal. You never stop having to learn new skills and improve on your old ones. You also get to work with many other health care professionals.

    I'm currently finishing a BSc (Hons) degree - specialist Nurse Practitioner - Community Nursing and have done some teaching in the university to third year student nurses. It's great!

  5. by   MHN
    kristy ,i have just completed my post grad diploma in community

    mental after 31yrs as general nurse and midwife and i have

    found the change great.Personaly though I think some basic

    nursing experience goes a long way before starting your psych

    training.Unless you are at an age where you have experienced

    lifes ups and downs these experiences help you a lot apart from

    the knowledge and skill you may learn doing the psych

    course.But in the end it comes down to you making the

    choice.MHN(Mental Health Nurse)
  6. by   bubby
    Hi there I am registered nurse with 7 years psychiatric experience in a large psych hospital in sydney Australia. I feel that whatever field of nursing you go into depends on the individual. At my university we were discouraged to a degree to enter into psych as it "isn't real nursing", but I went and did it anyway and love it. I love getting to know my patients and not having to worry about when the next dressing has to be done ect.... Psych nurses here in oz have quite a bit of autonomy and working in a multidisciplinary environment and using interdisciplinary care plans is exciting as you have quite a lot of say in the patients treatment. As for what do psych nurses do??/ we educate both patients and their families, we are advocate for patients care, we intervene in situations to prevent a pt self harming or becoming agressive, we provide a safe environment and we do a lot of counselling. Just to name a few. Psych nursing is not necessarily about curing anyone as general nursing is, its about educating pts, families and the community to provide a better quality of life for those inflicted with mental illness.
    As a student nurse in a psych facility I can appreciate that it semed like nurses do not do anything but surprisingly even when it looks that way we are all usually very busy observing patients, this itself is a crucial element in mh as you are looking for positive and negative signs of schizophrenia, you are looking for signs of self harm and also signs of agression. Nurses are social workers, occupational therapists, counsellors and a lot more in some way or another. We are with the patients 24/7 therefore know more about the patients behaviour than psychiatrists and a lot of the psychiatrists rely on nurses input and documentation in making decisions re a pts treatment regime. I personally work in an acute adult admisson ward and work with schizophrenics, manics,bipolar, modd disorders, personality disorders, drug and alcohol and also froensics.
    If you feel psych is where you belong go for it!! do not let anyone else discourage you. it is true you do not usually use IV but I do do dressings, give a hell of a lot of injections ect, remembering that a lot of these patients have enagaged in risk taking behaviours prior to being admitted to hospital.
    Finally keep in mind that in all aspects of nursing Psych nursing is 90% of it. All nurses will look after patients inflicted with psych problems in all areas of nursing.
  7. by   donmurray
    "Psychiatric Nursing is the art and science of using the self as a therapeutic tool" I can't remember the source, but it seems to cover everything. Looking at it again, it seems to apply to prostitution too! LOL
  8. by   Spazzy Nurse
    I work in psych, and I love-love-love every second of it. The most frustrating parts of my job are also my favorite parts. Every day is different, and one must really have to have a good sense of humor to work in the field. You also have to have a big heart, since these are illnesses (boy it's sure easy to forget that sometimes!!! LOL)

    My only regret is that I lost so many of the skills I had learned in school. I gained on the psycho-social end, but lost so much more. In a way I wish I could've done some work in acute care before hand, so I could have that experience sitting in the back of my head until I need to pull it out and use it some day. No matter what field you choose to go into, you'll lose skills that you don't use.

    My brother recently graduated with his ADN and wants to follow in his big sister's footsteps and do the psych thing. He would be so good, and if that's what he truly wants to do, I am 100% behind him. But I am encouraging him to think about doing something in which he'll utilize more of his skills so he doesn't completely lose them.
    Even float PT to a unit where you could use them, because it's such a pain to have to relearn them all again. Trust me..... I'm in school right now, and it'd be so nice not to have to do some of this all over again.

    Just think about it, and go with your heart. If you want to go the psych. route, go for it...... you'll have a career that is wacky and amazing and exciting and rewarding.
  9. by   PsychoRN
    I have worked as a psych nurse for almost 20 years and it is the only type of nursing I have done since I became a RN. Within the profession of psychiatric nursing there are a vast number of career options. I have worked as an inpatient staff nurse, community mental health nurse, manager of an inpatient psychiatric unit, quality assurance coordinator for a psychiatric department, utilization review coordinator for a psychiatric department and am currently the manager of an outpatient psychiatric program. I have no regrets losing the medical nursing skills I learned in school as I have gained so much more in the knowledge I have received through my experiences in psychiatric nursing.
  10. by   Orca
    I have been an RN for about eight years, all but the last year in psychiatry. Psychiatric nursing can be a very rewarding field of work. Nurses from other specialties tend not to understand it, or sometimes think of you as less of a nurse because you don't spend all day starting IVs or managing PICC lines (and, God forbid, not wearing a uniform!). I always told my staff that we have to put ourselves out there and give of ourselves to help our patients. We could not hide behind medical procedures and go all shift without having a meaningful encounter with a patient. I also told them that we save lives all the time, we just don't get the immediate verification of it that medical nurses often do.

    One thing to think about: I went straight from nursing school onto an adult psych and chemical dependency unit. This would come back to bite me several years later when I worked for a mental health hospital that was closed by the parent company. Since a large number of us were thrown out of work at once, there weren't enough psych jobs for all of us. I had difficulty finding work because I did not have that one year of acute care experience that everyone seems to be looking for. No hospital would even talk to me. I wound up drawing unemployment for 90 days before landing a rehab nursing job, which I left after six months to return to psych.

    It never hurts to have a broad background. There is a perception in nursing that once you have done psych, you cannot do anything else. Bear that in mind before you close too many doors early in your career.
  11. by   Orca
    (duplicate post deleted)
    Last edit by Orca on Aug 19, '02
  12. by   psych_00_RN
    I'm a new nurse, I received my license 18 months ago. Before that I worked as a psychiatric attendant at a state hospital for 8 1/2 years. Since my graduation I've continued to work at the same facility.

    During school I saw Psych nursing, like any other specialty, has it's good and bad sides.

    If you choose to persue psyhch nursing:

    Many other nurses will look down upon you because you don't practice "real" nursing, yet most of them don't have the patience or understanding required to practice in this field.

    You will not get to treat all of the rare & interesting diseases that pass through a medical facility, but you get a wider variety of symptoms from the fewer disorders you do treat.

    You don't get to pull out a canned treatment plan for every common ailment, but you are an important member of the treatment team and develop an individualized tx. plan to meet the needs of each patient.

    You don't see immediate results from your efforts; it may take weeks, months, or even years. You get to know your patients and watch as they they heal and grow (as a person).

    You have to do teaching to the patients and thier loved ones.

    It is true you will trading many of your medical skills for personal skills, but to me it is well worth the trade.

    Good luck in whatever you decide to do.
  13. by   Orca
    Spazzy, I have to agree with you about the value of humor. I use my sense of humor extensively in my practice, and sometimes a few humorous things come my way as well:

    A bipolar patient, who had the most complex delusional system I have ever seen (and it was consistent from visit to visit), came to the desk, deadly serious, and told me: "I am going to have to resign as Captain of the Starship Enterprise, because I am not ready for the responsibility. I am going to have to call Captain Kirk and tell him." I had to stand there with a straight face and listen to this. Fortunately, he did not linger at the nurse station, because I had to go in the back and be "inappropriate".

    Another bipolar patient who stripped nude, ran into the seclusion room, turned over the bed and hid under it to keep the aliens from getting her.

    Two patients, both claiming to be Jesus and each trying to perform miracles to outdo the other and prove that he was the "true Christ". When one of them tried to part the water in a styrofoam cup, I had to leave the room.

    An elderly black man, claiming to be the President of the United States, walking down the hallway discussing foreign policy with me. When I asked him where his Secret Service detail was, he said without missing a beat, "I gave them the night off."

    Not all the nut cases are on the other side of the desk. One nurse who worked with me (fortunately I was off the night she did this) went into a paranoid schizophrenic patient's room and sprinkled salt along the window sill "to keep the evil spirits out". She was terminated shortly after that.
  14. by   Spazzy Nurse
    :chuckleLMAO Orca!!!!:chuckle

    Isn't it great the stories we accumulate? That "parting of the sea" in the styrofoam cup thing would've thrown me into wild laughter!!