Psychiatric nursing... do you really lose all your nursing skills?

Specialties Psychiatric

Published

Hello!

I'm a new grad and I have accepted a position on the inpatient unit in mental health. I'm excited to start my career in this field, but I have a question for those who have or already work there. I keep hearing rumours that nurses in mental health lose their nursing skills and thus the chances of receiving a job in acute care are limited. My long-term goal is to become an ER nurse, so I'm wondering if there's anything I should do to ensure that I can do to achieve this goal in the future?

Hi there :)

I'm an RN (gradded 2012) and work full time in Psych Emerg and Psych Intensive Care in BC, Canada. I can tell you that it has been nothing less than an incredible experience. My clinical decision-making/judgment, assessment, and communication skills have developed substantially since working here. I also work in medical ER on the side (but less and less over the days) and have found that yes, skills do fade a bit, but it has been worth the trade off for my new psych skills. A lot of experience/exposure gives you some excellent psychosocial knowledge as well as ethical critical thinking (treating involuntary patients, for example). I would encourage you to try and keep your understanding of disease pathology and what not through research on your downtime. I've done that and was able to pass the NCLEX-RN (recently) and have barely worked in med-surg the last year and half.

Psych is simply amazing!

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As a psychiatric nurse, you will use your critical thinking skills, your assessment

skills, your communication skills... invaluable tools that are difficult to relearn

once gone.

As a psychiatric nurse, you probably will not start too many IV's, give blood,

insert foleys... except for on rare occasions. After a while you may lose some

of your hands-on skills, but those are so much easier to relearn.

Having said all of that... if you spend six years in psych, you are much much

less likely to get hired to an ER crew than if you spend say, six months to a

year in psych. I've known new grads who started their careers in psych, and

then moved on to ICU, Med Surge, wherever. Good luck!

How is it that so many arrogant nurses feel as if they're the only people capable of applying critical appraisal to making a decision?

As a new graduate, I am conflicted about which area to work in. Yes, I would love med surg - yet there are not a whole lot of these jobs available to new grads, presently, in my area. However, I also am really interested in psychology and have a decent chance of working in a comprehensive psyche residency program. I am puzzled and discouraged by the lack of support many nurses offer one another. We are taught that comprehensive nursing involves a holistic approach. Holistic nursing incorporates the physical and the mental components of the patient. How sad it is we do not respect all aspects of nursing, and nurses, who provide different areas of care. It seems we are sometimes our own worst enemies.

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Specializes in neuro/med surg, acute rehab.
I was sent to the psych unit several times for "emergency" situations - they did not keep a crash cart in the unit we had to bring it from the ER.

Wow - they don't keep a crash cart on a psych inpatient unit? I thought every place in a hospital had a crash cart. I mean, anyone can have a heart attack or anaphylactic (did I spell that right?) reaction.

Also, just wanted to comment that I once floated to our locked inpatient psych unit to work as the med pass nurse (for 26 patients!) and had a great day. It was fascinating being there, seeing how things worked. Also, while I was there a medical doc came over and decided to order a bunch of labs and an IV for some fluids on a patient and the other nurse (a psych veteran) literally had NO idea how to enter them into the computer or start the IV. I was happy to help her and she was so thankful. Then, a patient went completely pyscho and watching the veteran psych nurse handle the situation was amazing - calm, skillful, confident, kept the situation completely under control. Impressive.

So, yeah, this med-surg nurse could start an IV and draw some labs but was CLUELESS with the rest of the psych world!

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Specializes in neuro/med surg, acute rehab.

I hope my post didn't come across wrong - I was trying to make the point that while psych nurses may "lose" some basic hands-on skills, they gain so many other amazing skills and in-depth knowledge. I enjoyed the few times I got to float there as a med nurse.

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Just to play devil's advocate... you might just fall in love with psych nursing and lose your interest in emergency care. Regardless, go for it, and as others have said, you can always look for a per diem med/surg job. Also, there is an emergency nursing course offered at a university near me (So California). Perhaps there is one near you. That would strengthen your appeal to an ED Manager beyond possession of ACLS and PALS certifications.

If you are a psych nurse wanting to keep all your med-surg skills "fresh", then put in to float to med-surg when there is low census. This will keep you doing procedures & adding personal communication skills to your med-surg skills.

Specializes in Psychiatry, Mental Health.

I just have to pipe up and mildly protest this prevalent idea that "nursing skills" means "procedures". Putting in a Foley or starting an IV or taking an EKG are all really exciting and seem to measure your advancement toward becoming a "real nurse" when you're in school. But is that what nursing is? Procedures?

No. for past century or so, the emphasis has been on our place as members of the health care team. That means "silent skills" like observation, analysis, evaluation, decision-making, problem/risk assessment, patient advocacy, environmental safety, and many more are becoming key points of concentration. The argument could be made that these nursing skills become honed on a psych unit much more than on a more procedure-based unit.

I'm not really comparing one against the other, except to make a point, maybe give us something to think about it. If you really enjoy doing procedures, psychiatric nursing is probably not for you, but it is not a question of losing nursing skills, just strengthening other ones.

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Specializes in Psych ICU, addictions.
I just have to pipe up and mildly protest this prevalent idea that "nursing skills" means "procedures". Putting in a Foley or starting an IV or taking an EKG are all really exciting and seem to measure your advancement toward becoming a "real nurse" when you're in school. But is that what nursing is? Procedures?

No. for past century or so, the emphasis has been on our place as members of the health care team. That means "silent skills" like observation, analysis, evaluation, decision-making, problem/risk assessment, patient advocacy, environmental safety, and many more are becoming key points of concentration. The argument could be made that these nursing skills become honed on a psych unit much more than on a more procedure-based unit.

I'm not really comparing one against the other, except to make a point, maybe give us something to think about it. If you really enjoy doing procedures, psychiatric nursing is probably not for you, but it is not a question of losing nursing skills, just strengthening other ones.

There's a couple of "skills" threads going on in specialty forums right now...and guess what: the top skills people are listing as being essential for that specialty aren't all Foleys and procedures. In fact, you'd find their lists similar to the skills listed here.

But it's psych, so everyone thinks it must be different since the organ we specialize in doesn't always manifest its problems as visibly as a heart, lung or kidney might.

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Specializes in HIV, Psych, GI, Hepatology, Research.
I just have to pipe up and mildly protest this prevalent idea that "nursing skills" means "procedures". Putting in a Foley or starting an IV or taking an EKG are all really exciting and seem to measure your advancement toward becoming a "real nurse" when you're in school. But is that what nursing is? Procedures? No. for past century or so the emphasis has been on our place as members of the health care team. That means "silent skills" like observation, analysis, evaluation, decision-making, problem/risk assessment, patient advocacy, environmental safety, and many more are becoming key points of concentration. The argument could be made that these nursing skills become honed on a psych unit much more than on a more procedure-based unit. I'm not really comparing one against the other, except to make a point, maybe give us something to think about it. If you really enjoy doing procedures, psychiatric nursing is probably not for you, but it is not a question of losing nursing skills, just strengthening other ones.[/quote']

I love what you said. Period. :-)

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Sad thing - I had a doctor tell me that nurses were for comfort care. Retired APRN is right - nursing is much more than "procedures". My outlook is that once we are shown, do with coaching & then with observation (3 times) we are fixed & ready to go. This is unlike the ever learning of observation, lab values & medical as well as psychiatric disorders. To me the Psych Nurse encompasses all of nursing, because not only do we observe & assess general psych & health, we do wound care (they often come in with wounds), Infection control (MRSA wound patient no stranger to psych floor), Lung Assessment (COPD, CHF & pneumonia pts. after they come off of vent from OD); LOC assessment (daily, hourly, sometimes by the minute), & Medication side effects (EPS, B/P, etc.) & interactions. All of this while we do the daily discharge, admissions, documentation & pharmacy & kiss the Doctors & anyone else up the food chains' butt. All with a smile, with empathy & concern because god knows we don't want a patient complaint (who is a drug addict) to the program director about how we don't give all the PRN medications at once! Comfort Care --- righhhht.

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Specializes in Mental health, psychiatry.

I'm glad to hear a lot of these responses. I have been in mental for 3 months now but my ultimate goal is to someday become an ob nurse and lactation specialist. I have tried many times and never got a job in med surge so I took this mental health job to get nursing experience. Do you think 6 months is enough experience? I want to start looking elsewhere ASAP to get out if mh

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