Should I Stay or Should I Go?

[HealSpec]

So, as the title says, I'm having issues with whether to stay in psych. I went straight into it after school and I've loved it from day one, it's fascinating and I really love my current position. But lately, my job and me just aren't getting along.

I have ADHD and SPD, and while this makes it easier to get on the level of patients who also have it, it can also make everything so much harder. I feel like I make a lot of mistakes about charting and forgetting paperwork and stuff like that. When I float to another unit, being out of familiar territory makes me so anxious. If the unit is higher acuity or louder, it can cause flat out sensory overload. I've actually had to take a minute to go cry in the med room--more than once!--because of the horrible results of executive dysfunction + nursing. I've gone home and bawled for the next couple hours over mistakes and just generally being frustrated. And it doesn't feel like it's getting better. Lately, due to staffing changes I'm floating more, this is happening more, and I hate it. I'm considering leaving psych. But I'm afraid that leaving would make things worse, not better.

If I left, I'd be going into a different field entirely with much more to learn. Maybe it's different in other geographical areas, but around here psych nursing is seen as this gravy train, easy money specialty. (No offense to any of the awesome people on this board, this is absolutely not how I personally feel about psych. It's not easy for me at all! I work really hard at my job and can't see how it could be considered easy. But all my coworkers ever talk about is how this is barely real nursing and what a joke it is.) So if I can't cut it in psych, what if I go to cardio or med surg and make a mistake there? In psych, it would be a missed assessment that I could go grab, quickly, and punch in, or a precaution change that I could flag down a passing tech and go "hey, heads up". In cardio (or neuro or med surg, etc etc) the patients are sicker, the mistakes are bigger... I might make a med error, or hurt or kill a patient. At least in psych, no one is (usually) that sick.

I'm really stuck on what to do, and I don't feel like I can ask anyone who works with me for obvious reasons. I'd love to stay in psych but I'm getting frustrated and I'm not willing to go home crying 20% of the time (that doesn't feel normal. Is it normal?). I didn't pour my blood, sweat and tears into a degree and license to be so upset and discouraged so frequently. But what if my coworkers are right, psych really is "easy mode", and I'd be setting myself up for an even worse job if I left? I'm so confused, and I'd be so grateful for any advice on anything here at all. Sorry for the rant, and thanks in advance for any help.

[hawaiicarl, BSN, RN]

If you go there will be trouble, if you stay it will be doubled.

[FolksBtrippin, BSN, RN]

Consider community health, private duty, home health, school nursing. Working in child psych would be good preparation for any of those.

[HealSpec]

I would start out small, usually they give you the lowest dose and from there go higher, until you get the effect you want.

I'm not sure what a psych brain is.

A brain is a sheet that you use to guide your shift, like a more dynamic to-do list. They're used in cardio, ICU and stuff like that, but I haven't found one for psych. I had to make one, and it's helpful when I remember to use it! But that's not always.

[OldDude]

First let me say that I admire you, HealSpec, for your determination and perseverance in becoming a Nurse and working in Psych while having to deal with your maladies!

I can identify with you in many ways and one is the sensory overload thing. Too much stimulation terribly irritates me. I deal with that irritation through animated humor; sort of taking all that energy and sublimating it. I play DJ or MC and will give a play by play or a summary of the action which is entertaining to Staff and Patients and helps me at the same time.

As far as the floating to another unit, I am realizing that I'm not as sharp as I once was. I've never been 60 years old before. I have to take things more slowly and remind myself to focus by means of an inner dialogue.

I, too, am considering taking another position at another Hospital after being in this position for nearly 15 years. The change isn't going to be as easy as it once was. I'm really going to have to maul that one over.

I like to relay on old sayings and axioms for guidance sometimes. The one that popped into my head as I was reading your post was "When you're lost, stay where you are". Unless we have a well thought out plan, we shouldn't change things just because we're not 100% happy with the situation. We should "Bloom where (we're) planted".

I don't cry much anymore, but did so somewhat regularly when I was younger. Crying is an okay way of dealing with stress, so I wouldn't be overly concerned. Nowadays I exercise and workout a lot to deal with my stress. I also think I'm in a better place now than when I was younger. I'm pretty much okay with who I am. Most of the time.

I was recently reminded by a Newbie of something I said when I came in on a Friday for my three twelves: "Every Monday I clock out thinking I'm going to get fired for something I did or didn't do during the weekend, and every Friday I come in and see my name on the schedule".

The fears and feelings don't go away as we age. We merely take those feelings more in stride.

Good luck and the very best to you, HealSpec!

I just happened to poke my head into this post...I'm glad I did. Therapeutic words for all of us regardless of which hammer we are swinging or net we are casting. Thank you Davey. You spread more good than you realize.

[Amethya]

A brain is a sheet that you use to guide your shift, like a more dynamic to-do list. They're used in cardio, ICU and stuff like that, but I haven't found one for psych. I had to make one, and it's helpful when I remember to use it! But that's not always.

That sounds pretty useful. I kinda do a to-do list to remind me of what I should do. How does it work. Color me intrigued. xD

[Allie_G]

Hi there! Just some advice from a newer nurse- I started working in inpatient psych at a hospital straight out of school like you, I began my career September of last year. I absolutely LOVED it and would sometimes get floated to emergency mental health which gave me anxiety because it was a whole new environment with a quicker turnover, with brand new people so that was kind of stressful in itself so I know what you mean about the whole floating thing- I just tried to stick it out and kept reminding myself "It's only 8 hours!".

I, unfortunately, was laid off this August 2017 because administration downsized our unit from 23 beds to 13-14. I now work in an observation unit (part of the ED) which deals with an array of different types of patients including r/o stroke, MI, cellulitis, etc. Honestly, I miss psych nursing every day! The unit I worked on had very supportive employees and co-workers often gave off a sense of safety where you knew if anything bad were to happen or you had any questions there would always be someone to help you. Where I am now lacks that sense of security, could be where I am but also could be the way of med-surg nursing. I also have extreme anxiety going into work every day because I feel like I lack medical skills, even hanging an antibiotic I recheck everything 6000 times before I do it because we never dealt with IV's in psych. It's definitely a lot more stressful and I seriously praise anyone who can do it with ease everyday, just like some of these nurses tell me "Oh I don't know how you worked in psych! I could never do it!". Everyone has their niche and if you feel like psych is yours, I would stick with it because you never know what you might be getting yourself into. Hope this helps :)

[HealSpec]

That sounds pretty useful. I kinda do a to-do list to remind me of what I should do. How does it work. Color me intrigued. xD

I can post mine if anyone's interested, they're pretty generalized and I'd have to check and make sure it's okay with the board rules. But if it can help someone with psych then I'd be happy to.

[PixieRN1]

I worked NICU, PICU, peds float, Peds ER, and PACU before going into Psych. I love Psych so much better than anything I've done before.

Honestly, in each of those previous jobs, I would get tremendous anxiety before every single shift. How sick would my assignment be? Would I have enough time to stay on top of the dozens of super critical, life-sustaining things that I needed to do like yesterday? Would I forget to titrate my heparin drip because I forgot to look up my antiXA result?

Would I remember to change out my fluid types per the standing protocol for my DKA patient? Would I forget to look at my BMP on Room 12 and thus miss correcting their magnesium and potassium? Would I forget to reorder my drips when I noticed they were getting low? Would I forget to check the tube for my drip that I just noticed ran out and holy s***, it's not there and pharmacy never sent it?!

Crap! My patient's sats just tanked...is it the vent? Mucous plug? Bronchospasm? Clogged chest tube?? Where the h*** is the transilluminator?! What?! The med port on my CVL won't flush and I need to push this EPI now!!!! Crap, no choice but to push it with the only other line that has dopamine and narcs running because we don't have a PIV...please don't die or stroke when I push this....will someone get the resident to order TPA for my port?!?! Where the h*** is respiratory??

All shift. 12 hours. The good news about Psych that you can't say about the regular hospital is that as long as we provide a safe environment and medical does a good job of screening out patients too ill to be in the Psych pavilion, the odds are fantastic that no one is going to die on my shift. The thing I worry most about are falls.

I just really wonder if you are so distraught about screwing up where you are now, that your anxiety will about quadruple when you are in a situation where people very well may die, and through no fault of your own.

I agree with the previous poster. Talk to your boss about the floating. See your psychiatrist and have a conversation...ADD/ADHD meds have come a long way from when you were a kid. My daugther takes three types of meds for her ADHD and she is bright and vibrant and has more energy than anyone else in the house.

Peace and love to you.