Stand alone psychiatric facilities

Specialties Psychiatric

Published

Hello, Nurses.

I have 2 years ICU experience and 2 years dialysis experience. My sister works in a stand alone psychiatric facility that admits patients with chemical dependency problems and other mood disorders such as bipolar disorder. I was interested in working at this facility and told my sister to talk to the DON. The DON asked" does she have psychiatric expereience"? My sister was sort of taken aback and told her that I have ICU and dialysis experience so i can handle working in a stand alone psychiatric facility where there is really no skilled nursing involved. My sister say the RNs draw blood and the LVNS administer P.O and IM meds, no IVS. If the patient is having SOB or not doing well, they send them out to the hospital. I finally got the job but was just a little disappionted with some of these DON and their " Do you have experience question". The job is mainly paper work and milieu management, meaning how you can prevent a situation from possibly getting to the point where patients are throwing furniture along the corridor . Why exactly will a nurse need to have 3 years psychiatric experience doing this kind of nursing. It is was just annoying to me. What do you all think?

Specializes in Vents, Telemetry, Home Care, Home infusion.

Moved to allnurses Psychiatric Nursing forum for best chance of member response.

Specializes in Psych ICU, addictions.

With all due respect, it's clear you actually haven't worked psych if you think there's no nursing skills involved in it.

There may not be the medical ICU skills that you're used to, but there's a lot of skill involved in maintaining a therapeutic milieu full of patients with various psychiatric diagnoses at all levels of acuity, and in deescalating patients while maintaining their safety, dignity and rights...as well as keeping yourself and everyone else in the milieu safe. That takes quite a bit of knowledge and skill, a lot of which only comes with experience working in psych.

Also, it's one thing to read in a textbook about a patient with bipolar disorder or schizophrenia or other psychiatric disorders. To actually manage patients with these conditions--and manage them in numbers--is another. I'm sure you've had some patients with psychiatric disorders--after all, psych patients are everywhere. But you've also had them in a medical setting where the focus is on their medical concerns, and any psychiatric problems are pretty much handled by choosing between Ativan or Geodon. It's very different when the psych disorders are the focus of their treatment...and the answer to the problem is not necessarily an IM.

And while the LVNs are giving the medications, guess who's responsible for the LVNs? That's right, you as the RN. So a knowledge of--and experience adminstering--psychotropic medications is also necessary.

I've seen nurses brought to tears because they couldn't handle the psych unit. They realized that psych is not just drug-them-up-and-babysit the patients, or sitting in the group room playing cards with them every day. I worked with one nurse who would lock herself in the med room and cry during most shifts (she was 10+ years' experienced as a nurse but new to psych...she also didn't last very long).

I sincerely wish you the best of luck at the new job. If you are wise, you will rely on your sister as a resource as you start out. I'd also be interested in hearing an update after a few months of your actually working in the specialty. I'd bet that your perspective will be different.

What's "just annoying" to me is when nurses from other specialties assume that there's nothing to doing psych nursing compentently, anyone can do it. I've seen lots of med-surg and ICU nurses fall flat on their faces in psych units, in jobs that they took because they assumed psych nursing was going to be "easier" than whatever kind of nursing they had been doing.

Let's reframe; if a nurse with a few years' psych experience but no ICU experience was applying to work on an ICU, would you think it was unreasonable for the NM to ask about whether the individual has ICU experience, or to be reluctant to hire the individual because s/he didn't have ICU experience?

Just an FYI, psychiatric nursing shifts are typically 8 hours instead of 12. That's because the patients are really rough on the staff. Don't assume psychiatric nurising is easier, in fact it can be much more difficult. Some of my coworkers left psych to go to medical positions because they couldn't handle it.

Specializes in Psych.

Just........wow. Let me know if you feel the same way after working at this facility for 6 months. Do not kid yourself into thinking there is " no skilled nursing" in psych. Especially if you are detoxing addicts. Things can go quite badly, quite quickly for especially ETOH derides if you don't know what you're looking for. And just because they don't admit to ETOH dependence or minimize it doesn't mean you could have a serious problem. Happened at my facility, but thankfully we have a staff of experienced psych nurses that saw it coming.

Milieu management I is far more than "keeping people from throwing chairs into Tue corridor". Just wait until you have a unit full of addicts/personality disorders and come back and talk to me. There is no getting engrossed in charts or really anything in psych. You constantly have to have one ear to Tue ground to he aware of what is going on, at all times. Yah I hate it when other specialties think psych is "so easy"

Specializes in Leadership, Psych, HomeCare, Amb. Care.

When I read that post, my immediate reaction was "Wow"

While on the surface it may seem easy to manage a milieu, it is extremely difficult to do it well. Are your LPN managing the patients properly, are they demonstrating therapeutic behaviors, are they fully following the mental health code? Would you even know?

Specializes in Mental Health.

It doesn't seem unreasonable for the Nursing Manager to ask if you have psychiatric nursing experience if that is the type of job you are applying for (Duh!). There are plenty of nurses who are passionate about psych nursing and want to be there. They didn't just end up there for stupid reasons ; )

General med/surgical trained nurse on a psych ward (generally) = as useless as a psych trained nurse on a general med/surgical ward (generally). AS mentioned, the knowledge practice gap is just as evident. Furthermore, I will always argue that a higher percentage of your success as a psych nurse will depend on your interpersonal and communication skills, self awareness, and intuitive aptitude for psych nursing. Also, every psych nurse is reading that post, evaluating it and wondering, "you got the job but you are still annoyed that the manager asked the most GENERALIZED employment question in history". Hmmmmm

Well, I am sure that you can tell by my name that I have some strong feelings about this. The issue at hand was kind of hinted at by a couple of other nurses who have responded. That is the oldest question in the book! Even for entry level med/surg jobs the nurse manager/director would ask about experience. I have been in psych since I graduated in 2011 with my ADN, and am currently in a Master's program to be a FPNP. I recently started on an acute unit...I can see where you are coming from that your ICU experience might have some relevance in the psychiatric world. If a patient is not medically stable and require restraints, they are sent to ICU. However, like it has been said before, each specialty is a SPECIALTY for that reason. We all, even as individuals in our specialties, have unique skills/strengths and we all have things we need to learn and work on. I recently was a clinical instructor for an ADN program's psychiatric rotation. The first thing I said was, I understand that not all of you are going to love psych, and that is ok! We are all in our specialties because WE LOVE THEM! I wish you the best of luck, but you might want to open your mind because you are going to need it! ;)

Specializes in Psychiatric Nursing.

Part of milieu management is overseeing a group program so that patients learn coping skills and other things during their hospitalization. It also gives a structure to the milieu. 1:1 meetings with patients to assess their safety and their participation in treatment is also important. Searches, safety checks, visitors..you might want to get a psych nursing textbook so you have a good understanding of the specialty.

Specializes in Outpatient Psychiatry.

I've recently started as an intake nurse at a mental hospital. Having roamed around on the units, I don't have any desire to manage the milieu whatsoever. I do not want to back there working. No, it's not a safety issue. There are just too many people up roaming around doing stuff while the nurses are trying to give meds, chart, etc. Read: a lot more distractions than the acute setting in the medical hospitals I've seen. I'm not sure about nurses in general within the psych realm, but I do a lot with psychopharmacology. I don't give (and don't want to) meds, but I along with the docs determine placement so being a good assessment clinician and having a thorough knowledge of meds is a huge part of what I do. When I was in medsurg (which I hated) we did nothing but tasks; IV meds, pills, dressings, blah blah blah with so many to do there was no time to do anything but mindlessly run around doing technical work.

I'm finishing a three year psych NP program next May. I love working with mentally ill one on one, and the -ologies are fascinating. But I hand it to the unit nurses. I would't do that job for a tenfold salary hike.

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