Wanting to switch to psych nursing - questions

  1. Do you work in a mental health unit in a hospital or a stand alone psychiatric facility? I am currently looking at a job in a hospital and one in a psychiatric facility. Any pros/cons to consider?

    As a psychiatric nurse, do you have to run milieu therapy/group therapy? When I was in school, one time a nurse ran the group session. The other days it was the mental health technician/aides. I am not great at public speaking and not sure I would like doing this. I communicate better one-on-one. Just curious as to your part in this at your facility?

    What is your typical day like if you are a day nurse? What about a typical night for a psych nurse?
  2. Visit Scarlettz profile page

    About Scarlettz, BSN, RN

    Joined: Jan '12; Posts: 244; Likes: 166
    from US
    Specialty: 4 year(s) of experience in Med-Surg, Psychiatric

    4 Comments

  3. by   SwampCat
    I am super new in this field, but I will share what I have experienced. I am currently working the pediatric floor on the day shift in a stand-alone psychiatric facility that is affiliated with two major hospitals on the same campus. Full capacity in my unit is 9 kiddos.
    7am: shift report
    7:30 - 8:45: wake kids up and they shower and clean up their rooms; set out breakfasts away from each other. Orthostatics, morning meds, and a few minutes chilling out on their couches to watch some cartoons. At 7:30 charge nurse meets up with our sister units (adolescent and the Psych ED stepdown) to compare staffing notes and see if anyone needs to float and if there is enough staff for evenings. Kids can make phone calls or have visits.
    8:45 morning meeting. Yes, we RNs run it more often than the techs. I'm on a kid unit, so I don't really care about the public speaking. Also, think about your crowd; It's a psych hospital, not a prestigious awards banquet. Your public speaking prowess or deficits will likely be overlooked by the clients. We go over the daily schedule, any housekeeping stuff, and then each kid gives us a goal and we give them feedback on that goal ("You do a good job following directions already, let's see if we can think of something else you can be working on" "How will I know if you are meeting your goal?")
    9-11 is school down the hallway. There is staff there plus the techs so I will just pop in now and then. I mostly work on updating charts, care plans, placing phone calls, starting any discharge/admission paperwork, prepping for team.
    11 is usually recreational therapy until 11:45. Tech's and RT do something fun while we are out. 11-12 is when we do team meeting. RN, Psychiatrist, social workers/clinicians, and private insurance reps come together and discuss how each kid's stay is going, what needs to be done to get them home, what services we can help them get, and what their tentative d/c date is.
    11:45-12: cartoons, phone calls, visits.
    12-12:30: lunch and noon meds. phone, visits.
    12:30-1: quiet time. They get something off the quiet time cart and have to play by themselves during this time. I like to go around and really assess my kids at this time. I can get a good 5-10 minutes uninterrupted with each one. Sometimes they open up, sometimes it is all superficial chit chat. I try not to sweat it because my main job as an RN is to keep them safe. If they do not want to open up to me, I will let the clinicians work with them. Oftentimes the clinicians will take the kids to their offices at this time, too, to do a session.
    1-1:45: Rec Therapy
    1:45-2: phone calls
    2-2:30: snack & pm meds & "Rounding" where we sit with the Pdoc and each kid comes up and we chat about what's going on in their stay and how it is going, med concerns, etc. It's amazing how much these kids know about their medications!
    2:30-3: social skills group
    3-4: quiet time while the shift changes and loose ends are tied up.

    I will be swapping over to second shift next week and that is generally:
    4-5 freetime/playground
    5-5:30 supper & any supper meds
    5:30-6:30: rec therapy
    6:30-7 showers, pj's phone calls.
    7-8:30: movie time/ free time/ night meds

    I haven't done a night but getting report from the night nurse in the morning sounds like it is a lot of redirecting kids back to bed, helping with nightmares, trying to get kids back into bed if they are up before 6am, toileting, etc. Pyxis audit, chart audit, housekeeping things, etc.

    I'm sure I am missing some things, but this is the general M-F schedule. No school on weekends, instead is free time/playground if they have earned it.
    The adult and geri units are less structured with much more free time.

    Psych Pros: I get to pee within an hour of the urge
    WICKED interesting field!!
    I work right next to the Pdoc and we go back and forth about how each kid is doing. He knows me by name and that's important to me.
    I actually feel like I am making a difference to that person. On m/s I felt like I was making a difference to their ailment. You can only give so much "holistic nursing" on a med/surg floor. Psych floor is all about holistic nursing. Here I have 20+ minutes to talk, because that is my job. Who has that luxury on other floors?

    Cons: restraining is few and far between, but it still happens for safety reasons and i feel terribly when I have to.
    Hearing their stories... very few come in with average kiddo histories.
    Violence can happen at the drop of a hat (even if Broset said they were low risk).
    Some families are just as bad, if not worse, than the patient.
    Not everyone will open up so we can help them. That is the most frustrating aspect of the field in my opinion. When the whole team wants to help this one person, but they deny everything and insist they are okay. It's heartbreaking, no matter the age of the patient.

    I originally went into nursing school with the plan of CNM. So glad I got sidetracked!
  4. by   ScenicRoute
    In my hospital group happen off the unit at a treatment mall. I do run groups, but so do techs, rec therapists, psychologists, even my manager leads a group. I have done journaling, collage, music listening, coping skills, symptom management, and craft groups. Your facility will probably have some flexibility if they require you to lead groups. You might not have to actually stand in front of the class and teach from a curriculum if you're not comfortable with that
  5. by   Laurel32
    I would definitely go for a mental health unit in a hospital. Im a new grad. I love knowing that if things go south medically, I can always get support from ICU trained nurses. I work in a teaching hospital, which means we have residents to call for issues during the night. Awesome!

    I work the night shift. Usually things are quiet unless there is a manic patient awake or a patient with medical needs. I start at 2230. I spend the night passing sleeping medications or pain medications PRN. I go through charts and prepare for the AM med pass. During the night its just myself and another nurse with two techs for 25 patient's. The end of my shift is the busiest because I pass meds for 15 patient's. At this time the techs are taking vitals and managing the milue. I leave at 800.

    Yes the nurses on my unit run groups. We also have an occupational therapist, CD counselor and others that run groups.
  6. by   Psych77
    I've worked in a few different units. The nurse may run groups, or they may not. It really depends upon the facility, staffing, etc. Simpler groups are often done by mental health techs. One nurse I know is very knowledgeable in addiction so she always does the addiction group. Social workers or recreation therapists also commonly do groups. If you are into doing them often times your interest can put you in that position. I always found it hard to do all my charting/meds, drop everything and do a group, but I did it a few times and it was interesting.

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