Returning to psych nursing after a 3 year absence

[pinkiepieRN]

Hi there! I left psych nursing for a variety of reasons at the beginning of 2012 after 2.5 years of experience and am returning to an adult inpatient unit in 2.5 weeks. I know my meds and s/e, disease processes and have never stopped using my therapeutic communication & de-escalation techniques (was in LTC/SNF and management) and was able to handle the situational questions during my interview with ease. My organization and time management skills are still strong.

I'm worried that I may have learned bad habits during my 1st psych job and that I'll have to "un-learn" those. I know I'll have to get used to passing meds and charting again - but what else should I expect? Do you have any idea how long of an orientation for a seasoned psych nurse with a few years off might last?

[fawnmarie, ASN]

We have had several changes in my facility over the last 2-3 years. Like you, I love mental health nursing, and I am hoping that the changes will have a positive outcome for patients and staff alike. One major change that recently came about was The Joint Commission decided we were administering an extremely high number of emergency IM medications. We have been instructed to try all forms of therapeutic redirection before calling the MD for emergency meds. This may include offering the agitated patient a snack, juice, the opportunity to go outside or to their room to rest, and any other interventions that may relieve agitation, before asking the MD for emergency meds. Of course, all of these interventions must be documented to prove that medication is a last resort.I have mixed feelings about this new approach, but I am hoping it will lead to fewer incidents.

[fawnmarie, ASN]

Why did you leave psych nursing the first time? I also work adult inpatient and have been at my current job for 10 years.

[pinkiepieRN]

Why did you leave psych nursing the first time? I also work adult inpatient and have been at my current job for 10 years.

I was overwhelmed by management, was blocked in all ways to work towards or become a charge nurse or preceptor and felt stuck. We had wayyy to many seclusion/restraint episodes, I was bitten and I didn't feel safe. Management was very unsupportive and sat in her office all day, only coming out for major commotion at which point she wasn't much help.

[pinkiepieRN]

We have had several changes in my facility over the last 2-3 years. Like you, I love mental health nursing, and I am hoping that the changes will have a positive outcome for patients and staff alike. One major change that recently came about was The Joint Commission decided we were administering an extremely high number of emergency IM medications. We have been instructed to try all forms of therapeutic redirection before calling the MD for emergency meds. This may include offering the agitated patient a snack, juice, the opportunity to go outside or to their room to rest, and any other interventions that may relieve agitation, before asking the MD for emergency meds. Of course, all of these interventions must be documented to prove that medication is a last resort.I have mixed feelings about this new approach, but I am hoping it will lead to fewer incidents.

I like this idea and the unit I'm on seems to really promote it. I can only hope that staffing makes it practical. I knew nurses who were IM/quiet room happy and patients who spent way too much time back and forth between being agitated on the unit and quiet room/seclusion.

[fawnmarie, ASN]

As far as seclusion and restraints are concerned, we don't use those very often, unless the patient is violent and has not responded to emergency medication. However, we do give a LOT of emergency IM meds, usually Thorazine or Haldol, occasionally Ativan. The culture of my facility has always embraced the "nip it in the bud" approach, meaning that if a patient is escalating, exhibiting threatening or hostile behavior, we notify the MD pretty quickly. I am curious to see how this new, therapeutic redirection approach will work out...My facility is run by the state, things may be vastly different in private hospitals. Good luck to you as you re-enter psych nursing!

[pinkiepieRN]

As far as seclusion and restraints are concerned, we don't use those very often, unless the patient is violent and has not responded to emergency medication. However, we do give a LOT of emergency IM meds, usually Thorazine or Haldol, occasionally Ativan. The culture of my facility has always embraced the "nip it in the bud" approach, meaning that if a patient is escalating, exhibiting threatening or hostile behavior, we notify the MD pretty quickly. I am curious to see how this new, therapeutic redirection approach will work out...My facility is run by the state, things may be vastly different in private hospitals. Good luck to you as you re-enter psych nursing!

One thing that I'm excited about is that I'll be working at a teaching hospital and so many of my colleagues have certifications or advanced degrees. They use the "Recovery Model", which is what I believe all of this stems from. Thanks for the support!