Scared at new job in psychiatric hospital

[GypseyGirl]

I started a job a month ago with a state mental hospital. I was happy to get a job as a new grad, and they said they would give me 6 weeks of training. However, being in the unit, I've been feeling extremely overwhelmed. Many nurses and psych techs have been attacked by patients from broken ribs to punctured lungs and concussions, stabbing with pens...scary stuff! I was training in the Patient Observation Unit (the Psych hospital ER) and that was not as scary (the patients are only there for a minimum of 3 days and they're more being observed). Recently, I started training on the inpatient unit. I'm very concerned here because due to budget cuts, they have cut back a lot on staffing (there are 18 patients to 1 RN and 2 psych techs. A lot of these patients have a history of violence, many coming from the prison system, angry to be there, and unpredictable.

I am concerned doing med pass on this many patient as a new grad and making med errors. I'm concerned with my safety (the patients have free reign on the unit and are wandering around, constantly at the nurses station making threats and yelling). They say don't turn your back on the patients, but I don't see it possible to do this because they are all around me! I'm really not sure this is the right position for me or if it's worth risking my safety. As a new grad, I know there are not many options right now and it would be good to get experience. But I'm just feeling very scared and uncomfortable there. Any recommendations?

[GypseyGirl]

Thanks for the advice Merlyn. Maybe this environment just takes some getting used to. But I feel like all it takes is just one time for a patient to attack. They are very unpredictable. I would listen to the CNA's at my work, but there are none! Just RN's and techs on the unit! The techs go through a month training- many of them fresh out of high school!

[Merlyn]

Thanks for the advice Merlyn. Maybe this environment just takes some getting used to. But I feel like all it takes is just one time for a patient to attack. They are very unpredictable. I would listen to the CNA's at my work, but there are none! Just RN's and techs on the unit! The techs go through a month training- many of them fresh out of high school!

Best advice. After a while, and I hope that you are on the same unit, you'll get to know the patients. 98% of the the patient that I care for would give off warning signs be fore they would go off.

They would start to pace. they would start to rock, Get more friendly to you. or maybe they would just stair. Before I would walk, run or fly away I just asked them what is wrong I found out that just listening was a whole lot better then PRN and restraints. Also never try to brake up a fight between two or more patients. I got injured that way. I stated off on a all female unit. The HSTs referred to it as the Home of the Glow Girls. Fights every night. My first night there I tried to brake up a fight. I almost lost my ability to reproduce. After that night. I just helped to clean up the blood when they were finished. Just try and relax. Ask a lot of questions, and watch out for the signals. I know that I have given you a lot to think about, but if I can help another nurse from being hurt it is well worth it. Once you get to know the patients, you will do OK

[woodflower]

Merlyn,

Thank you for your comments. Do you recommend this area of work for a new grad. I am in the same boat and am just trying to get some experience and jobs are scarce, but I can't help but think in the back of my mind that the risk is not even worth it. I have not started there yet but have an interview and am trying to make the right choice.

Thanks

[chevyv, BSN, RN]

Thanks for the advice Merlyn. Maybe this environment just takes some getting used to. But I feel like all it takes is just one time for a patient to attack. They are very unpredictable. I would listen to the CNA's at my work, but there are none! Just RN's and techs on the unit! The techs go through a month training- many of them fresh out of high school!

Oh hell no! One month of training and some right out of HS!?! Run girl run!!!

[Merlyn]

Merlyn,

Thank you for your comments. Do you recommend this area of work for a new grad. I am in the same boat and am just trying to get some experience and jobs are scarce, but I can't help but think in the back of my mind that the risk is not even worth it. I have not started there yet but have an interview and am trying to make the right choice.

Thanks

No, I would recommend Med/Surge first. Get your assessment skill down first. When I went into psych I had been working as a Nurse for about 20 years. I remember the day I was giving report to the head nurse in psych and I mention that a patient had something going on in his lung. I forgot what it was now, maybe some rails or something else. The nurse looked at me and said with a straight face,"You can assess lungs?" It was as though I said that I could do brain surgery. She had spent all of her career in Psych.. She was a great Psych nurse but couldn't do anything else. You didn't do that much physical assessment on the unit. I had worked in Med/Surge, ER, Respiratory, CCU, ICU, I had gotten fired from a lot of jobs. So before psych, get your skills down.

[Multicollinearity, BSN, RN]

GipseyGirl,

In this thread you have painted a picture of this state psychiatric hospital with the following information: RNs earn $21 per hour. Many of the psych techs just graduated from high school. You only had 3-4 hours of training in self-defense and de-escalation. You describe incidents of staff assaults. The question is how many and how often. Some staff assaults are not preventable.

Based upon what you have said this does not describe a state psychiatric hospital that values safety by investing in training and experienced psychiatric nurses. It sounds like a facility that is playing off the bad economy by getting all the inexpensive "takers" they can. I wonder if the patients are just being warehoused or if they actually receive decent treatment.

The stakes are different when you are (literally) locked into a facility with those society has had locked up due to their danger. I wish you luck with your decision.

[woodflower]

Thank you for your advice, I am hoping to find something else.

[GypseyGirl]

Yes, thank you for your advice. The more advice I get from some of you who have worked in these types of facilities, the more afraid I feel! I actually got a call for an interview at a hospice place on Friday. The pay is much better and I think it may be more along the lines what I want to do, so hopefully it goes well! Good luck to you too Woodflower. It's tough being a new grad, but we just have to hang in there and be hopeful!

[woodflower]

Thank you, I wish you luck with your interview and I have a potential job opportunity as well. Fingers crossed!!

[Wabi Sabi, BSN, RN]

I think $21 per hour is too low for a psych nurse in that environment (considering all the risks and such). I make more than double of that working at a private psych facility and I have a LVN who passes all medications and processes all orders concerning medications and labs. I am also never the only RN in the unit (even when we have 18 patients). I mean, don't get me wrong, it's still a lot of work dealing with patients, doctors and family members. Last week, there were 7 discharges and 6 admissions on my shift (with me and another RN). But at least, I feel that I am fairly compensated for my work (considering I am too a new grad). The bottom line is if you don't feel safe, you should ask to work in a less acute unit. As far as feeling overwhelmed, that is normal. You are just starting out. I felt scared and overwhelmed for at least 4-5 months when I started. You will gain more confidence in yourself and things do get better. Good luck on whatever you decide.

[GypseyGirl]

Thank you Wabi. I understand that it is probably normal to feel overwhelmed and stressed out with everything you need to learn in a new job (especially as a new grad). I'm not sure whether this feeling I have is being scared in the environment, or if a lot of it has to do with feeling incompetent with my skills. I know it takes time to master your skills and feel confident as a new nurse, I guess I'm just not sure if this is the place to master my skills. I am still in training. The last few weeks I've been on the morning shift, but tomorrow I switch to the evening shift (which will be my regular assigned shift). I'm not sure whether it will be worse or better, but I'll give it a try and see. Who knows- maybe I'll love it. I will try to go in with a positive attitude tomorrow and try to make it through the next few days before I decide for sure.

Also, I wondered if I do interview for other places, if I should mention my current job at the psych unit? I don't know if it would look really bad to leave a job so soon after starting, and I know you're not supposed to bad mouth previous employers in the interview process, so I feel like I have to be careful with this one. Any recommendations?

[doggal]

I have worked at state psychiatric facilities in the late 1970's and late 1980's but not since. I have,however,worked as a consultant (RN,Psychologist,dually licensed) on TBI units, where violence can escalate quickly. With that said, generally the patients are more physically ill so the picture is different. I interviewed for a position recently at a state psych hospital that boasted of a no restraint policy, etc etc, -yet there have been many injuries. Certainly none of us want undue restraints, but there need to be consequences.

Until that happens, we as workers need to be in the face of NIOSH and others responsible for our safety. Do not do this alone-do it with your co-workers. But as a new nurse, go to your interview, I would say- and be brief re the safety concerns and clearly note to them that this is a state psychiatric inpt facility.