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Discussion

Stuck in Psych?

I have been working in psych nursing since I became a nurse 3 years ago. I used to work on an adult inpatient psych unit. I now work in a Psychiatric Emergency Room in Dallas, TX. Majority of the time it is a very busy, chaotic, and sometimes very dangerous place. As with any unit, though, we have our slower nights and I'm thankful for those.

Don't get me wrong, I love my job and I love what I do. I have always been interested in psych, even before I became a nurse. However, the only thing I wish I could do more of is practice my skills (IV's, catheters, etc.). The most invasive thing I do is draw blood (which is a task itself depending on if your patient is homicidal or not!)

Basically my question is what have some of the psych RN's on here done in terms of wanting to keep your skills fresh? Do you work PRN on a medical floor? I have been considering working PRN on a med-surge floor once I graduate with my BSN (should be this December) in order to gain experience, focus on my skills, etc. I think switching completely from psych to med-surge wouldn't be the best way to go necessarily. I think seeing how I like it PRN would be the best way to go because I know psych and have experience in it.

Also, I've read a lot of threads recently that ask if psych-nursing will pigeon-hole you into only being able to work psych. I don't think this is true, but being a psych nurse with only psych experience, it worries me to read...I think my psych experience is valuable and the things I have learned will definitely help me provide the best care that I am capable of. I think psych nurses bring a very valuable skill set to the table. We deal with very aggressive and violent patients, have to be on high-alert for behavioral changes in patients and determine whether it is from the medication, the street drugs, strictly behavioral without psychosis, etc. It is not an easy thing to do and anyone who says otherwise, I have doubts. There are things in psych that are easy, many things that are not. As with any other field of nursing, there are pros and cons, but that's for another thread. :)

Any thoughts, recommendations, or experiences with this would be much appreciated! Thanks in advance.

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    My first job was in psych. After three years, I started to get concerned; admissions were down, LOS was much shorter. I could feel that changes were coming. I didn't want to end up on some floor I had no interest in.

    Just as I was getting close to reaching my four year anniversary, I got a job in peds. My thinking was if I had to do IVs, IV meds, etc., I'd rather do them on kids.

    Making the transition wasn't that bad. It wound up being a good decision, because a few years later that psych unit closed altogether.

    If I were you, I'd start making changes now, before you are boxed into a corner and have to take what you can get.

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    What, exactly, is your goal following obtaining your BSN?

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    I worked as a psych nurse for 15 years so I was very worried about being pigeon-holed. My next job was corrections where I was pretty much hired for my psych skills but I had to learn a lot of other stuff on the fly. When it was time to "get out of jail" I managed to get hired on a surgical floor at a reputable hospital. Luckily they had an internship for new grads and "returning nurses" so I got a really solid orientation.

    I think the only thing that keeps nurses pigeon-holed is their own unwillingness to step out of their comfort zone. No one wants to go back to being the newbie who doesn't know anything. If you're willing to take the occasional plunge you can have an interesting and well-rounded career.

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    I am not 100% sure where I want to go from here, that is why I would like to get some med-surg experience to hopefully help me decide. I do enjoy psych, but I am not sure if I will be doing psych PRN and medical full-time or vice versa.

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    Thank you for your input! I definitely don't have much concern about us not getting admissions or having a low census. The LOS here is very short because it is a Psych ER. We are crisis stabilization so they generally stay for 1-3 nights, sometimes 4 if we can't find placement, etc. I really don't have concerns that our hospital will close or anything like that, and I don't necessarily feel like I will be "boxed in." I think with my BSN I would have a good chance of getting on a medical floor somewhere...just thinking I need to get some med-surg experience first before I officially decide if I want to stay in psych full-time or go to a more medically-based floor. I still do enjoy psych and if I didn't at all I wouldn't be here anymore for sure. I don't believe in staying somewhere that I'm not happy.

    P.S. Props to you for wanting to work with peds. I don't think I could do it!

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    I did it the opposite, I did medical before psych, and now I float to the med/surg floors whenever we're overstaffed/less understaffed. But I like your idea to work PRN as long as you can give the med/surg floor enough of your time to make it worth their while. If you work one day a month you're getting more out of it than they are (because they're going to spend a lot of money training you).

    As far as getting pigeonholed, I think you could really sell your skills as a benefit to a med/surg floor. When a patient or family gets aggressive in my hospital they call a code grey, which means they get me (or another psych RN) and we run the code until the patient is calmed down (or medicated). Why wouldn't they want those skills on tap on their unit?

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    Update:

    Went on my first Med/Surg interview and it went really well. However, at the end of the interview the nurse manager said she couldn't hire me because she "didn't have enough time or resources available for the time you would need to orient"...I was and still am upset about it. A big positive though was that the HR recruiter called me back and said she was heartbroken that the nurse manager said she couldn't hire me. She is seeing about talking to another Med/Surg nurse manager to see if she can help me find another position.

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    If you are interested in switching fields, I suggest a speciality with in built in structured training program, such as the OR (disclosure- this is what I did after many years in psych). Most nurses do not have previous OR training, regardless of background. I moved on from the OR to another speciality. Overall, I found my years in psych highly beneficial. I also learned how to spin the strengths, such as assessing situations, responding to emergencies, and even recognizing destructive patterns and how to de-esclate (comes in handy with office/unit politics). I emphasized the cerebral requirements for psych, and assured potential employers that I could master new skills, because I can critically think well.

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