Suggestions for the RN new to Psych

[PG2018]

Having recently applied to a plethora of psych RN jobs in another region of the state, I'm interested in what to expect at the interviews I've been invited to.

I'm in a three year psychiatric mental health nurse practitioner program (about to finish up the second year), but I've NEVER once worked in psych! Psychiatry just really interests me so I chose this path, and I'm really digging the classes I'm in. In my locale, there isn't any facility or clinic in which I can do my clinical rotations for PMHNP so my wife and I are going to move, and we're looking forward to it. In doing so, I want to get a job more related to my field. Most of the positions seem really open to having a student and working around school scheduling.

For one year, I worked in med-surg and did not like it. It was a truly horrible experience. I quit a year to the day I started and went to work in an office approving drug orders. Prior to nursing, I state government administration.

I know RNs don't engage in psychotherapy, but I don't see exactly what I'll be doing at work. Yes, I realize there are assessments, documentations, medication administrations, and typical nursing duties, but what makes psychiatric nursing unique? For example, I've seen nurses sitting in day rooms playing games with psych patients. Is that typical? Oddly enough, this has never been covered in any of my classes. The first interview I have is with an organization that doesn't have physically ill people housed there although they have typical diseases (HTN, DM, et al) so I'm wondering how much daily shift assessing and medication giving there is to do. General questions like that.

So with seemingly so little to do, from the outside looking in when compared to med-surg or the experiences I've had floating to the ER or ICU, there doesn't seem like a lot to do. I don't mean to imply that I think psych nurses don't work because I know they work hard. I just don't know what to expect!

So any comments, replies, suggestions are immensely appreciated.

[Umberlee]

Well it sure depends on what kind of psych nursing you'll be doing. The outpatient side is a horse of a completely different color and there are patients all along a continuum of psych disorders which can all benefit from some degree of nursing involvement. On the outpatient side the nurses mostly do injections, coordinate refills and med changes, speak to patients or their families regarding medication concerns, and counsel/intervene depending on the situation and degree of severity. On the inpatient side it can really be feast or famine. I think all acute care is like that though, isn't it? I have not had much time working inpatient to spend much 1:1 with my patients though I would really like to. When I work days it is just too busy and when I work nights, well, they're hopefully asleep. I have to say that the thing I'm most proud of though is that I haven't had to restrain or inject anyone. I have come close, but have been able to either get the patient to take oral meds or de-escalate each time. I know there are not always patients who will de-escalate or accept PO meds so I have gotten kind of lucky but I'd much rather be a calm and therapeutic nurse than a hogtie and inject one. I seem to work with an entire flock of nurses who pride themselves on not taking any BS from patients and jump to e-meds. The way they talk to these people sometimes just blows my mind. But, that's just not my style.

I too am working on my PMHNP but just started. I much prefer outpatient for a variety of reasons and though I definitely want to get some inpatient experience for grad school clinicals, I much prefer the more calm and pensive approach one can take with an outpatient caseload, at least from what I see so far. Plus, no call! After years of heavy call duty I am more than ready to be done with call like, forever :)

[Sheryl18]

I work in an inpatient psych hospital, I wish I had time to sit and play games with my patients. I am busy doing meds, orders and admissions. I talk with my patients while I am administering meds and ask how they are feeling etc. It's usually the only one on one time I get with them. Also with psych you still get medical problems, finger sticks and insulin, wound care etc.

Good luck!!

[PeacockMaiden]

I work inpatient psych. I run my tail off all shift, following up on orders, calling docs, other legal paper work, dealing with escalating patients, supervising my floor staff, passing meds, doing detox protocols, finger sticks, dealing with med seekers, and doing admissions and discharges.

Sometimes I have to send someone to the ER for a medical issue (which is a bunch of paperwork and phone calls). My staff had to physically restrain a patient last night...so for me, that's about 1 hour more of paperwork.

Inpatient psych is primarily a paperwork position unfortunately. A lot of documentation and charting, sign this paper, etc.

I certainly don't have time to sit around with the patients. I don't even have time to take lunch breaks and bathroom breaks! It is pretty chaotic most of the time. I regret that my time is very limited in talking to the patients. I essentially put out fires all shift.

[HangInThere, BSN, RN]

I work on a Geriatric-Psychiatric unit in a large city hospital with patients (majority over 65 years old) who have dementia, schizophrenia, MDD, bipolar disorder, delusions, PTSD, anxiety, personality disorders. It's wonderful to interact with a team of capable nursing assistants, psychotherapists, psychiatrists, physician assistants and social workers - especially when the patients make progress. I love to see the day when they return home or to LTC/shelter/group home with more balance. Anyway, I'm always busy, vigilant. After hand-off, my focus is on medications and getting feedback from the patients to assess effectiveness. During and after meds, I talk with patients, hold their hands, make them comfortable, and encourage them to interact socially with compatible patients. I settle disputes, direct patients' to control their aggressive verbal and physical outbursts, reorient confused and disorganized patients, wheedle out the real meaning of seeming illogical phrasing, and attend to needs. Reviewing team documentation and adding mine to the files is a big time suck, but necessary.

On my unit about 25% of the patients are active through the night. They are internally preoccupied and/or repeatedly request I call them a cab to go home. Sun-downers. The nursing assistants and nurses watch everything patients do to be sure they stay safe. Safety is big! Safe from falling if they are unsteady, safe from each other, safe from hurting themselves (some hit walls or climb on tables). Restraints are not an option, so that is exhausting. De-escalation is worth the trouble, PRNs PO are very useful, and IM sedation is only a last resort with an OK from the psychiatrist on duty.

I prep patients for dialysis, scans, colonoscopies, court dates, placement interviews, transferring to medical floors, and surgery. I do wound care, occasional PEG feeds, enemas, assist with straight caths, phlebotomy, urine samples. It's a lot.

Then every so often, there's a quiet shift with a harmonious census and I have the opportunity to interact with patients and other staff in a way that is so enjoyable because everyone accepts each others' level of acuity and can go with the flow. The experience is extremely rewarding, trust me.

Peace-out.