Typical Day at Work?

[RN1485]

I'm a newish nursing grad who recently made the switch to psych nursing because I loved my clinicals and I find psych itself super interesting....well already (and it's only been 2 months) im feeling overwhelmed and burned out! I already left my 3 month cardiac job because I just HAD to do psych and now I'm hugely regretting my decision.

I'm scheduled to work 7a-3:30p but rarely do I ever get out on time. I usually get out at 6. There are 37 patients and 3 nurses with one being charge. I have to write weekly notes, shift notes, progress notes, special observation notes, prns and refusals and group notes. Today for example: 1 weekly, 1 shift, 3 progress, and 2 special observation. Lots of medication refusal notes and prns. We didn't have group today but if we did that would be more notes. The other nurses chart too but I always seem to get the most. The LPN can only chart on certain things and the charge nurse making the schedule gives herself a lighter load. So much charting and it's all free hand. No check a box charting. It wouldn't be so bad if we didn't have pts becoming aggressive everyday! We have 5 on our unit that wreak havoc. Seclusions, holds, cocktails every single day. I'm in a state facility so we get the worst but I'm wondering how typical is this across the board? I'm really wishing I stayed where I was but now I feel like I have to stay where I am for a while so I wont be viewed as a job hopper.

[greenbeanio]

I don't know. I don't think it's like that everywhere. We mostly just cover the basics in our notes, do charting by exception, and its all computerized. I'm the slowest one of everybody and even I have gotten it down so I'm usually no more than 15 minutes to 1/2 an hour late getting out. Take a look at the other psych units and see - maybe it's just this one place.

[MidLifeRN2012]

I work in an acute psych unit in a hospital and the ratio is 1:10 at most Yes there are restraints and cocktails but not on a daily basis , depending on the patient mix and the level of psychosis. A lot of our patients are repeaters because we deal with a lot of homeless drug addicts but it does make it easier to get to know them

Keep looking. Psych was not my first choice as a new grad but the only field to give me a chance after 2 years looking. So far it's pretty good and it is definitely not boring. :)

[DanaerysTargaryen]

Your workload does sound heavy, but I think a lot of what you describe is more "new grad issues" than "psych nurse issues." Give it a few months and see if your time management improves so that you're able to get out closer to on time. I am lucky in that the ratios at my psych jobs are decent and no one is overburdened with too much charting. But I have also worked in long term care where ratios are worse than what you describe, and I noticed that most of the new grads I worked with started out routinely leaving work hours late, and gradually adjusted to the point that they were staying after their shift as most of us did the majority of the time, but not for nearly as long. As the tasks you're dealing with and your charting become more routine to you, your speed will improve.

I also would not give up on psych based on this particular job. Charting on and medicating 18 acute psych patients would not be my cup of tea either, but I love my current jobs where the staffing ratios are more reasonable and the behaviors are on average a little less severe than what you're describing. At my full time job we have 2 RN's and a CNA to maximum 12 patients on night shift, even more staff on days. Chin up. There are better things out there for you than your current job, whether psych turns out to be your thing or not. Keep putting applications out there but in the meantime, recognize that you can learn a lot from this job about time management, managing a heavy workload, and managing your own stress in the face of these things.

[RN1485, BSN]

Thanks for the input! I've been getting out earlier now (only an hour later instead of 2.5hrs) so that's better. I've learned a lot of nurses will leave on time and then do late entries later. I don't do that though cause I'm worried I will forget.

The behaviors of the residents are still tiresome. Listening to yelling every single day and dealing with those who won't take their meds unless you give them something in return (usually they want a sandwich or cookies) is mentally exhausting as I'm sure yall know. I thought when I switched over that this would be a good break from physical stress but I think the mental stress is much worse in my opinion.

I actually have an interview for a L&D residency this week but I KNOW they are going to ask why I left my 2 jobs so soon after starting. The HR lady kind of already asked and I'm

not sure what I would tell them..except that I had a really big interest working psych and that's why I switched but now I feel it's not for me. Im excited about the interview though. At least I'm getting phone calls.

[DanaerysTargaryen]

Tell them you had to do charting and meds on 18 acute patients… If that doesn't strike them as a problem you don't want the job anyway. Tell them you missed the medical aspect of what you did before your current job, but like xyz aspect of labor and delivery more. (I hated L&D myself so I have nothing to contribute there, hehe. :)) Then pivot to what you would enjoy about the current job and talk it up. Basically you want to make sure they understand that you left voluntarily rather than being pushed out. You want to be sure you sound positive even when talking about these jobs that were admittedly not for you- no one likes to hire someone they see as a whiner. And you want to make them understand that you have no intention of leaving this new job as soon as the last two. And you want to do all that and move on as quickly as possible.

Just my two cents having been through a lot of job interviews, many of which I don't think I did very well at because it took me a while to catch on to how to be a good interviewee as well as a good worker. Your work history may not be as much of an issue as you think it will be. I'm always surprised at how many people, both in nursing and outside of it, have kind of spotty histories including getting fired, which you haven't been, and still do fine finding job after job. It's also understandable that it would take a while for you to find your place as a new grad.

[RN1485, BSN]

Great advice, thanks!

[RN1485, BSN]

So I had my L&D interview and even though it went well, they went with another candidate instead. I was somewhat relieved because I'm really not sure if I want to go back to the hospital. Things have gotten much better on our unit. Many of the individuals who had behavioral problems got discharged so things are a lot better. Now we might have a CIR/restraint once or twice a week instead of everyday. I think I was just mentally exhausted. I also don't want to give up on psych too quickly as I'm still interested in it. So I'm still undecided on which route to take.

[Second Chance RN]

I'm a bit late to the conversation, but I wanted to add some encouragement. I knew I wanted to be a Psych Nurse from ½ thru school, I was hired @ a state psych hospital and have been there almost 2 years. The first 6-8 months were just tough, finding my way, charting, practicing all the therapeutic stuff I learned in orientation, S/R, med cocktails, physical and verbal aggression, etc.

I am on an Acute Stabilization Unit we have 28 beds, generally 2 RN's, 1 LPN, and 2 techs. Charting, treatment plans, and close ops took some time to master, but it has all gotten much easier. Talk to the experienced staff, find out how what they do that saves them time.

Pt populations on an acute unit fluctuate one week is awful with demanding addicts who decide after being pink slipped they "really don't want to detox" and start throwing chairs....fun, fun. The borderlines, and behavior issues, finding out that your pts had sex on your shift....that is fun to explain.

It gets better as you experience all that the human psyche has to offer, and you as a nurse learn to cope with it all. Good Luck

[RN1485, BSN]

Thank you for the encouragement! I feel like I still should give psych a try even though I think my facility is the cause of a lot of stress. I think, like any area of nursing, it really depends on the facility. Unfortunately, we are so short staffed that it can be overwhelming at times. Lately we've been getting pulled all over the hospital so there really is no stability.

I know in school I did my clinicals in facilities that treated pts with substance abuse and I really enjoyed that. Additionally, the demographic was varied. In my unit it is pretty much all schizophrenic pts which can be challenging.

Im trying to stick it out though cause I know it'll be a good stepping stone for the future.

[DanaerysTargaryen]

Short staffing will make your work difficult and less enjoyable no matter your specialty. It really sounds as if you still have some passion for psych but your current workplace is hard… So I think you are doing the right thing by trying to stick it out. On the other hand there is also nothing wrong with continuing to look and interview. Putting in an application does not obligate you to take another job if offered, and it keeps your options open if you are still on the fence. Very best of luck to you no matter what you decide!

[femaleRN]

OMG! That's crazy! I work in inpatient psych in a hospital and our RN to pt ratio is 1:5. We don't even have to lead any groups. Just med's, daily assessment, adding any notes about anything abnormal then discharges and admission, plus with get 2 techs.

[RN1485, BSN]

Where do you work?! That sounds amazing!