What to look out for as a PCA in The Psychiatric/Behavioral Unit

[Anatomy Jane, CNA]

Hello all!

I recently got hired as a PCA for a new children's Behavioral Health Hospital. I'm very excited, but I can't help but feel extremely nervous. I have never worked with any kind of psychiatric patient before. The closest kind of experience that I have had with this would probably be briefly working in the Memory Care unit as an STNA, having to deal with the aggression and confusion that came with it sometimes, but I'm almost 100% sure that it doesn't even begin to compare to psych. I am in Behavioral Health training at the moment, learning about what to do, and what not to do, in certain situations, along with verbal de-escalation, which I happen to think I won't be very good at, at all, and learning holds, restraints, and blocking techniques to protect ourselves when a patient does escalate. I haven't visited the new building that I will be working at yet; I will be going in a few days. The more I think about actually starting soon (in the next few weeks), the more nervous I get. As embarrassing as it is, I also can't help but feel as though I will be intimidated by these kids ? I really do not wish to feel intimidated and show these kids that I somewhat fear them, I want to do nothing but help them. So, I guess my questions to you guys who have had some psych experience is: What do I look out for when I begin working at this new Behavioral Health Hospital? What do I need to do to not feel so intimidated by them? Could you give me any situation that you were in with a psych patient, and what you did in that situation?

Please, do not take any of this the wrong way. It is just how I feel. I went into this field because I have a passion for it, but I guess I just didn't thoroughly think about it, and how it might make me feel; fearful. Nonetheless, I am still very excited.

Any advice is greatly appreciated!

[Trishalishus, PhD, CNS]

Be real, be humble, be careful.

Don’t *** these kids - they’ll write you off if you’re a fake. It’s ok to be nervous. Don’t pretend to knowledge or wisdom you don’t have. If they know you’re new, they’ll understand. But they’ll still try and take advantage of it - coz that’ s what kids do.

Set self- and other-respecting boundaries. you are not their friend. You cannot be their friend. Aim for respectful, compassionate adult.

Keep your trap shut and listen. Don’t give advice. Listen. Empathise. Listen some more. Offer to play cards or do colouring in or play music with them. Don’t judge and don’t try to pretend a wisdom you lack. Listen.

Watch your back and take care not to provide them with a weapon (risk of dsh) eg can lid, other sharp things.

[maggie0, BSN, RN]

I'm working as a mental health tech right now, as I finish my nursing degree. I work with adolescents a lot. Honestly, there's no need to be intimidated; they're just regular kids, but with problems. Cultivate a "mom" or "dad" voice, maintain firm boundaries, but be willing to joke and have fun with them when appropriate. I am always amazed at how smart and insightful these kids are. Sometimes, being wise beyond their years is a source of their problems. Often this is combined with impossibly difficult family situations. (What some of these kids go through will set your hair on fire.) And sure, there's early-onset mental illness. But I end up loving and caring for almost every kid, on some level.

I have only been afraid for my safety once, when a 10 yr old I was observing in the ED grabbed my arm and attempted to bend it back. I was alone at the time (and should not have been) and was caught off guard. That was my mistake--I was kidding around with him and should have maintained a professional distance, since I didn't know him well, as well as a physical distance. A learning experience!

[cvh1576, CNA]

Hello,

I just finished my orientation for the adolescent psych unit. I can understand the anxiety, I'm with you on that. Today will be my first day alone on the floor, well, not being on orientation anymore. I have some anxiety and a little scared but on my floor everyone seems to help and have your back. I've never worked with kids myself so it's a new experience for me also. I've learned to demand respect, set boundaries and they'll give you respect back. Treat them like a human being. They'll try to manipulate you if they know you're new but thats every where. I come from a background of working with substance abuse and it's kind of the same thing. Set boundaries, be observant, watch your back, stay humble.

[hppygr8ful, ASN, RN, EMT-I]

21 hours ago, cvh1576 said:

I've learned to demand respect, set boundaries and they'll give you respect back. Treat them like a human being. They'll try to manipulate you if they know you're new but thats every where. I come from a background of working with substance abuse and it's kind of the same thing. Set boundaries, be observant, watch your back, stay humble.

I have worked with adolescent psych patients for close to 20 years and can tell you that you won't get very far if you "Demand" anything. Your final sentence here will take you far but also become fluent in Trauma Informed care.