What is psych nursing like exactly?

Whispera, MSN, RN · Jul 11, 2009

If I was you, I'd talk to someone who works where you're thinking of working, since no two places are alike. Job-shadowing for a day or so is a good idea too, if that's allowed there.

Nurse4life09 · Jul 11, 2009

If I was you, I'd talk to someone who works where you're thinking of working, since no two places are alike. Job-shadowing for a day or so is a good idea too, if that's allowed there.

I did happen to meet someone who worked there, totally out of the blue. But I've since lost touch with that person. I think I will just try to shadow there for the time being.

wonderbee, BSN, RN · Jul 19, 2009

Shadowing may be problematic in a psych facility due to the sensitive nature of mental illness. Find out as much as you can about any prospects before the interview. It is true that no two facilities or units are alike. It can be violent. You can get hurt. It can be peaceful and therapeutic. There is still plenty of medical stuff going on too.

Kialya, ASN · Jul 20, 2009

Here is a day in the life of a psych nurse where I work:

I work 3-11 pm. I have a 5 pm and 9 pm med pass and care for up to 10 patients directly. I get out of report with the day shift around 3:30 pm run and get my meds pulled, go find whatever patients I can find before 5 pm and assess them. (suicidal? anxious? hallucinations? detoxing? any medical problems I need to address?) Give the 5 pm meds. The patients go eat dinner at 5:15pm Go down with them and chart while eating with the unit. Get back on the unit around 6:15. More charting and assessments. Put out any 'fires' (pts who are anxious/restless/out of control/borderlines). Re-assess anyone who had pain and was given any pain meds earlier. In the meantime, complete new patient admissions (which take about 1 to 1.4 hours to accomplish for each one) and discharges as they happen. We usually do about 3 admits on the evening shift. Answer the phones, do paperwork (here we are unit secretaries as well as RN's). Pull the 9 pm meds. Our facility has almost no computer anything so all our charting is done manually and we kill trees by the forest. You blink and now it is 9 pm and time for the night med pass. By the time you finish the last med pass you realize it is actually going on 10 pm and you still need to chart on 4 patients. Update your census and acuities and brief the PM supervisor of any 'problem' patients. Help with the billion small tasks that are never accounted for ('I need socks!' 'Where do I get a bandage?' She just turned the channel and we were watching that show!' 'That tech over there is just texting and I already asked him 3x for a blanket!' why didn't my doctor give me an order for Vicodin?' 'When am I going to be discharged?' etc.) Sign all the BHT and LPN paperwork. Look at the time and realize it's going on 11 pm and the grave shift will be here any minute. You haven't taped report yet and still have 3 patients to chart on. Looks like more overtime again.

Go home and be thankful you have a job that is rewarding and pays well. :bowingpur

Return the next day. :uhoh3:

EarthChild1130 · Jul 23, 2009

I work in outpatient mental health, so my day is different than an inpatient unit...I work 8-5, Mon-Friday...the majority of my day is spent filling prescription refills for patients as they are faxed in by pharmacies and various paperwork-type stuff such as prior authorization forms from insurance companies to make sure that the insurance will pay for medication prescribed by our MDs or our NP. I have time alloted during the day to return calls from patients related to questions about medications, illness management, etc. I also schedule patients for weekly med box fills, as we do have some patients who, for various reasons, cannot safely manage their own meds. They see me temporarily to learn safe medication management, what their meds are, side effects, etc. I also run a nutrition/activity/wellness group once week, a diabetic education group once a week, and a weekly injection clinic where patients come to receive long-acting antipsychotics. In the middle of all that, I make sure the sample cabinets stay stocked, help the case managers put out their fires, and do 'spot-check' stuff for the MDs and NP like vital signs checks, AIMS (Abnormal Involuntary Movement Scale) tests, and Mini Mental Status Exams...We also have our fair share of crisis patients, and I respond to those as well, with members of our crisis team.

I also worked inpatient, and our unit ran differently than the post above, but I think this post is long enough!! lol:D

rnrainy · Nov 8, 2010

I was on a cardiac step down unit for a year before going to psych and it is not easy, or easier! My unit is 8 hours, probably because 12 hours is too much for a person to deal with, so I am now on midnights, 5 days a week.

Days/Afternoons have alot of work to do, I've stayed a few times and must give those shifts props for maintaining each and every day! My shift: between 7-11 patients, addressing issues not dealt with by the other shifts, intakes and admissions, and mostly, dealing with the patients who can't or aren't sleeping.

Most of the time, it is just maintaining a safe environment for staff and patients with safety rounds, redirecting others, and the occasional 1:1.

Good luck!!

laurenicoleRN · Nov 9, 2010

At my facility the RNs are more in a supervisory role. The psychiatric nursing assistants (PNAs) watch and aid the patients directly. The 2 LVNs give all the meds. We have 60 beds. It can get pretty chaotic sometimes.

euzueta · Nov 23, 2010

Wow, that sounds like my day! Too weird! lol.

Noah'sRNMom · Nov 24, 2010

I work 3-11 at a state mental hospital. Unless you work day shift at my hospital, you are not going to get to participate in any type of groups, etc. Here is my day. I come on the ward. As I'm walking down the hall I usually get stopped by the same 3 patients asking me various questions. Some want me to feed into their delusions, some ask me when I think they will be discharged, etc. But, it's usually the same people. When I finally make it into the nurse's station, I get report from the daylight nurses. They notify me of any med changes or any new orders that were written during the day. Then, I make my ward assignment sheet. We have 28 patients on my ward. The RN runs the ward and I have 1 LPN who passes the meds and usually 2 aides, unless I have a 2;1 or 1:1, then I will have more help. I assign my LPN his tasks and my aides their's. I also assign breaks. Then I peer review all charts. If it's treatment team day, which is once a week, I make sure the orders are right and taken off correctly and that the necessary changes have been made. My dr. also stays late, so I usually have several orders that need to be taken off as well. I have a 4pm accucheck that I have every day because I have a brittle diabetic. During this time, I have to stop to answer the door to the thousands of times that patients are coming to my door asking for various items or various questions that usually aren't that important. 5:30pm is dinner. I send an aide to do diningroom and I usually stay back because I always have patients that have to eat on the ward for various reasons. After dinner, is when we rotate breaks. I also will do any treatments that need to be done. 7:30 is when we get everyone ready for meds and have a wrap up group. After that it's meds and snack, then everyone is usually in bed by 9:30. I do have some patients that are up later. After 9:30, you pretty much have the rest of the time to do whatever you need to do. I will usually finish up my ward report that needs faxed to our nursing office by 10pm, then I chart on whoever needs charted on. Keep in mind that this is just the routine and that there are usually several incidents that get thrown in there from day to day. Example: A patient who gets off the ward (AWOL), two patients fighting, a patient assaulting staff, a patient banging their head off the office door, etc.. When anything out of the ordinary like this happens incident reports need to be done and mounds of paperwork. hope that helps a little!

manchmal · Dec 2, 2010

Hi...I'm an RN student, half-way through, and I went to school specifically to do psych nursing. I have a BA in a different area, and went back to school to do this. Before I made that choice, though, I spent a while volunteering at a state hospital. Maybe you could look into this? Where I am, you can get trained, sign the HIPAA stuff, and there are volunteer activities that are pre-scheduled, and even a volunteer coordinator. You could probably spend a few days shadowing to see what it's like in that specific facility. Would probably make you look more attractive to hire, too, since they would know you are taking it seriously, I'd think?

You guys are all so helpful...I've been reading posts here for 3 hours now. I'm getting a little anxious about what starting off as a psych nurse might be like. I have done clinicals on a psych floor of a private hospital, and have volunteered quite a bit at a state hospital, and the two seem different -- in both policy, and environment. I actually think I prefer the state hospital environment, though I've not done clinicals there so I worry I don't really know what all the RNs do there.

I have some questions that are nagging at me...

1. My psych class/clinical didn't train me much about safety, transporting a patient who is flailing, etc., making decisions about when patient is danger to self/others, using restraints, etc. Are these things you would learn in orientation or on the job? Where I had my clinicals, the patients weren't always as acute as those I've seen at a state facility, so we didn't learn a lot of this...is there any sort of website or good textbook that shares this info, or is this something you experienced psych nurses have learned "on the job"? I know they do safety/orientation training, but I figured I'd learn a little more in my psych nursing class.

2. Medicating an agitated patient who is in restraints...how do you access IM sites if they're on their back?

3. Job prospects...I want to work at a state hospital, I'm pretty sure...and they are closing these hospitals and consolidating them more and more. Is there going to be anywhere to work in the future? I ask because I have been told (same old story) to work a year in med/surg first to make myself more marketable, but as I left a good job/career specifically to do psych nursing, I don't want to work med/surg particularly...I have to decide what area to do preceptorship in soon, and I really want to do psych, but I will have to do preceptorship at a private hospital. Some instructors are telling me to do med/surg...

I'm sure I'll think of more to ask. I'm glad to be here! :)

NurseDaddy2006 · Dec 3, 2010

Let's see... I've done psych nursing two different ways now.

I spent maybe six months working on a renal unit/med surge environment after graduation, and it wasn't for me. I wanted to be a psych nurse and got the opportunity to transfer to a large hospital's psych unit.

Inpatient psych is something I did for 13 months or so, and I liked what I was doing. Working three 12s per week, days. Come in, get report, figure out which nurse is charting, which nurse is doing meds, who's charge for the shift. The unit census was usually 29 or so. Two teams, blue and green. Most shifts you had 14 patients to do meds or charting on. If you did meds, you were handing out 8's, 10's, 12's, 14s, 15s, and 18s. Any diabetics on your team you're doing fingersticks and acting accordingly. You'd give any PRNS. Chart those. Answer the door. the phone. Get socks. Open the laundry. Encourage sharing of the payphone. Break up disputes. Run a med group. Run a stress reduction group. I liked patient interaction and discussion. I didn't like admissions. Preferred discharges. For me, the biggest issue was with co-workers. That unit was known amongst area hospitals as a place that chews nurses up and spits them out. In fact, when I interviewed at another hospital I was told "you lasted 13 months there? You've got what it takes then. You're hired". LOL. I left that unit and was out of work for a while. Then I landed my current job.

Outpatient psych is something I've been doing since August 09. I work for an organization that has some congregate sites with folks who came from area institutions and are being treated and supported for a transition back into the community. We also have apartments with three consumers in them, followed by our case managers. We've got clinics too. At this job, I get paid to think. It's an oversight/consultant/trainer/educator/harm reduction kind of thing. I write training programs and train new hires on mental illness and medication. I intervene when incidents occur. I step in when it looks as though someone fell through the cracks. I only write notes on people I meet with. I run groups. I create signage (on typical stuff like smoking, and diabetes, and what is hypertension). I consult with staff when they don't understand a new diagnosis or medication someone came back from the doctor with. I work Monday through Friday with no weekends, holidays, or on call. I also make a lot less than I would working a psych unit. But I'm happy. Its the first job I've ever had in any field I've ever worked in, where I don't find myself trying to find ways to get out of it into something better. It's the first time I've been able to say I really like my job.