Why do one year Med surg nursing before going into Psychiatry Nursing

GooeyRN, ADN, BSN, CNA, LPN, RN · Nov 23, 2007

I worked psych straight out of school. I had no problems. I left when I got married and moved. I really miss working psych! I worked psych for a little over a year. I live in the boonies now, and there aren't any psych hospitals, actually, there is only one hospital locally. So I work there in med-surg. It was a rough switch at first since I was only given a 2 week orientation. I think many people say to work med-surg first, to get your physical skills down, so you can bounce specialties easier down the road. If you get burnt out of working psych for 10 years, I imagine it would be hard to switch specialties. If I still worked psych, I think I would be terrified of switching specialties by now. (I am an RN for a bit over 4 years.) Even though I don't LOVE med-surg, I am glad I now have the experience. I have a lot more confidence in my skills and I am not terrified of switching to another area. So many things will be the same. I also think many people say to work med-surg first to fill all of the openings on med-surg units. Many people don't want to work med-surg, so its a way to fill the positions, even if only temporarily. If you KNOW you want to work psych for the rest of your career, go for it. You will do fine. But, if you aren't sure you want to stay forever, I would work med-surg for even just 6 months to get some experience.

sarmedic70 · Nov 23, 2007

Hi all. Hope everybody had a great Thanksgiving Day............and didn't eat too much :lol2:

I totally agree that there's a possibility that one of the other reasons that has been indicated in working Med-Surg before "specializing" is to fill those positions. The first hospital I worked in, I was originally hired for the ER (and by the ER coordinator even); however, I had to orient to Med-Surg and L&D since we were a rather small hospital, and we "did it all" essentially. One day our DON asked me how it was going, and I cheerfully replied how much I loved working the ER and how I was in my element there (I am also a medic, so it's a "given."). I guess I should not have been so cheerful about it........ :lol2: The response I got back was something to the effect of: working in ER all you do is get the people stabilized and send them on their way...........thinking to self: Hmmmmmmmmmmmmmmmm...........really now!!............then she went on to say that in Med-Surg is where one TRULY gets the "experience.".........................again, thinking to self: Hmmmmmmmmmmmmmmmmmmm.........really now!!.....................Also the comment was to me that ALL newly graduated RNs must spend a minimum of 6 mos doing Med-Surg and if she had her way about it, a minimum of ONE year. So, next thing I know I am working Med-Surg most of the time. Actually, I was done a favour in that I rapidly discovered many things and one thing further solidified my initial thoughts/feelings that I am NOT a med-surg type RN ..................There was a reason I wanted to originally "Track" either emergency medicine or psych medicine. It is my "cup of tea." Most of my friends, also RNs, were surprised about this as well. Had another RN, in my nursing program, who had also been working as a medic in the ER, and when she got her RN license, "they" took her OUT of the ER (where she wanted to be), and put her on another unit. In a year, she was THEN back in the ER. Go figure! She was working in a different hospital than mine.

So, why not keep a RN where he/she truly knows will enjoy and be good at, vice what is needed.............I understand the "supply and demand" needs after having been a career military type (non-medical) for over 26 years; however, in nursing we truly do have a choice (or at least so I thought at that time). I guess "they" didn't/don't want happy nurses :lol2:who in turn would thoroughly enjoy their work (and it NOT be "just a job") of which translates to then ensuring the patients were happy........... :lol2: Happy nurses = happy patients, eh? Additionally, the end result is not being able to retain nurses..........either they leave the hospital or even nursing all together.

I "paid" my dues in Med-Surg and moved on to my "passion" of being in psych nursing now. I turned down working ER at a couple of other hospitals. Am I a happy RN? You betcha! Do I feel I benefited by working Med-Surg even though I didn't enjoy it? You betcha! owever, that is me.

Truth be told, each nurse needs to decide for himself/herself as to what is best suited for him/her when it comes down to it. Simply put! :lol2: There are pros and cons either way one looks at it. I feel that some "attitudes" truly do need to change in nursing these days with the shortages we have, and permit the nurse to have the choice vice all the other presumed reasons. There are nurses who are well-suited to do Med-Surg as there are nurses well-suited to do other specialty areas. And to ensure that our patients have the best care possible is to ensure we have nurses in specialties of which they are happy and bested suited in being in. To have the "mentality" that a nurse MUST first get Med-Surg experience does a great disservice to all concerned, and in the end "they" will end up losing that nurse anyway...............and right now, the medical field cannot afford to further compound the nursing shortage.

Ugh! I didn't mean to write a "book" here..............I have thoroughly enjoyed all the posts on this subject. All have had very good points!...............the bottom line truly is: What is it one truly does want to do? And allow one to make that choice so that the job is not "just a job" but a "passion" and one that somebody truly looks forward in doing every day. My most stressful days, so far, in psych have been far better than any day I spent in Med-Surg, despite the experiences I did benefit in getting by having to work on Med-Surg. Of course, I no longer work there as a result................... :lol2:

Thanks to all for allowing me to put in my "two-cents" worth. Go where your heart leads you and what you know you will be good at and thoroughly enjoy! Let nobody else dictate to you otherwise.

Have a great day!

showbizrn · Dec 6, 2007

[

What I'm trying to say is that just because one does psych nursing it doesn't mean that you throw all your other skills out the window, they can be just as necessary in a psych unit.

Sorry folks.

I've seen some nurses "scramble" when a psych patient has medical problems. Some of the medical and surgical nursing implications don't come second (or first) nature to the nurses who don't have a med-surg background.

Trust me. You can see the difference in the nursing practice between the Psych nurses with the med-surg background and the Psych nurses without. The Psych nurses with the med-surg background are more grounded (and confident) in integrating the body systems with the mental/emotional/behavioral issues.

Anyway. Go where your spirit leads you.

You'll be a happier nurse for it!

:welcome:

PMHNP10 · Dec 10, 2007

I want to go into psychiatry as a nurse but my coworkers a re telling me to go into medsurg for one year before going into psych. they explained about going straight into psych would not be as profitable for me and some organizations require the nurse to do a least one year med surg. Is that true? and Why?

As I tell students when I get the opportunity to talk to them... you need to get a little medical experience because it is in your patient's best interest; and it is in your best interest. And keep in mind that I have never ever, absolutely, positively had any interest whatsoever on God's green earth to be a m/s nurse. I did it for a few to get the experience and left without looking back.

patient's--managers want to see you are well rounded and will provide their patient's competent, compassionate care. Medical patients come on psych floors, and you need to know how to start an IV, assess for a DVT, know what to expect when giving lasix, know what to do when a pt. c/o cp, know s/s and tx. of hypoglycemia etc.

yours--the best way to put it is that you are much more marketable with some solid m/s experience; also, you just spent several thousand dollars and 2+ years in school to learn how to become a prudent caregiver, but once you pass the NCLEX, that's all you've done--EARNED A LICENSE TO LEARN how to become a prudent practicing nurse; you owe it to yourself to take that opportunity to learn while the info is still fresh in your head

so let's pretend you get on a psych unit that does not take any significant medical patients; you work on that floor for 10 years, all the while never doing a tube feeding, never changing a decub. wound dressing, never suctioning, never inserting/removing/assessing a foley, etc; then say that floor is closed and there is no other psych unit within 75 miles; let's just say the transition to m/s will be quite challenging after 10 year of not using many of the skills you never really learned in the first place

Personal experience--I worked on a ortho/neuro floor for a few months and went into psych immediately after; I knew I didn't want to be a m/s nurse; only became a nurse to be a psych nurse. So I went to a psych floor that did numerous ECTs. Part of the routine for these folks was to get an IV placed. There were only a couple nurses who knew how to start IVs, so as the only night nurse who knew, I was able to help them out a great deal, and they were very very appreciative. Look at it this way...it gave me an "in" with the experienced staff, which made my experience that much more enjoyable

so, yes, you can become a psych nurse when you graduate, and yes, you could very well be a very compassionate psych nurse, but it's really better for all parties involved if you have some solid m/s experience.

Good luck to you.

2bnursenikki82 · Dec 17, 2007

I'm a nursing student who tech's at a psych hospital and I can tell the difference in the RN's who worked med-surg or another medical specialty before moving to psych. You're going to have your run of the mill "sick" patients in psych...the diabetics, the COPDers, the asthmatics, you see lots of chronic uncontrolled conditions. You learn how to pick up on that stuff quick, especially diabetics. I see SO many diabetics in psych.

You're also going to have the patients who OD'd and were in ICU for a few days, or weeks, and was extubated that morning before they were sent over and still don't have much of a gag reflex and have so many meds on board that they can't even stand, let alone speak coherently enough to tell you if they're having some serious complications. We get wound care patients that PT won't see, we get end stage renal patients and cancer patients....the nurses with more extensive medical backgrounds beyond what they picked up in school can communicate more effectively with the medical docs that come around and are quicker to alert the psychiatrist when something goes wrong so everyone can make sure a medical consult gets done.

Just my two cents.

Weeping Willow · Dec 17, 2007

m/s is not essential but it definitely can't hurt. you will have many patients who have multiple medical and even surgical issues in psych. think of each body system (derm, eent, neuro, gi, gu, gyn, endocrine, resp, cv, immune, orthopedic, etc.) and you will see that there are lots of illnesses we all can get. why should psych patients not have some of these, just because they are in psych wards?

keep up to date by reading, reading, reading of your professional journals, and not just in psych. keep in touch with fellow nurses who work in a doctor's office - preferably family practice or internal medicine, school health, or even summer camp nursing, as you see lots of variety in all of these settings.

never assume that a psych patient is faking a medical or surgical problem. maybe they are, but don't lose your license over it. you are not paid to diagnose, only to evaluate (vitals, bowel sounds, breath sounds, edema, rash, discharge, rom, apparent deformity/swelling, etc. just use your basic physical assessment skills to determine the present physical condition and report it to the physician. if you think the person needs anti-itch med, decongestant, cxr, ct of abd, whatever it may be, just ask, "do you want to order some calamine lotion or hydrocortisone cream? do you think he needs an antibiotic for his purulent-appearing urethral drip?" whatever. persist until your patient gets everything he or she needs. use your supervisor if necessary or call the doctor again. do not let other nurses or the aides deter you. "oh, he's faking it. oh, he just wants attention." you know what, give him the attention and you might actually prevent a bigger problem - be it appendicitis or a violent outburst. meet the needs of your patients and you will all be safer and happier.

don't try to convince the other nurses, just quietly do your own thing until you are satisfied that the right things have been done for the patient. this is not the easiest thing for an inexperienced nurse, i know, but strive to do it anyway.

never assume someone can't be having a med or surg issue just because he is on psych. the opposite is true, too, as any med/surg nurse will testify. wholism is the key. and attending to the psych patient's physical needs will thwart many an outburst of violence or verbal aggression.

i wish you all the best.

the advice of 2bnursenikki82 above is absolutely excellent.

sarmedic70 · Dec 18, 2007

AMEN to the last two posts. :lol2: I work in a state mental hospital facility, and we have a geriatric unit. Talk about multitudes of MEDICAL issues along with their psychiatric issues of our patients. I know of way too many nurses, who get pulled to work that unit, who don't remember some basic nursing skills. One told me the other day that one of the psych techs had to show how to put on the regulator of an O2 tank because she could not remember how to do that. I was talking to another RN who said one of the techs had to show her how to do something that was a M/S related issue.............then with the other units and the various possibilities of M/S-related issues, too (anorexia nervosa, diabetes R/t the various medications, et al)............so the more I think about all the various really good comments/points made throughout, the more I am convinced that having a really strong M/S background is encouraged. We owe it to our patients, truth be told! I know, personally, I have benefited by it (along with also still working as a medic), and as such, my assessment skills along with having a good "index of suspicion" pay off as a result. :uhoh3: Enough to know something truly is not right, and be able to assess it and pass it on to the physician/psychiatrist.

There is no right or wrong answer when it comes down to it; however, again, as one poster said.................WHOLISM IS THE KEY...........even with dealing with our Borderlines.....................:balloons:

At any rate, it is a personal decision overall............... I have enjoyed the various discussions throughout.................

Cheers to all! :balloons:

Thunderwolf, MSN, RN · Dec 18, 2007

per weeping willow

never assume that a psych patient is faking a medical or surgical problem. maybe they are, but don't lose your license over it.

so true.

in my past, there had been several occasions when i began a shift to walk into a legit patient physical health concern that was either not taken seriously or was simply passed over because (can you believe this?) it was not a psych issue. yes, treating the whole person is the correct path...and the ethical path. let's also not forget the phenomena of the mind-body connection.

smallrice · Dec 26, 2007

that can be helpful for you if you have medical experiance. in fact, lots of psychi. patient have medical problem such as DM , hypertension ...these are very common medical problem in dementia or the elderly patient..

andreadrea · Dec 30, 2007

Personally I never did any med/surg nursing before doing psych, nor did I ever feel that I needed to. However I always tell nursing students it is their choice, as some feel more comfortable doing this.

My first nursing job was at a long term care psych facility with 89 patients. I was responsible for 30 of them. Of the 30 on my hall, I had 5 diabetics, I think 8 with COPD, one with chronic liver disease, one with a weird overactive pancreas thing where he'd get hypoglycemic occasionally, as low as 31 one time. Lets see, there was also wound care, I had 2 patients who would periodically get MRSA infected wounds. The other patients on other halls were a similar mix.

So what did I do? Well to start with, this was a long term, chronic care facility, so anyone with medical issues was supposed to be "stable". Still, I wrote down everything I wasn't familiar with, and when I'd get home I would research this stuff so I would know what signs to look out for, if a patient was "going south". I would do internet searches, and I bought a few books off Ebay, as well as referring to my med-surg text from nursing school. Once I felt confident with my knowledge of the patients on my hall, I researched the illnesses of the patients on other halls. A lot of shifts, I was the only nurse working. This facility employed mostly LVNs and LPTs (licensed psychiatric technicians). In fact the Team Leader for each shift, the person in charge of everything, was usually an LPT! So I wanted to make sure I knew what was going on with all of our folks, so that I could be a resource to other staff.

My research paid off. I detected quite a few problems that required a trip to the emergency room in my two years working there. There were a few EMS calls as well. I learned an enormous amount from the nurse-practitioner that came there a few times a week. It was a steep learning curve, but it was doable. I had also told the director of nursing that we HAD to have some nursing and medical reference books on the floor, which she supplied. I learned so much about diabetes and COPD that I taught inservice trainings on them. We always had a MD on call for questions or concerns, which helped. And of course I learned a ton about the care of mental illness as well.

About 2 years ago I changed jobs and went to work at a large, public hospital in an urban setting. It has 4 psychiatric units plus a jail/psych unit. I had another learning curve, but it wasn't too bad. After all, I'd already seen a lot! Since that time I've dealt with a stroke, a few codes, delirium a LOT, a few serious chokings, and a lot of calling our MERT (Medical Emergency Response Team). No one has ever criticized my reports to the MERT when they arrive, and in fact I've gotten kudos a few times. I'm now charge nurse of a unit, so when we call the MERT I am the one to give them report when they arrive and coordinate everything.

I'm 4 1/2 years into my nursing career, and so far I've never missed having med/surg experience. Although somedays with all of our complicated patients, it feels almost like I am working med/surg. It might have been easier to learn this stuff working med/surg, but I never wanted to do it, and I'm happy with the path I've taken. Now my biggest challenge is getting nurses on med/surg to give me a complete report when they transfer a patient to me! When I ask about mental status, etc, they say things like "He's acting like a psych patient." Oh do tell, what precisely does THAT mean?!?

PsychRN-Kris · Jan 2, 2008

I went straight into psych right out of school and have never regretted the decision. I was even told that I wouldn't be hired without the year of med-surg experiance and that I'd make much less money. I was hired right out of school and I work at a locked involuntary facility and make a very competitive wage, more than my classmates who work med-surg at the local hospitals. I still manage many medical issues at my facility and I'm confident that I'd be able to brush up on any necessary med-surg skills if I ever needed to make a change out of psych nursing.

Weeping Willow · Jan 3, 2008

Personally I never did any med/surg nursing before doing psych, nor did I ever feel that I needed to. However I always tell nursing students it is their choice, as some feel more comfortable doing this.
My first nursing job was at a long term care psych facility with 89 patients. I was responsible for 30 of them. Of the 30 on my hall, I had 5 diabetics, I think 8 with COPD, one with chronic liver disease, one with a weird overactive pancreas thing where he'd get hypoglycemic occasionally, as low as 31 one time. Lets see, there was also wound care, I had 2 patients who would periodically get MRSA infected wounds. The other patients on other halls were a similar mix.
So what did I do? Well to start with, this was a long term, chronic care facility, so anyone with medical issues was supposed to be "stable". Still, I wrote down everything I wasn't familiar with, and when I'd get home I would research this stuff so I would know what signs to look out for, if a patient was "going south". I would do internet searches, and I bought a few books off Ebay, as well as referring to my med-surg text from nursing school. Once I felt confident with my knowledge of the patients on my hall, I researched the illnesses of the patients on other halls. A lot of shifts, I was the only nurse working. This facility employed mostly LVNs and LPTs (licensed psychiatric technicians). In fact the Team Leader for each shift, the person in charge of everything, was usually an LPT! So I wanted to make sure I knew what was going on with all of our folks, so that I could be a resource to other staff.
My research paid off. I detected quite a few problems that required a trip to the emergency room in my two years working there. There were a few EMS calls as well. I learned an enormous amount from the nurse-practitioner that came there a few times a week. It was a steep learning curve, but it was doable. I had also told the director of nursing that we HAD to have some nursing and medical reference books on the floor, which she supplied. I learned so much about diabetes and COPD that I taught inservice trainings on them. We always had a MD on call for questions or concerns, which helped. And of course I learned a ton about the care of mental illness as well.
About 2 years ago I changed jobs and went to work at a large, public hospital in an urban setting. It has 4 psychiatric units plus a jail/psych unit. I had another learning curve, but it wasn't too bad. After all, I'd already seen a lot! Since that time I've dealt with a stroke, a few codes, delirium a LOT, a few serious chokings, and a lot of calling our MERT (Medical Emergency Response Team). No one has ever criticized my reports to the MERT when they arrive, and in fact I've gotten kudos a few times. I'm now charge nurse of a unit, so when we call the MERT I am the one to give them report when they arrive and coordinate everything.
I'm 4 1/2 years into my nursing career, and so far I've never missed having med/surg experience. Although somedays with all of our complicated patients, it feels almost like I am working med/surg. It might have been easier to learn this stuff working med/surg, but I never wanted to do it, and I'm happy with the path I've taken. Now my biggest challenge is getting nurses on med/surg to give me a complete report when they transfer a patient to me! When I ask about mental status, etc, they say things like "He's acting like a psych patient." Oh do tell, what precisely does THAT mean?!?

I applaud your self-teaching. :yelclap:You learned MedSurg on your own. More than one way to skin a cat. I don't know that all nurses are willing or able to do that or see the need for it but it has worked out well for you and that's good.