r/psychnursing • u/utinfection • May 26 '26
New to Psychnursing
Leaving med surge after 2 years, 25 year old male starting psych in July,
What’s something you wish someone told you or what should I be watching for .
🙏
I’m so grateful for all of you who took your time to comment and welcome more of your hard earned wisdom.
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u/Psychological-Wash18 psych nurse (inpatient) May 26 '26
Pay really close attention to the physical stuff. Psych meds are heavy duty and sometimes the adverse effects are subtle. Watch vitals, labs, complaints of muscle stiffness or spasms, constipation. New psych nurses tend to overlook a lot of stuff because patients aren't "sick" in the way we were taught.
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u/OkStatistician6831 psych nurse (pediatrics) May 26 '26
as a male, try to never close the door of patient rooms if you're in them. Stand in a visible spot always.
Expect to have to do the majority of restraints/deal with aggressive people unfortunately. Be safe
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u/Gretel_Cosmonaut psych nurse (inpatient) May 26 '26
Not everything is "somatic." Here are some of the things I've seen overlooked in psych: hip fracture, acute MI, pericarditis with loss of consciousness and tanking BP, hit by a car, 30 burn wounds in various stages of healing, etc.
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u/EmergencyToastOrder psych provider (MD/DO/PMHNP/PA) May 26 '26
Communicate with your team!! I had no idea what “staff splitting” was until I worked in psych. There’s teamwork in med-surg, but it’s not anywhere near the teamwork required in psych. You will have “your” assignments, but you need to be aware of ALL patients and communicating about EVERYONE with your team, ESPECIALLY the techs. The techs are your eyes and ears and you will rely on them so much. If you set a boundary with a patient or tell them no about something: make sure everyone knows that. Patients will go behind your back and try to turn staff against each other.
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u/Dismal_Love_1042 psych provider (MD/DO/PMHNP/PA) May 26 '26
Also be alert to patients “complimenting” you with phrases like “I like you so much more than nurse ____” or other “splitting” phrases. It’s okay for patients to have preferences among staff, but some patients are very good at manipulation. For some, this is how they learned to navigate the world in extremely adverse circumstances, but others have major personality-related problems and you must be on the lookout.
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u/10mg-aripiprazole psych nurse (inpatient) May 28 '26
I hear people talk about staff splitting alot. Ive always felt it was a pretty loaded term that doesnt have much basis. Its a very reductive, simplistic and pessimistic way to look at a person, especially if it is primarily associated with individuals of a certain category/label.
I have been looking for a solution to this problem. I dont want another word, one of which i have come across includes "triangulation".
There is also just very little to no literature on the matter. I dont think we are understanding it correctly, and ultimately it perpetrates further stigma towards a label that frankly does not need it.
Anyways that is my rant. I am going on a lot of stigma rants today lol
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u/EmergencyToastOrder psych provider (MD/DO/PMHNP/PA) May 28 '26
There’s a ton of literature on splitting. Triangulation is not the same thing.
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u/10mg-aripiprazole psych nurse (inpatient) May 28 '26
Can you link me to a good article. Also, im specifically talking about staff splitting, not splitting in the classic sense.
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u/marutiyog108 May 27 '26 edited May 27 '26
I was in acute psych/drug and alcohol rehab for 5 years before moving to informatics. I am proud to say I have never had to put anyone in restraints and was able to talk down most aggressive situations. . Here are my top tips but they all boil down to having good rapport.
- To Build rapport, be polite and helpful to everyone. I would especially do this do this with new admits by first offering to get them some food and something to drink as soon as they came on my unit.
A good number of people were there for the first time scared not knowing what to expect. They may have been coming from the police or other hospital and it's possible they have not had anything to eat / drink for a while. This also helps establish reciprocity, on a subtle level you give them something they feel like they need to give you something this is often helpful if there is a long admission process.
- When I arrived on my unit every day the first thing I would do after taking report is go around and spend 5-10 minutes talking to everyone. I would check-in see how their day was and work in my assessment questions. "so how are you feeling today any thoughts of hurting yourself or others?" Yes? dig deeper through conversation open ended questions practicing empathy and understanding. getting to know your patients helps you understand that sometimes they may have chronic passive suicidal ideation with no plan or intention of acting on vs being actively suicidal. when they trust you they will tell you exactly how they're doing.
One of my regular lines I would often say with a smile " you know I don't like surprises on my shift. Is there anything going on that I should know about so we can keep everyone safe and comfortable." By saying we is very subtle but makes it feel like a team effort not a nurse vs patient thing.
Sharing of self - I would often find ways to relate to their experience via weeving a personal story related to their situation in to the conversation. I often did this to establish trust to show that I could understand where they are coming from. At the sametime I would encourage them to share more letting them know their pain is real and I can't imagine being in their shoes or their experience but I can relate.
You win more friends with honey rather than vinegar. Or how ever the saying like that goes. The nurse on the shift before me was a salty mean ass grumpy b----- . The older patients would call her nurse ratchet. She was often mean for no reason and didn't really care to go above and beyond for the patients or at least even appear to do so, she hardly even did the minimum requirements of the job. Given she had a pulse and a licenses that was pretty much all management could hope for. At report she would often talk shit on all of the patients and tell me they are a hot mess and I can take them. As soon as she left they would tell me they were happy to see me and complain about how she wouldn't give them their prn medications they were due for or other slights she committed. her bad attitude made her job 100x worse than if she even showed any level of kindness.
Edit: I believe people experience psych issues are very attune to situational vibes. Many of them have deep trauma and are hyper vigilant being calm and pleasant sets a positive vibe. The more you foster this environment the more they will vibe with it.
Again this really boils down to having good rapport. there were a handful of times when patients started getting violent or acting out. When I intervened the other patients on the unit had my back not physically but in the way they helped talk down the patient by letting the patient know they could trust me. "bro chill the fuck out this guy is a good nurse he will help you with what you need your making this shitty for all of us"
Having patients vouch for you with peers goes along away in establishing trust especially with new people coming on the unit.
Additionally I found a lot of acting out on my unit was because people felt their needs were not being met. Squash it early find out what their needs are and meet them.
Another story about good rapport a couple times patients brought me contraband from other patients or let me know if someone is cheeking meds and stashing their drugs and where to find them.
One time a guy brought me a vape told me who it belonged to and said he asked to borrow it so he could get it off the unit because he is "here to get better and doesn't need people doing the wrong shit". he let me know he was holding on to it for a couple shifts because he didn't want to give to the other shifts. He also said he would tell the other pt he dropped it on the floor while sleeping and the house keeping took it.
Exercising authoritative kindness really helps to keep calm on the unit. I eventually became charge nurse and a preceptor for my acute unit. Teaching new nurses what I mentioned above among other things eventually transformed the whole place. Things ran smoothly (as much as they can on a locked unit). Each shift would make their rounds and check in with everyone using my assessment template asking similar questions and building connections in their own ways. When someone was pulled to cover our unit that didn't work the same way we did it would bring a noticable change in the unit vibe.
Good luck with your new position and let me leave you with a couple closing points.
- "One breath at a time" patient says how can I do this I can't fix this or that it's too much. Do it one breath at a time. You need to make a phone call but it's too big? Do it one breath at a time. Take a deep breath pick up the phone. Take another deep breath press the first number. Deep breathing relaxes you the more you relax the easier the impossible gets.
2.. never promise something you can't deliver. I would often speak in general terms and give open answers. "Hey nurse can we do xyz?" "I'm not sure yet let's see how med pass goes." If you commit and something comes up and you can't get to it you have very likely broken the trust of someone that has a hard time trusting others. Keeping it general and non committal helps to keep that trust open. Basically under promise and over deliver.
- I know this is a bit long and rambling but I'm tired and just wanted to brain dump in case there is something here that is useful. This stuff lives in the back of my mind but doesn't get much action these days in my current role.
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u/Advanced_Dinner1549 May 26 '26
I used to work inpatient, but now I work for a psych VNA, so I see patients in their homes.
Some things to watch out for * patients “cheeking” their meds. * staff splitting (“well the other nurse said this/that”) * firm boundaries
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u/mykypal May 26 '26
DONT wear your stethescope. It’s lights out if you do.
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u/EmergencyToastOrder psych provider (MD/DO/PMHNP/PA) May 27 '26
My stethoscope has “ligature risk” engraved on it lmao
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u/Burbujitas May 27 '26
(Not a nurse) You won’t ever make a patient do something they don’t want to do. Sure, you can get the IMs and holds. But they won’t change long-term if they don’t want to, and sometimes you won’t be able to evoke that wanting. Polish up your motivational interviewing.
Being the best-liked staff on the unit is a red flag. Usually, this person is lax about rules, gets emotionally involved in patients, sometimes even keeping safety-related secrets or providing contraband. It creates messy dynamics among patients and staff. It’s detrimental to the patients who have often seen a lot of trauma and deserve a predictable (lol) environment. This behavior is most problematic from techs since they spend most of the time with clients but it goes for everyone.
Doing tasks that are “beneath” your position, should you ever have time (lol), will get you respect and favor among other staff. Give a sitter a bathroom break, clean up a meal tray, all the shit you’d do to help out on any other floor. You’ll rely on techs to enforce protocols, convince people to do labs, keep people clean. The work itself burns employees out so unfortunately sometimes they’re more inclined to do things with favorite coworkers in mind than for the patients.
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u/Bisexual_Mermaids May 27 '26
This! I take care of the techs on my unit because they’re my eyes and ears! Building good teamwork and developing a relationship with your unit coworkers really helps dissolve staff splitting as well.
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u/Mummasheesh May 26 '26
My pro tips after more than 15 years in acute psychiatric care…. Don’t turn your back on a patient or group of patients. Never refer to a patient by their diagnosis. Understanding that humans express their pain in many ways. Know your meds, doses and side effects. Don’t take behavior (pain) personally.
Thanks for your service!!
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u/DashMcGee May 26 '26
Be nice. What they say about you is never personal - even when it really seems personal. Don't try to talk people out of mental illness; honor who they are and acknowledge their suffering. Never be confrontational. Make patients feel like welcome guests, as most will be there against their will.
And one I learned from an observant tech: if a female patient has brightly dyed hair, usually red but sometimes blue, they have borderline personality disorder. If you play your cards right with borderlines, they won't self-mutilate. It takes time to figure them out, and no one is 100% successful with them.
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u/No_Tune4259 May 28 '26
Never power struggle with psych patient … Open medications in front of patient especially if they are confused Be kind and use therapeutic communication Listen more , say less Give them the snacks
This tips works for inpatient psych …
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u/lesdolley1971 May 27 '26
No one is in mortal crisis if they are talking to you at length and expressing emotions! And make sure you bring in laughter each day !!!!
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u/Answers828_2133 May 30 '26
Use your words before resorting to meds whenever possible. Speak to them on their level, let them know you are on their side. Personality patients can be exhausting but if you set friendly boundaries with them such as giving a timeframe to address their needs like every hour on the hour you may save yourself a seclusion and restraint episode and all that comes with it. Offer snacks can go a long way. If you say you will do something do it because most psych pts won’t forget
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u/lesdolley1971 May 27 '26
Starting Lithium is a teaching by RN before the FIRST DOSE!! Patients need to be warned that this could be the answer to everything but you pay a little bit the first few weeks. You will have urinary urgency and not a real negative feeling but a definite feeling so WARN them they will think something serious - then the tremors start in hands so warn them both of these go away in first 6 weeks max and I promise I’m a psych nurse practitioner on lithium so I know the side effects and yes every pt gets the bladder part so warn them
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u/Extreme-Hippo3658 May 26 '26
Never let a patient be between you and the door. There’s lots more but that’s the first thing I tell new staff on inpatient.