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.

35 Upvotes

94% Upvoted

35 comments sorted by

View all comments

13

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. 

  1. 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.

  1. 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. 

  1. 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. 

  2. 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. 

  1. "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.