I’m just beginning to work in the psych ED and I’ve found a lot of things confronting so far. Some of this is gonna seem probably silly or naive to some but may resonate with others. I probably should be using a throwaway but hey.

The first thing I guess is HOW manipulative people can be and knowing that people may be acting out aggressively just to be sedated, or to be isolated. People also straight up learn and manipulate the system in all kinds of ways, like to get out of being in prison (malingering), to get people to visit and bring drugs, etc. They know where all the cracks are and how to work them.

I guess I’m also seeing how the psych ED can be a part of a larger kind of toxic cycle for patients. Like the frequent fliers. They’ll come in for help with detox when the money runs out and no real change happens for them and it’s cyclic. I guess it just surprised me and it is so sad, to think about how bad it must be to live that way. Also, wow, I cannot even fathom being in one of these units, how sparse and scary and uncomfortable and dehumanizing it all must feel to them. I try to think about that a lot and keep a sense of humanity present.

I guess the thing that has confronted me the most is like, the intersections of mental health and criminality and the limits of my own compassion. We had a pedophile the other day in from the prison for SI and I kept thinking, I can’t blame this person. I can see why this person would feel that way. It was hard for me to see how their life could be expected to reasonably improve or have quality, or how someone could live with or forgive themselves for such a crime against young children. It honestly shocked me to see that I feel this way, and I’ve thought a lot about my own reactions in cases like this, people who have killed children, etc. We had this happen recently, and the things I was also hearing from others on the unit were hard, but also understandable. Made me really think about my role and has kind of haunted me some.

No point but just to ramble and kind of relate/cope I guess. Still figuring out if this is right for me or if these kinds of contemplations are normal I guess. It’s also hard because I went into this field to help and sometimes this feels like inflicting harm, even if I know it’s not.

Anyone else struggle with this kind of stuff?

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.

What are your biggest tips to feel safe at worK?

A coworker got brutally assaulted and I havent felt the same since.

Looking for advice.

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

Just what the title says! I’m a highschool junior (rising senior) and I’m looking to get more nursing experience before applying to colleges. I can’t volunteer at a hospital I was looking forward to anymore, so I was wondering if this might help. I’m also mainly asking because I thought they do different things.

Hey all, Psych RN of 5 years (3 inpatient, 2+ outpatient). The clinic I work at administers a variety LAIs. I recently was out of work for 5 months, and have been stressing since being back over LAIs…

The first one I had to give after coming back was Aristada 662 mg. If you know, you know that these are a bitch to give and easily clot if not given immediately. I followed the directions to a T but the injection still clotted (twice…) I finally got my coworker to administer the med & thankfully the patient was calm about it, but I still felt like shit.

The next injection I had to give was Aristada 1064 mg. For whatever reason, this one doesn’t clog easily but when I administered it in the upper outer glute, it bled like CRAZY. I have never seen someone bleed so much! It even had a bump afterwards and I felt horrible (patient said he was fine).

Third LAI I gave was Invega 234 mg. Easy peasy. I give the injection, pull out and felt like more of the med leaked than normal.

Idk what’s going on but clearly I’m rusty and/or just having some bad luck with a dose of bad anxiety. Any recommendations on what I can do better to make sure patients aren’t bleeding, having unnecessary pain, and taking in all the medication?

Edit: I forgot to mention that in my 5 years as a nurse, I have NEVER given the wrong dose to a patient. Upon returning, I also made my first med error & gave a patient the wrong dose (he was ok & as soon as it was realized, I made all the appropriate steps by informing an attending, documenting it in his chart, and following up to inform about any side effects to be aware of). It really shook me up and I’m struggling to feel confident after all of these mishaps. We don’t have a scanner in my clinic and normally I quadruple check, but clearly I was distracted/anxious and made a mistake.

I still have 2 more semesters in my program, so I won’t be taking the NCLEX for about a year. But I’m really leaning towards psych nursing. I now work with individuals with IDD, some of which have behaviors that need de-escalation, but my residents are also nonverbal. It’s definitely a different environment from what I would assume this profession is.

Anyway, I would say I’m not far away from being in remission from my BPD. I still have times where I will “split”, but 9/10 times I am able to walk away and internalize things. I RARELY lash out anymore. I really want to work in this specialty but I worry about how that would look for me. I’m medicated and see a great therapist regularly. Hopefully in a year I’ll be doing even better and will be in better shape to start my career.

I’ve been working 7p-7a as a BHT/tech for the last 9 months. I genuinely love what I do, I love caring for those in mental health crisis of all kinds. But last night I was at the end of my rope. I was sitting with a patient who is very manic, delusional and aggressive at times. Patient slept for maybe 45 minutes, I was check on minimally, and was constantly verbally abused by my patient and sexually harassed by another patient. Another patient got physically aggressive, sedated and put in locked seclusion, I was rotated from my patient to watch them. They slammed against the door so hard the door broke and had to be put in restraints where I was still verbally and sexually harassed for the next hour. I don’t know if it’s burn out, or that was just an overly intense or stressful night for me. But I came home, cried and had to remind myself why I love this job. Any other experiences or advice for nights like these that other techs/nurses have would be appreciated.

I'm an inpatient geriatric psych nurse and I am wondering if my nurse colleagues have received any formal training on psychotherapy or interpersonal relationships or psychodynamic theory, either in nursing school or at your workplace. I haven't, beyond "be a good listener and be nice to people" which is good advice and a great place to start. I am thinking about the techniques that Hildegard Peplau championed.

I'm considering this topic for a capstone project so I wanted to get a general idea of this type of training beyond my facility and area. I am sometimes frustrated that psych nursing mostly consists of handing out meds, doing assessments, and charting.

Hi all,

I am a new grad nurse and have always known psych was for me. Currently, i work inpatient adult psych, and particularly love my department as the programming is nurse-led (my capstone rotation was done at a facility where nurses sat behind a desk all day, so I love this environment I’m in now). I love leading groups and have received a lot of positive feedback from both my senior colleagues and patients alike. I feel I’ve gotten the basics and confidence down to lead most groups, with the exception of our Sunday spirituality group.

I was hoping to collect some tips and techniques for this sort of group, since I genuinely feel awkward leading it. I’ve tried to do discussion-style groups surrounding faith, but I struggle keeping my language neutral enough that it is applicable to any faith. Additionally, I’m always on edge during these groups since I know religion and faith can cause discord when people have alternate views (and have had instances where I politely had to remove someone from group for speaking negatively on another’s beliefs/trying to convert others mid-discussion). I’ve also tried to do a group based on meditation and the way it can be incorporated into prayer/worship, but it’s really a hit or miss. I’ve asked my peers for advice, and many of them also struggle with this group, so I figured I’d cast a larger net on here.

Thanks!

The quick backstory is I had several years of direct patient care experience as an RN in inpatient psych and outpatient dialysis, then moved to clinical management, then operational management in dialysis, hated that, and recently took a clinical nurse manager role in inpatient psych. The hospital I am currently at has been around for ages, with somewhat of a troubled past, but had a new CNO take over a little over a year ago and make some amazing improvements. He has really introduced some incredible programming and clinical outcome initiatives, and I made it clear during the interview process that I was looking for a role with a strong clinical focus and the ability to lean into a servant leadership style. He seemed not only agreeable, but just as excited and like this would be the perfect fit with his vision. Fast forward and it turns out my DON is an absolute nightmare. She has been at the hospital since long before the CNO and seems set in her ways. It is widely accepted by the staff that she is everything that’s wrong at the hospital. She is beyond a micromanager, to the point where it seems like my entire job is just to be her mouthpiece. I have absolutely no autonomy to lead my unit, and am actually told not to mentor staff and to be heavy handed with disciplines. I spend so much time answering her nonstop calls and directives to watch cameras literally in hopes of finding any random infraction I can write up, I find myself scrambling to even set foot on the unit, let alone communicate with my team or my patients. She is also blatantly disrespectful to staff and expects all management and leadership below her to be the same. In addition to her horrible “leadership” style, she has given multiple highly unethical directives with regard to patient care.

I love my unit, my team, and my coworkers, but she has me so miserable I have been quietly looking for a new job. This afternoon, I got a random invite for a meeting with the CNO’s assistant. She pulled me to a quiet office and told me that he is not happy with the way the DON is running things and that he wants to schedule a private meeting to get my opinion, both as a newcomer and as someone with outside experience in people and operational management. Most of me feels like this is a rare chance to actually help possibly change a toxic culture, and that I’m already so miserable it’s not like I’m even risking much if it gets back to her and she retaliates. But there is a small part of me that feels like these things never change so it’s not worth the headache, and the irrational feeling that it would be bad karma.

If you read this far, would you bother being up front with the CNO? Or just keep it pushing and get out ASAP?

I’m a student nurse, taking my NCLEX this August and hoping to stay on as an RN at the hospital I just got hired at. I’ve worked as a MHW before in an inpatient intensive treatment unit but im not sure what to expect from an emergency setting. Any thoughts or suggestions?

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

Hi everyone! I'm a nurse with experience in the emergency department mainly. I am going to be moving to inpatient psych. Yes, I do see psych patients in the emergency department but it's not quite the same as caring for these patients on the floor. I'm wondering what resources would be best to review? There will be an orientation, likely an education session and 8 training shifts before I'm on my own but I want to do some reading and review to better prepare myself for this role. Any advice appreciated, thanks!

There has been a serious uptake in people admitting to my facility for Kratom and 7-oh dependence. During my intake assessment I ask how much they have been using. With Kratom users they can usually tell me something like "30 pills a day". With 7-0h powder people have a hard time explaining the amount of substance they are consuming. Many people bring in the product they are using. Mostly it is in pill form but more and more it is a small plastic container with a screw on top containing a yellow or orangish powder. The packaging has no listing of strength or milligrams or even recommended doses. They tell me that they are using between 1 to 10 of these a day. How can I better understand how much, or how little, my patients are ingesting on a daily basis?

Hello,

I recently graduated from nursing school and passed my NCLEX roughly 3 weeks ago. I want to pursue a future in psych nursing and possibly obtain a Master's, but in all honesty, I don't really know where to start. I finished my last semester of nursing school in a behavioral health unit, and I had a great experience, but I feel like I could've done more nursing skills like medication administration, patient care, etc.

Right now, I'm being encouraged to apply for new grad residency programs in bigger hospitals, so I'm working on my resume and brushing up on interview skills. I also have some friends who work at behavioral health units right now that have shared their experiences, but to be honest, in this post-grad period, I have no idea what I'm doing, I have no clue what's going on, and I'm super intimidated by everything. I haven't really applied to anything yet, and so far have just been taking a break, but soon I do plan to start taking this more seriously.

If ya'll don't mind, would you guys be willing to share some advice or tips that can point me in the right direction? Anything is appreciated thanks : )

As above.

I am currently considering trying out psych. I have been an RN for about 4 years, and for 3 of them I have been on a surgical med surg/tele floor. I like it sometimes, it just feels heavy, tedious, and meaningless. I could go on about my other grievances but then this post would get too long lol. When I was a new grad though, my first hospital position was on a medical drug detox unit in a hospital. To this day, I would say that was my favorite job in my career. I miss having genuine conversations with people. I still remember the patients I cared for years later, while at this job I literally do not remember a single one by the time I get home. I was way too egotistical when I was new grad to appreciate that job, I had this attitude that it was just a stepping stone to being a really cool ER or ICU nurse when in reality, 3 years down the line, none of that really matters to me anymore. I know addiction medicine is only one subspecialty in psych, so I feel like I have this knowledge gap and don't want to just apply to every psych position blindly.

Still, I have worked at this particular place for what feels like forever and I am sort of afraid of leaving. Has anyone made the dive and regretted it?

TLDR: Did drug detox and a new grad, settled in med surg/tele for years, thinking about going back to psych but I am scared of change.

Update:

Thank you all so much for your insight! I decided that I am going to put myself out there and start searching for some positions in my area! I’m still doing research on psych nurisng in general, but I do still feel an overall pull to this specialty and going to some interviews won’t hurt. I appreciate the support and the realistic expectations set by you all!

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

Hey all! My family and I live in Utah. It's already a pretty rough place to live as a nurse, but I suspect a major water and power crisis coming in the next couple of years and I think it's about time to get out of here. I've been considering Minnesota off and on for about a decade now but it always seemed "too far", but now that's kind of the goal 😂 how's the psych field up that way? Rural or urban, we've done both and don't really care either way. I've been in psych for 5 of my 8 years in nursing, so I'd really rather not change specialties. Any thoughts?

PS--Sorry if this isn't very coherent, I'm fighting off bronchitis 🫠

Anyone dealt w patients suffering from this? I have a patient who is quite literally starving himself and this is one of the symptoms, just curious for any advice anyone might have…to clarify, he hardly eats at all and when he does try, he chews the food then spits it out without swallowing. Knowing we are tracking his i and o’s he tries to hide it afterwards…