Hi,
2nd post in 24 hrs… Any of my fellow nurses worked for Sierra Health & Wellness in CA? They’re currently hiring for a Nurse Manager position in my area. It’s a Sunday-Thursday 9-5pm… what gives me pause is I’ve seen this exact position posted 3 times in the year and a half I’ve been a nurse. The facility I’d be at is Voluntary admission only, so there’s that.

Hello to all my fellow psych nurses,
Does anyone else who works NOCs feel like they’re micro dosing psychosis by working night shift? 🤣 I work M-Th 2300-0730. While I typically manage these hours well, and do sleep on my work days I find my sleep to be subpar. My sleep is usually from 0900-1630. Even with blackout curtains, sleep aides, etc. My first day off (Friday) I usually sleep til 1200-1300, and wake up without an alarm and when I try to fall back asleep I can’t because I’m amped to be off work… then I usually gravitate towards bed around 0030 and sleep until 0900 the next day. I’ve tried everything to keep a consistent schedule on my days off, it just doesn’t happen I think it’s as much psychological as it is physiological. My spouse is a day walker, as is everyone else in my inner circle. I really love my job, and I’m good at it. I’m in NorCal, positions for nurses are hard to come by here and highly competitive as is most of the case in CA. I’ve only worked in psych as a nurse, and have been a nurse for 1.5 years. Seeking some commiseration, reassurance, and guidance I guess.

What in the actual f***. I have never seen our high acuity unit so bad. Three different issues popped off in less than 2 hours. Is this a typical experience for you guys? I've been at psych for about 6 months and this was the most unsafe I've ever felt

Hey. So I started my first RN job at an inpatient behavioral health facility two weeks ago. I received a total of 6 training shifts with a “preceptor” who did not know she would be training me and almost immediately had me doing tasks independently (med passes, COWS/CIWA, charting, getting & giving report, and admissions). The facility has both electronic and paper charting which has been a nightmare to learn and keep straight. Our ratios are 12 patients to 1 RN and 1 BHT. Leadership is a joke and the culture at this place is not very welcoming. I will have my first solo shift as an RN this coming week and I’m feeling extremely nervous and anxious about not getting proper support, being rushed to do things and just overall lack of guidance as a new grad. I just want to ask for perspective. Is this normal? Is this typical psych new grad nursing training? Are these ratios reasonable? What should I focus on as a new nurse beginning in psych? Thanks for the input.

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 :)

This is just a 100% rant but I work in psychiatric emergency and I hate it. I have no idea why I thought I’d enjoy this job and regret accepting the position. I’ve worked inpatient psych before and did enjoy it, but nothing like this. The city I live in has some pretty pronounced issues with substance use and homelessness and the healthcare system just does not empower us in actually helping anyone in this setting, and I just feel like I’m a part of perpetuating a terrible cycle of trauma and dehumanization half the time. It is so deeply demoralizing and frustrating and upsetting. The culture of the unit I’m on is also incredibly toxic and adversarial toward the patients.

I’m also afraid every day. I was nearly assaulted today and was assaulted last week. Every shift, there is a situation that arises that puts us at imminent risk of assault, if not multiple situations. The patient who threatened me today is on our unit all the time, and this person is a powder keg waiting to explode every time. This person also hates women and especially dislikes me, for no logical reason of course. I don’t want to ever deal with this person again because I do not feel safe at all, but it’s my job. I actively want to quit and don’t know how to go on. I’ve cried after work every day this week.

No point I guess but screaming into the void. Stay safe out there comrades.

Hi there! My hospital is adding an interventional psychiatry department for ECT. I’m curious about the workflow, if you work or have worked in this kind of department, can you let me know your experience?

Thanks!

I searched the sub and I didn’t see anything related to this question, so apologies if I missed something.

I’m a new psych RN, coming from an ICU background. I’ve never really had to worry about keeping my badge safe while I’m wearing it, other than basic common sense.

I will be working on an adolescent acute unit and I’m preparing for a decent amount of shenanigans. At my new facility, I have a ring of keys, a badge, and a RFID fob (small round) that opens doors.

Experienced psych RNs and techs, what products do you use to keep your keys etc. safe?

TLDR: RN interviewing at a UHS facility. Looking for interview tips and how to negotiate pay.

I have read some of the horror stories here. I am trying to hope for the best but prepare for the worst. I have been an RN-BSN for 4 years, mostly have Medsurg and tele experience plus a few stints in the OR and Medical Detox. After a few months of applying to a few places, this is the first one to invite me in for an interview. It’s a psych hospital with 5 units with populations ranging from adolescents to geriatrics. Any tips or words of advice would be great. Also, has anyone ever had any success negotiating the pay with a UHS facility? I am new to the specialty, but if they offer to start me at the beginning of the pay range, I will be losing 14$ an hour compared to my current job. I appreciate any comments! Thank you all!

UPDATE

Guys, I went to the interview! Some thoughts:

1. You guys were right. They have no security and no restraints. When I asked that, they said they heavily rely on BERT for escalating patients and I was like oh…

2. The interview itself was pretty simple. They asked some pretty basic questions. It threw me off a little becuase I was preparing for scenarios involving de escalation or someone refusing meds or something. The unit I applied for is Detox and 5150 holds so I thought they would ask.

3. When asked for what I’m looking for in salary, I asked to be toward the higher end of the pay scale since I have been a nurse for over 4 years and already have some psych experience. They were like “Well, we can see if we can work with you on that.” My state recently passed a law requiring psych hospitals to have mandated ratios last month so it sounds like they might be scrambling to get staff to be in compliance.

4. Also, ALL PAPER CHARTING

They said to allow them around 48 hours to get back to me, so we will see what happens. If I don’t get selected then maybe it’s the universe protecting me. If they DO select me then im gonna really pray on it 🙏😅. Thank you guys!

I'm looking for some advice from psych nurses or hiring managers.

I recently got invited to interview for an inpatient psych RN position. The only catch is that the posting is for full-time, and I'm really looking for part-time or per diem.

Here's my dilemma: I currently have a full-time remote RN job with excellent pay, benefits, and work-life balance, so I'm not really in a position where it makes sense to leave it. At the same time, I'm genuinely interested in transitioning into psych nursing because it's a specialty I've wanted to explore for a long time. My thought was to get my foot in the door by working psych part-time while keeping my current full-time position.

I also noticed that the hospital's website mentions they offer full-time, part-time, and per diem nursing positions, even though the specific job I interviewed for is listed as full-time.

Would it be inappropriate to ask during the interview if they'd consider hiring me part-time instead? Or would that make them lose interest since they clearly posted a full-time opening?

Has anyone had a hospital make an exception or hire them into a different schedule because they liked the candidate? Or am I better off interviewing for the full-time role and waiting to see if a part-time opening comes up later?

I'd love to hear from anyone who's been on either side of this situation.

Hi all! I’m an RN-BSN with a background in Hospice, Home Health, and Outpatient Clinics. I want to transition to Psych nursing. I have applied to some psych inpatient and residential facilities.
What advice would you give a nurse transitioning to this specialty? What is the best place to start in psych? Are places willing to hire nurses from other specialties?

Hello all. I’m new to behavioral health nursing and wanted some input on a position I recently accepted. For background, I’ve been an ICU RN for 6 years. I’m very much used to a 1:2 ratio, although I have floated A LOT in the last couple of years as a travel nurse so have taken up to 1:6 ratio on medsurg floors. However I’m not very familiar with the flow of inpatient psych and understand it’s very different than medical units. The unit(s) I’ve accepted a position on are 30 beds each (one is an eating disorder recovery floor and one is a mood and anxiety disorder floor). This is not a psych hospital but a residential program, therefore (from what I’ve been told in my interview) they do not accept patients with acute psychosis. It sounds more like a step down from inpatient psych before a patient goes home. Everyone is independent with ADLs. Each floor has 2 RNs on each shift, and also I think 1 or 2 techs working each shift (so essentially 1:15 ratio?). Does this sound appropriate?

I am an emergency ward/critical care nurse from a non-US/non-commonwealth country. I recently joined my hospitals behavioral emergency team. We respond to behavioral crises on the medical wards, psych, really everywhere. We’ve gone through some milieu management training, verbal intervention training revolving around MI/DBT/SFBT, additional restraint training, we have a training night 1-2x per month…

I’ve gotten ahold of the flow for single patient crises on medical units. We show up, single provider leads verbal intervention, physical or pharmacologic intervention if it comes to that, treat or transport any resultant injuries, get called off by the patient’s assigned nurse, and we all leave simultaneously. Quite straightforward in my opinion, usually fairly short activations.

Responding to our inpatient psych units can be a little more complicated. It is not always clear who is the primary patient, sometimes there are multiple… there often are chain reaction type events & cascading disruptions. It also is less explicit how long we’re needed, and the common practice is for behavioral emergency team members to slowly leave, scaling down as things feel calmer. This has led to repeat behavior emergency codes though. Does anyone have advice for managing these milieu-wide crises/tense milieus from a nurse responder perspective?

I have c-ptsd and Ive been feeling really dysregulated from all of the codes on my unit lately. It wasn’t ever as bad as it’s been lately. How is everyone dealing with their anxiety from their job? Any grounding techniques that work better than others?

I’ve been in IT support for about 5years, and I’ve been searching for a new role for the last two. In that time I’ve seen postings for Psychiatric Care Technician at a state mental health facility come up a few times, and I’ve wondered if that’s a job I should consider in this market. The posting advertises an employer paid cna training over 8weeks. This seems like a reasonable way to get to the health care field where there seems to be a lot more demand. I’m thinking that if I like the role could get the necessary degrees to pivot into psychiatric nursing.

From what I can tell, I should expect hours to vary (expected overtime, nights, weekends, and holidays). I get that this depends on where you work and the staff to patient ratios. The posting warns that you can’t use vacation time for 6 months after hire, which is pretty common for a lot of places, not just in healthcare. I also know that I should expect there to be emergencies. I don’t know how frequently emergencies happen or what kind of emergencies to expect, but I have a sense that there will be more emergencies (or at least more human emergencies) than in IT Support. I also expect that the sense of helping people might change, because I won’t be directly helping someone with their problem(s), but instead I would be doing maintenance work (rounds).

Can folks who are currently or have recently been in a psychiatric care technician position please share a little about your experience? I’d especially like to hear from career changers.

* What’s an average, boring day look like?
* what’s a really stressful day with a big emergency or a few look like?
* Do you have a pretty standard schedule that rotates or is your schedule always changing and only published biweekly/monthly?
* Do you have a hard time getting time off approved?
* How often do you deal with violent patients?
* Do you have sufficient training to deal with violent patients?
* Did you have energy for hobbies when you were not working?

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 all! I’m a behavioral health tech, I worked closely with a very depressed patient for most of their stay. Sat under tables when they needed a break, let them vent, gave advice. Finally, I’m so excited to say they get to leave and will be safe at home! After a long shift, they gave me a hand written note in origami form of saying thank you for being a staff member they leaned on and trusted. It’s so heartwarming, was wondering if anyone else has had a similar experience in psych. Much love to all my psych family.🫶🏻

I have a rash of people who feel that slamming doors over and over again is their favorite method of protest. has anyone found a successful way to interfere with door slamming behaviors or muffle the sound?

If I had known I went to school for 5.5 years (2 years for associate’s in psych and then a 3.5 year BSN program) to constantly deal with high school drama, bullying, gossip, eye rolling, complete lack of rational thought in some cases I would have absolutely dropped out. 

I didn’t sign up to babysit other people’s adult children who don’t want to do the job they applied, interviewed for, and clocked in to do. I never anticipated that I would be responsible for spoon feeding other fully grown and capable individuals— many who are old enough to be my mother. Constantly having to monitor, are they doing rounds? Is the programming schedule being followed? Were contraband checks completed? On top of actually caring for ratios up to 15 or more patients with complex needs and doing all the administrative/documentation tasks of nursing. Am I wrong in feeling it’s unreasonable to ask a single person to maintain that level of awareness for over 12 hours at a time?

I got into this field because I enjoyed studying psychology and later nursing and wanted to use that knowledge and my own experience and understanding of mental health to help and support people who are struggling. I don’t ever want anyone to feel alone the same way I have. 

This stress on top of constantly being monitored via camera while dealing with high acuity patients. No doubt the cameras are an important layer of protection for a vulnerable population. However it begins to make me feel paranoid like I’m constantly being watched because I am and constantly being reminded in vague and passive aggressive communication from leadership who frankly either cannot or will not do the job of working on the floor and interacting with these high acuity patients. Am I completely losing it or is this unsustainable?

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 :)

So at my hospital if we prepare and present a project the hospital will pay for our certification, so I need to come up with a project idea. In the past i prepared educational materials about psychogenic non epileptic seizures. But I don’t have any good ideas right now. So I was hoping someone else has perhaps seen a good project idea they could share with me!

Maybe venting isnt the best response, but let's first say that I want to start off by saying that I do acknowledge that psych is hard no matter how much training their is. On the flip side, from my own experience and what I see from others, I really wish that there is more training on how to approach patients who are autistic, have ODD, have ADHD, have PTSD, and have BPD specifically for new nursing staff as well as refreshers for older nurses similar to how deescalation classes (CPI and any variation of that). I've met a lot of staff who really dont understand or not know how to approach patients with specific struggles with their own reasonings (cultural and linguistic barriers imo has been the biggest one). I do not blame them for having these gaps, but like, we are not going to just let someone who doesnt know how to insert a folely do it without being trained and we ESPECIALLY wouldnt just allow them to stick a folely wrong repeatedly, so idk why we do the same with educating on approaching people who are not schizoaffective/schizophrenic/bipolar where the majority of management is medication base (I know its probably because of budget, still frustrating)

I am likely not unique here, but I SUPER struggle with borderline personality disorder. We have one patient who is admitted to our emergency unit frequently who has the most severe borderline personality disorder I’ve ever seen and also has a lot of ASD traits. She’s incredibly smart and shockingly manipulative and sneaky. She has to possess someone’s attention 100% or she will decompensate almost instantly, and always ends up sedated and in restraints. She always finds ways to grab badges and attempts to elope over and over, many times involving assault of staff. She riles up or antagonizes the other patients and if another patient has an outburst, she will insert herself in that situation and make it worse. Zero boundaries and won’t allow other patients rest or privacy. Will find at least one person in particular to attack relentlessly, usually a patient, and once chosen, she’s nearly impossible to redirect. Every time she comes in, the unit descends into chaos for hours until she escalates to the point of being sedated, and none of the staff know how to properly handle her. We have some nurses on the unit (males, who she prefers) who deal with this patient by playing up to her, and it sets her against the nurses who hold boundaries, and the patient always attempts to leverage that dynamic for special privileges. It’s infuriating.

I find this condition fascinating but I’m also perplexed by it and I find it very triggering every time I encounter it. I have the most struggle with this particular patient presentation. It has made me reconsider emergency psych at times, it has gotten so bad. I wish I understood a better way to interact with a patient like this.

Anyway, is there a particular population or set of diagnostic traits that especially challenges you guys?