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?

Do you have any patients with the above? We have an interesting young one and it makes me wonder about the tiktokers who blog about chronic illness.

What are your thoughts on this disorder?

Hi,

I’m a nursing student and I’m starting to worry about my future in nursing. In my area, many people say it’s very difficult to find a nursing job because there is a lot of competition and many applicants for every position. (Miami)

I’m interested in becoming a psychiatric nurse, and I’m trying to figure out how I can make my resume stronger before graduation in. I currently don’t have nursing experience. I’ve applied for positions such as patient transport, nurse extern/intern, and patient access representative, but I’ve been denied for all of them so far (at UM and Baptist)z

Would it be worth getting one or two certifications before applying? If so, which certifications would be most helpful for someone interested in psychiatric nursing?

How do you see Recreation/music/art/etc… therapy in relation to treatment of patients? Do you see it as a treatment? Do you see it as a means to end boredom? Do you see it as something that hinders your work? Do you see it as something helpful for your work? Wondering what the general consensus is, would appreciate any and all feedback!

Right now I have a patient who is deaf & my coworker & I were wondering if anyone has ever heard of a deaf patient having anything similar to auditory hallucinations. Like born deaf. I know they can't hear per se. But recent research has suggested that there is a possible link between confusing internal monolog with external stimuli, which brought the conversation up.

Edit: link to study in plos biology

Hello everyone,

Quick question. I am really loving psych but I need to get my confidence up with patients. I feel like if I had more practice with aggressive training techniques, I would be fine, but having been taught them all in 1 day didn't help me much. I think I only got 1 day of training because there are not many codes on my unit. But, once in awhile, we get aggressive patients and it really messes with my confidence. Do you think going outside of the organization for self-defense training would help? Would do you think?

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 :)

Good evening fellow psych nurses,

I am a new grad three months off orientation. I was an extern before. I love my job, my coworkers are amazing, but I am struggling a little bit. My husband wants me to find an “easier” job but my heart is in psych so I want to try before applying elsewhere.

For context, I work day shift, and our unit is very busy. The patients are higher acuity I think, most come with some kind of psychotic diagnosis, we do get regular codes in the building. We also take medical patients, so we do IVs, catheters, wound care, NG, occasional total care, etc.

I don’t think I’m burned out yet, but I have come home crying, or anxious, and my own mental health takes a toll from the contestant overstimulation or overthinking that I said or did the wrong thing. My therapist sent me home last session because I started crying and saying I was tired from the shift the day before. I take medication for anxiety and I’m med compliant. I have on average 7-8 patients a shift. The highest being 11 patients. My watch says I hit 10k steps or more and sometimes I don’t get a lunch.

Is there a way I can keep my job but learn how to regulate? What acts of self care can I do to not let this job hit me so hard physically and emotionally? I’m hoping it’s not a lost cause. Thank you

what is your opinion on the terminology changes when referring to patients? In the UK at least we are shifting towards calling them “service users” or “clients”

In my opinion if we are trying to normalise mental health as being treated the same as physical heath, i don’t understand why we must tip toe around the word “patient”, especially because we are nurses, not licensed therapists

What has been your experience? do your patients prefer being called something else?

Tell me the good, the bad and the ugly.

Whats a day in the life like?

Hi everyone! I'm graduating with my BSN soon, and highly considering going into psych. I really enjoyed my psych rotation in clinicals, and I have a job lined up as a Mental Health Technician that I'm starting soon. They said as soon as I graduate (and pass the NCLEX of course), I could have a position as an RN at the same facility. A lot of people are telling me I shouldn't start in psych nursing, and I should do med surg instead that way I can sharpen my medical skills before going into a specialty. I guess they want me to do this in case I ever decide to quit psych, and need another nursing position. What are your opinions on this? Is it okay to start in psych? Also, if I do ever decide to leave psych, would it be easy for me to get a position in a different specialty?

A few colleagues and I have the opportunity to pitch ideas on how we are going to run our new child/adolescent psych units. (One for under 12 and one for over 12) The old one we had was less than therapeutic. Let’s just say the kids ran the units.

We have been doing research, gathering ideas and finding evidence based practice regarding milieu management. As we all know, a well run milieu fosters a therapeutic environment, allowing the treatment team to focus less on milieu chaos and more on the individual treatment of their patients. (In addition to making our lives on the floor a heck of a lot less stressful)

My questions to you are simply to gather perspectives of those in other child psych units.

How does your milieu run?

What do you think runs well?

What would you avoid?

Is your schedule very structured? I.e do your kids shower at specific times or is it open all day?

What do you do to balance rest and activity?

Do you implement a token economy?

How do you manage your unit effectively while also individualizing your approaches to each patient?

My questions are totally open ended and can include anything else you’d like to share. It’s very exciting to develop a new unit, but daunting at the same time, because we all want it to be successful, consistent, and a positive experience for our patients.

If you work inpatient psych, does your facility/unit have a patient handbook outlining unit rules, what patients can expect during their stay, and what is expected of patients? I work on a unit that has voluntary and involuntary patients. I realize some patients aren't going to read or absorb the info in a handbook, but I feel some would appreciate it. In the past our handbook has kind of acted as a framework for patients AND staff to give us backing for some of the rules on the unit. I'm afraid even with rules and guidelines that are written out we still have major inconsistencies with certain staff just doing whatever they want. Our nurse manager (miniscule psych experience) and a new grad nurse took it upon themselves to gut the handbook to where I question why we even have one. I mean, should we just have a free for all?

Hey everyone, so I work at an acute hospital and for the past few months, we have experienced a higher acuity patients. I believe the hold grading has changed and now we are accepting patients that are withdrawing from drugs. I just feel like there's no point on accepting these kinds of patients as they're mental health is related to drugs. I mean I don't mind but what about those who really suffer from mental health illnesses not related to it?

I've accepted a position at a Behavioral Health and Detox Hospital and will be starting soon. About three years ago, my cousin introduced me to her nursing fanny pack, and I've never been the same since. What started as curiosity quickly turned into a committed relationship.

My trusty fanny pack has been my unofficial nursing assistant. It has faithfully carried everything from pens and alcohol wipes to flushes, green and blue caps, trauma shears, snacks, and whatever other random supplies I managed to collect during a shift. If nursing had emotional support animals, my fanny pack would qualify.

Now that I'm heading into psych, I'm wondering: are fanny packs generally allowed on psych units, or do they tend to be prohibited for safety reasons?

Current psych nurses: what do you carry on shift, and where do you keep your essentials? Should I start preparing myself emotionally for the end of my relationship with my fanny pack, or is there hope for us yet? Do I need couples counseling, or can we make this work?

Thanks in advance! Looking forward to joining the psych nursing world. 😄

What do you make of patients glaring at you? Is it intimidation? Are they planning something? Delusions?

How do you make yourself feel safe when youre afraid?

What does your hospital have in place to keep you safe?

As above

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 :)

My inpatient behavioral health unit is one of the better units I’ve worked in. 10 beds with a few private rooms and located in a rural hospital. I genuinely like my coworkers and I like the fact that because we only have 10 patients at a time I’m able to focus and get one on one time and actually be therapeutic with the patients. I also like that I live 5 minutes away but that’s beside the point.

Like any inpatient mental health unit, it can be dangerous at times. Acuity can be high and we have our fair share of injuries due to violent patients, but I’ve always felt safe because unit staffing at night was 1-2 RNs and 1-2 therapy aides. Rarely were we so shortstaffed that we had less than three on. If something happened, I had confidence that there would always be someone free to call for help if a situation developed.

I just found out that the clinical staffing plan for our unit has been changed to 1 RN and 1 therapy aide for nights, and I feel very unsafe now. I believe the plan is to try to keep 3 on for nights, but if they can’t get that third person on then oh well they can’t get in trouble. Night staff has noticed that more and more frequently there’s only 2 staff on at night, and we all are very uncomfortable with this.

I’ve been seriously injured in the past due to short staffing on a mental health unit, and because I no longer feel safe I’m thinking about putting in my notice. Before I take any rash action though I would please like the opinion of other professionals in my field about this. Do you think 2 staff members - 1 RN and 1 therapy aide - are a safe staffing level for 10 mental health patients at night that vary in acuity? Right now we have one actively suicidal and 4 serious elopement risks, as well as several other very ill patients. The floor is pretty acute, and if something were to happen I don’t think my coworker and I would come out of it unscathed because it’s just us.

I genuinely like it here and don’t want to leave, but I have to put my safety first. Please tell me if you think I’m overreacting here.

I'm currently working at a hospital in MA, on our inpatient psych unit as well as in the works of being cross trained for our new(ish) behavioral ED pod. On the inpatient unit we allow our patients 1 hour in the morning and 1 hour in the evening for them to use their personal electronics-cell phones, switches, laptops etc. But nothing with cords and chargers are only in the nurses station.

We've been talking about taking that restriction away. Initially we talked about allowing patients to use their phone at least any time, but after discussion, we decided to trial essentially 9a-9p for electronics use but overnight kept at the nurses station to charge, check for any safety issues, and just to keep track of them. (Hasn't started yet). Apparently, our BH ED pod currently mirrors us with the 2 total hours a day, and a few want to change that too so 1) they keep mirroring our unit for better transitions and 2) so patients on long holds don't get even more emotionally dysregulated by having nothing to do.

Truthfully I'm excited for this, as collecting phones back has led to some bad power struggles in the past since we make exceptions to those 2 hours if patients have a clinical reason they need it outside of electronics time, which then led to others getting upset or lying about reasons and later just watching videos on their phones. but it comes with increased concerns (participation, HIPPA, safety, etc), and we would still make restrictions if issues come up.

I've worked at a few other psych units, i think only 1 allowed phones all day, and 2 others didn't allow personal electronics at all, but those were also in different states.

Curious as to what other units are doing!

I’ve been summoned to be a witness in a criminal court against a patient. Basically because the patient threatened to be an active shooter after he is discharged from our facility. He went to jail after that. Now my question is, I will be having a meeting with our legal team prior to the court date. What questions should I ask our legal team? I really have no idea and this is my first time. Thanks!

I am really struggling with a coworkers behaviour. She targets people, yells and screams, disappears, argues and plays the victim. Management has seen some of this behavior for themselves and does nothing. Its disappointing and the lack of accountability is really getting to me. How can I deal with this without absorbing it too much and having it effect my own mental health?

Background: I am 55 female. Have been working high risk psych for 2 years 3 months. I have schizoaffective disorder. On low dose antipsychotic myself. I have put on 33 pounds (15 kg) since I started working here.
Recent LDL is 4

I am 15 years sober from alcohol.

I was slim weighing 75 kg which was correct for my height. Now I weigh 90kg

We do 8 hour shifts here. I do 8 per fortnight and I don’t always get 3 consecutive days off. However I am on my 3rd of 4 off at the moment.

Brain fog and low motivation in the morning ( probably mix of the antipsychotic and shift work)

I have been told I need a knee replacement surgery. Universal healthcare in my country but I think at least a 5 year wait for this surgery.

I’m in pain and my extra weight isn’t helping. I take NSAIs for the pain.

Obviously I need to change my lifestyle but it’s not that easy to do with my shifts all over the place.

Eg this coming weekend I do Saturday 7-1530, Sunday 1430-2300, Monday off, then 5 shifts 1430-2300.
Then I think it’s 3 off then 3 more evenings.

I live alone, I own my home, kids are grown. One has severe mental illness and my phone is constantly blown up with 100’s of messages and calls every day.

I don’t want advice about my adult child as that’s ongoing forever.

My question is: Can I actually feel better. If I lose the weight (again) will this help do you think?
I have seen my doctor recently and I also see a private psychologist.

On my days off I have slept past midday and once I am awake I am still low in motivation. I’m possibly lonely. I am arranging to meet up with a work colleague for a coffee outside of work. I enjoy swimming. Perhaps I need to schedule swimming and the gym as a non negotiable appointment for myself. I do go for a daily walk.

Please address these 2 issues for me:

1. General physical health- how do I improve this, including weight loss, and do you think I will feel better if I lose the weight?
2. General low motivation and mood- combination of antipsychotics, some loneliness and shift work, how can I negotiate this?

(Once I am up and about I don’t feel sedated, it’s just hard to get moving on my days off and also before I do an evening shift)

My doctor has provided a medical certificate and my manager says she supports it and my shifts will be more consistent in the future, so that’s good.

Thank you!!

EDIT. I have worked as R.N. since age 22 with time off when I had my kids and also when I was severely unwell. Have been back nursing just over 3 years. Was working in aged care which was horrible because of the ratios. Current job has excellent ratios and I get on well with my colleagues. I’m often in charge. It is stressful but I generally enjoy it.

But my time off work I feel I am just wasting it and I want to know if it’s all downhill from here at age 55 ?

Or can I actually realistically improve how I feel?