February 20, 2012


Forum poster: What motivates you to go to work each day?

Me: Tequila

Seriously...I don't drink tequila. I go to work because I'm never bored there. And I'm not...even on a slow day, something happens to make it challenging. I learn something new every day.

The workouts are going great except for the Reynauds. I'm still trying to figure out how it's getting triggered.

I found out my class instructor was also a psych nurse, which is nice. Sometimes I really do feel alone in the world...because I usually only encounter other psych nurses in psych settings. I rarely see them in class with me, and when I run into a nurse on the street, psych nursing is usually not in their job history/description. If anything, the words "psych nurse" cause them to look ether terrified or disbelieving, as in, "you're wasting your life as a psych nurse?"

I won't deny there's a stigma about being a psych nurse...like we're the inmates running the asylum. Not all of us are crazy, thank you. You do have to be a little crazy--and have a big sense of humor--to survive in psych. But we're not all coming to fix our own mental problems. Some of us fell into the specialty. Some of us were called to it. Not all of us are on the couch and taking SSRIs and recovering from various addictions. A lot of us, yes. Not all of us.

Or the misconception that psych nurses aren't real nurses. I always think of that and laugh to myself whenever I take report from the ED nurse who sounds absolutely terrified of my-soon-to-be patient and feels that the only two ways to treat them are drug 'em and/or restrain 'em--no middle ground. Little do they know that if they sat down for five minutes (just five) and talked to the patient, there's a good chance that the patient's night won't end in restraints or an Ativan coma. Of course, not all patients will be simple to take care of...but a lot of nurses (not just ED), as soon as the learn the patient has a psych history, are quick to brush them off.

There's a lot to psych nursing...it just doesn't involve tubes and IVs. We're treating a different part of the patient: the mind. For that, you can't rely on a tube or (in most cases) an IV. You rely on you...and a few good psychotropics. But believe it or not, the answer isn't always just drug them up and forget about it. The meds alone won't help the patient...at least not for the long term.

And for the record, not every difficult patient is a borderline personality disorder patient. That actually irks me, that people are so quick to slap on the "borderline" label at the first possible opportunity. Patient disagrees with the nurse? Borderline. Patient changes their mind about something? Borderline. Patient tells nurse one thing and doctor/family something else? Borderline.

Reality? Maybe...maybe not.

Anyhow...the state APNA conference is coming up, and I'm looking forward to going to it. It'll be cool to hang with other psych nurses and get a chance to network. I actually met the APNA president not too long ago...in fact, she was the first person I met in the room: she came up to me and introduced herself as Marlane. Later on I found out it was the Head Kahuna. Pretty cool.


Medic2RN said...

I think a lot of nurses really don't know what psych nurses do. You guys normally work at another facility than the main hospital (at least in the hospitals I've worked in) and appear to be clouded in a fog of mystery. I remember giving report to a psych nurse who was about to receive my patient transfer from the ICU step down. There was a mismatch of the information I thought she should know and what she thought was important. Unfortunately, I couldn't answer some of her questions because I did not know. We were speaking the same language, but different dialects and missing the whole picture.

FWIW, I've never thought that psych nurses were not 'real nurses' whatever that means....I believe it is a specialty.

Meriwhen said...

I agree with you on the different dialects...sometimes it's hard to get a report from another nurse (usually an ED one in my case) because we have different priorities. Most of my patients are medically stable...or at least we can manage their med issues on the unit. So tell me about how they are behaving so I can figure out how to best calm them down.

But then there is the other extreme: the ED/other nurse is trying to give me just the psych angle with no med details, and I'm telling them, "ok, but what is their blood pressure? How are they medically? Exactly what are they experiencing right now with their withdrawal?" I think that sometimes non-psych nurses forget that we deal with the medical end too...maybe not dealt with as in-depth as they do, but they're still there for us to handle.

The worst is when they try to give me report bedside ...which I understand is all the rage outside of psych but is a big no-no in psych (can you imagine giving a beside report next to an Axis II patient?!?). I had to tell one ED nurse to leave the room and call me back, since all she was saying was "uh, he's fine..." Once I got her out of the room, I learned all about the hallucinations and SI.

Medic2RN said...

When giving a report to a psych nurse now, I let them know all the pertinent medical information ie: chief complaint, V/S, what we did, etc. and the reason the patient is coming to them. What I've observed and then ask them "what else do you want to know". This has helped me understand what is important to them.

As far as bedside reports - I'm not a fan. There are some things that the nurses need to know that should not be spoken in front of the patient.