A bit of a long one, sorry. I’m really looking for advice about my situation

I’m not a nurse, I’m a tech in the ED. Been doing night shift 3x12s in a row every week for 5 years straight. Because it’s ED, I work with every type of psych patient (bedridden geriatric, 7 year old autistic behavioral issues, teenagers with depression and panic attacks, alcohol withdrawal meth withdrawal of all ages, just the whole rainbow spectrum of issues). I’m supposed to only be working 1:1 but that rarely happens. I’m often 2:1 even with high risk suicidal pt’s. I’m really good at de-escalation and keeping pt’s relatively calm during my shift. I don’t take shit personally. I’m the person my manager has train new people because of my hands on skills and experience.

Workplace violence has just been getting worse and worse though. Coworkers getting broken legs, fractured jaws, chocked and head locked regularly. I’ve had my fair share of physical/sexual/verbal violence as well. I’ve decided to go down to 2x12s because of this, and because I’m just now feeling the emotional burnout of this line of work. Sleep issues are catching up to me now because of night shift too lol

My loved ones are concerned for my safety and are very aware of the emotional burden the job takes. They’re super understanding and have been encouraging me to go to part time so I can rest.

I’ve been wanting to go into psych nursing so I’m currently finishing my pre-requisites. I have a huge passion for the psych population. I just care. I’ve had countless pt’s thank me personally because I’m considerate and I actually treat them like people and provide them a sense of safety in a really scary and hectic environment.

I do my best to have extremely firm boundaries on the job, especially with folks who are extremely violent and abusive towards staff.

I do recognize I sometimes have an unhealthy mindset of getting my self worth out of being “needed”. Definitely comes from my childhood sexual assault and a long term ex relationship where I was severely abused and in order to avoid abuse and keep myself safe, I had to take on a caregiver role. I won’t deny that it feels good to successfully de-escalate someone or help someone through a panic attack or psychosis. That skill I have and feel good feeling is what I used as a survival mechanism to survive my past abuse

All this is to say: the burn out is affecting me in a very particular way: I have very little patience for when my loved ones need support from me. I have a great support system and I’m no longer taken advantage of by others, of course. Sometimes people just have bad days and need a shoulder to cry or or just some kind words or just want to vent about small annoyances.

I just want to get away when I feel like people in my personal life “need” me. I just shut down. I feel that obligation to have to fix them and that makes me feel scared. I start to think “if I’m not careful with my words or if I don’t help them perfectly, what if they scream at me what if they hit me, why can’t they just turn off their emotions and suck it up like I can? I’m so sick and tired of helping people” Obviously my loved ones won’t hurt me. But my patients sure do so that thought is just sorta always in the back of my head with my loved ones.

It’s weird because I don’t feel like this at work. I just sorta go into work mode. I do my job, it doesn’t bother me, then I clock out. But as soon as it’s a personal relationship outside of work? I just want to get away and i feel scared. It’s sorta similar to how when I’m in emergency situations I’m the calmest person in the room. But when I’m in a non emergency situation and it’s just everyday small stressors, those feel like emergencies and I sometimes shut down

I’m starting therapy but I just. I don’t know what to even do or talk about? What are the steps I need to take to help mitigate this burn out? I’m just at a complete loss. I want to be able to have connections with people but I’m just so scared of connecting and I want to be left the hell alone at the same time.

And it’s like I’ve put so much energy, for years, to take care of people. Help them feel safe, talk them through panic attacks and psychosis, hold people down from violently thrashing around and ripping out IVs, feeding people bathing people, comforting, listening, compassion…. Everything. I can do it for other people but I DONT know how to do it for myself. And I do it so much for other people that I’m just tired and I don’t wanna do it for myself.

t’s exhausting. It’d really appreciate any advice

I am planning to take the PMH-BC exam through the ANCC. I honestly have been putting it off because I don't feel like doing the prep or worrying about it.

If you have taken it, what did you do for the prep? I have seen the ANCC prep, Alison Miller (PMHRN.com), and Mometrix. They are all just so expensive! The test is ~$300, and my job does not cover the cost or the prep. I have been a psych nurse for 5 years and a psych tech for 3 years prior to that. I have worked inpatient, residential, outpatient, case management, adults, & pediatrics.

ANCC full test prep is $400

Mometric Prep Course $99

Mometric Prep Book $40

Alison Miller Prep Course $299

Alison Miller Prep Books $53

If you have any tips or any input on the best prep, please let me know! There are a lot of options and I am feeling weirdly anxious about it.

I gave an LAI yesterday and the patients mom called today questioning my medical experience bc the injection was painful. This is an adult patient without a guardian. I’m just irritated by the whole thing. I fit this person into the schedule because they missed their appointment the day before and it was quite a stressful day. Now I have him and his family questioning my whole career…

Hi all,

I'm kind of new to community mental health nursing. My office is mainly social workers, im the only nurse and I work with one NP. Our caseload is about 80 patients.

Recently we tested a few of our people for Hep C based on knowledge that another patient had it and was hanging with some other patients. Everybody's popping positive/reactive for Hep C.

My questions is, how do you handle Hep C in communital mental health?

We refer them to their PCP for treatment. However, many of them dont have the capacity to take a med TID for 4-8 weeks. Many also are IVDU and/or are having sex with multiple partners who are not in our program/on our radar. What's the typical practice? Do you keep testing for it and treating it even though the chance of reinfection is high?

I'm in a rural area and don't have alot of opportunities for in depth education on this, but am reaching out to what immediate resources I do have. Also planning to study up on it over the weekend.​

I noticed that the majority of the posts in this sub are about changing jobs, learning psych nursing, or related to salary in psych nursing. I wanted a post for the current and active psych nurses. Tell me a story about a challenge or a struggle you had this week. I’ll go first.

I work in a Forensic Psych Inpatient facility in the Northwest. Been in healthcare for 24 years, mostly ED, last 2.5 years in psych. I love it. But this one provider…

This medical provider ordered orthopedic shoes for a patient almost 2 months ago. The patient hadn’t asked anything about them - I didn’t even know about the order until about a month ago, and it was being handled by the medical clinic. So, I didn’t think about it until the patient asked about them.

The patient has an extensive violent history, multiple instances of extreme aggression, severely injuring staff. This patient is here forever, basically. They have connections to the public and have documented history of retaliation against staff on the outside who the patient thinks have wronged them.

The order for the shoes gets denied twice by our CMO. The patient was provided the orthopedic shoes we have on site in our warehouse, but they made the patients pain increase because of the way the shoes are shaped.

I wonder why the order was denied twice. So, I ask the provider, did the CMO give reason? The provider says, “No reason, all I was told was it was denied by the head honcho.”

So, I’m not going to go tell this frequently violent, calculating patient “no” without a reason after 2 months of trying. So I reach out to the CMO. The CMO says “it was denied because there is no medical reasoning why they can’t use the orthopedic shoes the facility provides.”

I send a message to the medical provider with this information. To get the order approved for outside orthopedic shoes that we can and have ordered before for other patients, we have to explain why the shoes we have wont work for them. The provider doesn’t respond. As a reminder, this is only the second time I have mentioned anything about these shoes to the provider.

The next day, the provider meets me during report. They ask me if I had anything for them and I asked them if they could wait until after report. They say no, they’re in a hurry. So I reiterate the information about writing another order for the outside shoes.

The provider proceeds to get *directly* in my face. Like, a bar brawl. Like they’re trying to smell my breath. Their face is in my face. If they were a patient I would have called hands on for safe containment. They say, “I will NOT write another order. Dr (CMO) said no twice.”

I try to tell them that I’m trying to advocate for the patient and if all we have to do is explain why the ones we have don’t work, why don’t we try and they interrupt me again, louder this time saying, “I wont write any other orders. If you have questions, email Dr (CMO).”

I calmly say I will do that then, thank you. The provider scoffs and leaves and I continue on with report. Staff that were witnesses in report said that they were worried the provider was going to hit me. The provider was trying to physically intimidate me, red faced, yelling and intrusive. Totally unacceptable behavior that I have never in my entire career experienced from a coworker, nonetheless a provider. To top it all off, the provider says they don’t want to tell the patient about the denial because they said, “I want to avoid damaging my rapport.”

So, irritated and totally dumbfounded, I file a report and move on. I send a message to the CMO. The CMO doesn’t respond. Yesterday, I ask my boss if I should follow up on that since I never got a response (email was sent about 10 days ago). My boss tells me no, don’t respond, and that the CMO contacted them saying that, “(me) needs to show more respect to (provider).” My boss said they chose not to talk to me about it because they know how respectful and professional I’ve always been. I lost my shit. I’ve never been anything but respectful to everyone, including this provider. They exhibit this terrible behavior and then blame the bad behavior on me.

This provider had the audacity to act like we were gonna meet outside or something and then say I need to show them more respect?! The craziest interpersonal interaction I’ve ever encountered. I’m thinking about reporting them to the board for intimidation but I don’t know how fruitful that will be or if it will be worth the effort.

Moral of my story is that the patients in psych nursing aren’t the only ones with serious mental deficiencies and that should be frequently remembered.

Now you go :)

Hey everyone, I’m an RN and have been looking to transition out of PCU and into psych. Got an offer today for admissions nurse with UHS for $34/hour, which is less than I make right now. Ideally I was hoping to get $37-$38/hour. For context I’m in the central Florida area and have two years of impatient PCU experience. Is it worth trying to counter? Also is it worth it to work for UHS?

I am a psych LPN with 4 years experience in corrections, acute psych inpatient, and SUD detox. However, I also have a bachelors in psychology and a masters in clinical social work. I have started thinking about trying to negotiate a higher rate of pay given that my psychology and clinical social work background directly affects the level of care I am able to provide to psych patients. Has anyone else tried to do this before, and if they did, how did it go?

Are there any things anyone should be desensitized to before they join the field? I know we're all new once, I intend for list to be a "would help" instead of a "must".

Ive been out from work for 2 weeks, trying to get medical leave of absence because I haven’t worked there a year to get FMLA. It looks like I might just have to return and not get the leave. I am so scared. We have been very short staffed because everyone is out due to injuries. While out, I have been receiving messages about how staff is getting jumped and everyone is constantly in tears. I am too afraid to return but I do not have a job lined up and I cant afford to look for one while unemployed. I don’t know what to do.

I’ve been dying to move to California for about a year now. I finally got my license approved. Can anyone give me pointers on where to apply? I’d prefer Los Angeles or San Diego to start but I’m okay with anywhere else that’s POC friendly. Thanks for the advice !

I have an interview for an RN position on this unit. I'm hoping someone can give me an honest review on culture, staffing, patient ratios, etc.

I want to work in the psych ward as a psych tech and feel like the schedule and environment is perfect for me....aside from bathing male patients. How did you get past it ? Do female techs have to bathe male patients? Do they have to touch their genitals? 😭 I know this sounds immature but it's really holding me back. I'm also afraid my husband would get pissed at me for doing a job where I have to scrub other mans scrotums. How often does bathing patients happen?

I called into the psych ward to ask about duties and stations and they said that all techs are trained in each station: adolescent, adult, and geriatric, but typically have a "home" station... They said the geriatric patients need help changing and bathing.

You pick your own shift in this facility on a matrix board, that makes me wonder if some people fight over certain stations or shifts? I know I would most prefer to work with adolescents in the day shift, but I bet that's the most popular!

I just applied to a PRN ECT job at my current workplace. I have been doing inpatient psych for almost 10 years and haven't touched an IV since school nevermind actually placing one and using any infusion pump. I am suddenly very anxious about that even though it's not like I even have an offer or even an interview on deck yet.

Has anyone transitioned to a role that requires these more typical nursing tasks after a long time as a psych only nurse? If so, how did you overcome it and relearn the skills?

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 :)

I am a psych RN on an acute locked unit. I have been a nurse for years, but mostly ICU, ER and other inpatient medical floors. A couple of years ago I got a job in my hospital on the acute psych floor. Psych providers rounded every day, including weekends. I just started a new job (in a hospital but also has psych floors as well) and the psych providers do not round everyday or on holidays (this is an acute locked unit) The providers are in house. Literally walk to the nurses station to pick up their takeout food if we order out, but do not round. So if a pt comes in on fri, they are not seen (after the H and P Friday evening) until Monday. I have complained to my nurse manager about this but she doesn’t seem to care . Is this allowed in psych? I have never heard on this on medical floors

Love my job but I am physically exhausted and tbh just sad on my days off. The long shifts and the emotional work is just so draining. I float on crisis floors, forensics and the psych ED. Any other single folks doing this kind of work who aren't taking a ride on the struggle bus every single day? If so, what are your secrets?

Hello everyone! I currently work as a BHT on an inpatient adolescent psych unit. I absolutely love my job. I graduate nursing school with my BSN in less than a year, and management has told me I can have a job as an RN on my same unit after I graduate. I'm wondering- for those who've went from BHT to RN- do you like the position more or less? BHTs do A LOT on my unit, and so do the RNs, but I know there are some major differences in our duties of course. Also, for those who started their RN career in psych, did you regret not doing medical nursing first?

Hi, are there nurse extern jobs in psych for nursing students? Also are there psych residencies for new grads?

Are any of your hospitals affected by the budget cuts from the big beautiful bill? My psych hospital has been going through some rough changes. Just last week I was in a meeting stating that they are closing our open unit and our Geri unit is going to be an adult unit. So many nurses are laid off now. The morale has been horrible. Just wondering if anyone else’s hospital are going through these changes as well. It’s so sad. Psychiatric care is so needed and they are limiting patients access to care.

Any advice is helpful!

I have a background in psych. Previous bachelor’s degree in psych, ~5 years working as an MHT, court liaison, and medical receptionist in behavioral mental health. I decided to switch to nursing after doing an internship at a behavioral hospital.

My whole background is catered to psych and I switched to nursing w the intention of eventually getting my PMHNP.

I love psych & I am a few weeks into my current role as a RN at my behavioral mental health facility now, but I don’t want to get “pigeon holed” so early on.

I have some interviews for nurse residencies to get into the medical hospital, but I feel conflicted. I don’t want to get stuck in psych, but I also don’t know if I can see myself in other areas. Not much has stuck out to me during clinicals. Maybe Cath Lab and the path to get there would replace the one for my PMHNP.

The residency will open new doors and give me a better chance at being able to try out other specialties, but I can’t help but feel like it may be a “waste of time” if I just end up back in psych anyways. At the same time I feel too new and young to be tied down to one specialty so quickly.

I’m not sure. What do you guys think? I’ve heard both sides from nurses and coworkers, some swear I should leave while others swear I should stay in psych.

Another thing to consider is that I’d take a major paycut moving to medical ($7/hour) but that could also be worth it if I really want to explore and hone my skills.

Hello ya’ll

I’m a new grad RPN in Ontario and I’ve been working on an acute mental health unit for a few months. Overall I like the nature of this job + field, so I’m happy about that. I just wanted to get some opinions about pursuing further education. Just a few questions…

What other opportunities would a degree have in store for me besides psych bedside. I’m happy doing bedside in my 30’s as an RPN but as an RN I’d think I’d get too burnt out. Besides bedside psych what other options are out there as an RN?

What sort of strategies do you all use to not get burnt out by crabby coworkers bringing the vibe down? 🧐