There is a news story circulating in my local community about our regional hospital and a situation they had involving a wrongful hold (I’m in Florida so it’s the Baker Act). It was in the ED and the care team realized that the patient wasn’t actually experiencing psychiatric decompensation because her lab results came back and it turned out she had Serotonin Syndrome (which my team calls a unicorn condition because of its rarity 🦄) but the care team had already given the patient 5mg IV droperidol so they decided to continue the hold. The only decent thing the attending did was email the head of psychiatry to tell him that the patient didn’t require the hold and that it needed to be removed when the other physician conducted the second MSE on the patient.

This story is so sad and heartbreaking. The clinical team in the ED didn’t want to face the legal backlash they thought would be directed at them if they lifted the Baker Act 2 hrs after giving droperidol. It’s all so wrong and everyone in my community is buzzing about this right now. It’s definitely the daily tea here ☕️ 🫖

But I really want to know how a situation like this should be ethically handled. I’m certain it’s a very uncomfortable situation to navigate because of the guilt and confusion and other emotions that arise, but ethics should be respected above trying to avoid legal backlash. Has anyone ever realized that a patient is under a wrongful involuntary hold after the hold has been enacted? Or even realizing that the hold was wrong after the patient is discharged? How do you handle a situation like this? Do you apologize to the patient?

Also, isn’t droperidol contraindicated (or at least warned about) for Serotonin Syndrome because it prevents sweating and exacerbates extrapyramidal effects? Idk, it’s been a minute since I’ve studied this topic…

I am a psych tech a short term urgent care for crisis stabilization. On our floor we have up to 50 clients with 2 techs on the floor. There are 4 nurses adjacent, and usually a few techs doing admissions. Is this okay?

Hi everyone! Looking for advice here, I've been a psych nurse for almost three years, I started out in ER psych and worked there for a year and a half & after that went to inpatient psych. I've always loved my time in the Psych ER & always liked the ER in nursing school.

Lately I've been considering switching to the ER to:

1.) Get some medical experience

2.) Stregenthen my skills

3.) Try something different bc why not lol

Im really excited at the prospect and basically have a position with my old ER but im nervous at the same due to having to almost learn my skills all over again & nervous people will think im dumb since I dont have much medical experience 😅. Any psych nurses on here that have gone from Psych to the ER??? Any good resources to brush up on certain skills on?? Any advice would be appreciated!

I work nightshift at a 20 bed adult inpatient psych unit. Had a patient on the unit recently, bipolar, manipulative, sarcastic etc. Tells one of the techs in passing “Hey what I gotta do to get a shot around here?” Techs relay this to me shortly after. As I’m walking to see the pt, he stops me and asks “What I gotta do to get booty juice around here?” Mind you he is calm as can be, even has a smirk when he asks. I’m like ugh great. I explain like no we don’t do that here IM B52s are not voluntary medications. I don’t verbalize qualifying behaviors like oh if you start getting rowdy, destroying property, fighting, etc bc he’d pick up on that and would start escalating. Sure enough, later in the night he gets up starts screaming to the top of his lungs, banging on the pt doors waking everyone up, beating on the nurses station glass with his fists, stating he’s going to “F*** us up”. Techs try to deescalate but we already know what he wanted. We are a restraint free facility, plus we have limited staff, and this guy is BIG. I notify aprn and they give order for b52. We tell him we have orders for an injection, he stops the ruckus, smiles and walks back calmly into the room. 2 shifts later during the other nightshift he did something similar and received another IM injection. I obviously don’t want to keep appeasing patients like this. But when you have ppl that continuously disrupt the unit, are damaging property, and can hurt themselves in the commotion what else do you do? How do you navigate this? Anyone deal with something similar?

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 I'm 3 weeks in in my preceptorship and currently assigned with 3 patients. And this week I got quite frustrated with this male teenage patient which was bizarre cause I thought I was starting to build a good rapport with him.

So I approached this patient yesterday to try to check in with him. All of a sudden, this patient got up and walked to another room completely ignoring me. I thought it was rude, so I pulled him aside and educated him about having respectful interaction. Another instance was when I called this patients name like 4 times to give him medication but he just pretended to not hear me. This patient is the most difficult in the unit and would be cued (lectured) a dozen times every shift. He gets irritated when he doesnt get what he wants and glares at staff. Note that this kid have been punished a few times by getting denied privileges and being reset back to his room but I honestly think he's not receiving enough consequences. What I mentioned here is just the tip of the iceberg, he's usually very disruptive and childish which makes his peers hate him. And also if I list every one of his behaviors here, this post will be too damn long.

Now I'm not sure if I just havent built a thick skin yet but lately this has been really frustrating me. Sometimes I find myself taking these thoughts home and having difficulty sleeping. Any advice from experienced nurses in this area? I need to survive this until the end of the year.

Hello, fellow psych professionals!
I’m nearing the end of my second semester in a BSN program, and I’ve had clinical rotations in both acute and community mental health settings.

Before nursing school, I also had experience as an OT intern in Asia about 10 years ago, working in acute, chronic, and community mental health. I really enjoyed the experience, and after my recent psych rotations, I’m starting to think this might be the specialty I want to pursue after graduation.

One of the acute crisis facilities where I completed a rotation is currently hiring, and I’m interested in reaching out to the director to see if they might consider hiring me in a nursing student intern role rather than as a tech.

However, I’m wondering if I’m jumping into the field too soon. I still have three semesters of nursing school left, and I’m not sure how challenging it would be to balance work with classes, studying, and clinicals.

Would you recommend getting some experience in psych now, or waiting until after graduation? For those of you who worked while in nursing school, how manageable was it? And for psych nurses, do you think getting into the specialty early is worthwhile?

I’d really appreciate hearing about your experiences and any advice you’d give if a close friend of yours were in my position!

How many california nurses here work at a hospital where they mass fired techs after the new ratios were passed? Having only one tech on the floor for a 24 bed unit has been exhausting, especially on an acute adolescent unit.

I am a tech right now as I am in school for nursing. The hospital I work at requires a bachelors degree in a human service field to be a mental health tech. Why do we make so much less than nurses than nurses with the same amount of education, just a different type of education? For example, we have a new grad nurse on one of the units I work in and they do not know very much about psych disorders and non medical preventions, treatment, and causes. But us with a degree in psychology had to study and learn those things. Basically, it seems like we have the same amount of knowledge, just in different sides of frontline psych treatment.
Is it a hot take that nurses and techs should make the same?

Hi yall,

So i recently secured a job as a new grad which starts next week! I am so incredibly excited, you may recognize me from another post I had made.

I have been beginning to have some anxiety lately because I had an unfortunate instance where my birth control method failed and I am at risk of becoming pregnant--i should be able to confirm in a week or two. I am married and stable, but I didnt anticipate the birth control to fail. My anxiety stems from a sort of shame about getting my first job brand new and then possibly having to go on maternity leave in 9 months or so--i feel strangely embarrassed. Would i look like a bad employee? Would it negatively affect my ability to learn? Probably. I feel so awful about it.

I wholeheartedly welcome a baby between me and my husband, I just hoped I'd have more time to get settled into being a nurse. Shoot. Please no shaming me, ive already told myself everything anyone else could say. I am just seeking support and any comments that may relieve some anxiety. I have been reading about how in the US there's many protections for pregnant nurses. I am glad for that, but a lot of my shame is just around my unlucky birth control failure and feeling irresponsible.

I have a ton of family support and could easily return to working full time after I recover. Is there hope for me to still be a good nurse and perform well in my career if I end up being pregnant?

I still dont know if I am or not have have 0 symptoms so far, but I will not be able to confirm for 1-2 weeks.

Hello,

I am interviewing for this position for a nurse residency at a facility that I think would be awesome to work at. My city doesn’t have a lot of opportunities for new graduates, so it makes me even more desperate to get this job. I know psych is my field, and I know I can be at this facility for a long time. I’m wondering what questions you faced so I can put my best foot forward. I know I’m passionate about this field, but I don’t want to be caught off guard by something 😭

I’m a new nurse, working in psych for about a year, and I’m working on the great practice problem for my BSN and new grad residency. Does anybody work on a unit that provides specific education for patients prior to events of aggression/violence that outlines the possibility of seclusion/restraint for patient safety?

I’m a new grad and I’ve come to love my experience so far working as a nurse in my psych facility. However, while looking around other psych hospitals here in LA, I noticed that most of them start off new grads at a base rate of $40-$45/hr. Is that common pay for psych everywhere else, especially in California? If it is, why is that?

I interview tomorrow morning for a DON position at an Adult Residential and Mental Health Facility. Patient population is 1370 - incompetent to stand trial. I’ve been a charge nurse for 2 years at a PHF, and do most of the chart audits, legal log / hold audits, assign staff their daily duties, manage patient behaviors, seclusion events, manage staff, and all the typical nurse duties (coordinate/communicate with doctors, tx plan review, admin meds, etc etc). I’m very nervous about tomorrow, and want some feedback from you guys as to what your red flags would be for a company? Being DON is a huge responsibility and risk, I want to be sure it’s worth it. I love what I do now, I however do not love my current management (VERY laissez-faire in the worst ways possible), and I do not love the idea of NOC shift for much longer (my current shift).

Currently in nursing school- interested in becoming a psych nurse. Does anyone have any insights into the west coast job market? I am currently located in the PNW and open to moving, but hoping not to if possible. It seems like pysch might be a little easier to land than some other specialties.

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 :)

there is someone in my psych preceptorship with this and it’s kinda wild. She genuinely just loves being a patient so will pretend to have various types of illnesses. How does psych deal with this? because as far as I can tell, it’s not something that is being challenged

Hi my beautiful psych community! Today I was a 1:1 with a violent patient. He had two BERTs today, one in which he punched another patient. 20 minutes after that incident was over, the NP showed up to do her daily assessment. Since I was his 1:1, I was sitting in his doorway, and she closed the door on me. I opened the door and reminded her that I was his 1:1, so needed to be able to see him, and she said "We don't need 1:1s while an NP is present", and then closed the door again. A few minutes later I hear the patient punching the wall, and the NP immediately exits the room saying she was "turning care back over" to me. I've never had a provider shut the door on me during a 1:1. Is this usual? I think I'm also questioning this NP in particular, because a few weeks ago I overheard her telling a patient she thought our 15 minute checks during her consultations were "annoying".

There is a certain client with a diagnosis of BPD who is fixated on me. She is extremely violent and requires restraints almost daily. I've only worked on her unit a handful of times, but she despises me. When she sees me she postures and threatens to assault me. She has made up multiple false complaints about me. I haven't been on her unit for days, and she is constantly talking about me to the other staff and voucing her desire to harm me. I am worried about her looking me up and stalking me post discharge.

The HRO and some of the staff are not the wisest and I wouldn't put it past them to provide my full name. Actually I'm not sure if the HRO is required to provide her with my full name when she makes complaints. I have an uncommon name so I would be easy to find with Google.

I'm not even sure why she decided to fixate on me. She really likes the male staff and it's possible she saw me interacting with a male that she fancies. But there's no way to know with this type of client.

I'm wondering if anyone has experienced with being stalked post discharge.

My psychiatrist has closed it’s clinic and now i’m kind of out of options because i can’t find psychiatrist from the region to get an appointment to have my adhd meds checked and prescribed again. I talked to my mom about it and she thinks it would be finde asking a psychiatrist in my clinic to referr me to another colleague they know. She works in psychiatric nursing as well but im skeptical of the image i paint if i ask them for help. Does anybody have experience with that?

I’m a nurse with several months experience in inpatient psych. I have a coworker who is known to be, well, rather abrasive in their patient interactions. They’re a stickler for the rules and frequently escalate rather than deescalate when a pt is agitated and rude toward them. Even in casual interactions, this nurse can come off as rude and not very empathetic. Now don’t get me wrong, she has good qualities too, but she racks up a lot of pt complaints.

My question is, what is the therapeutic response when a pt complains to me about her behavior toward them? It comes up often enough. I’ve had pts get taken back or upset and say something like wow, why is she so rude, etc. I see where they’re coming from when I witness the behavior, but obviously I’m not about to throw my coworker under the bus. It makes for an awkward interaction when I want to validate the pts feelings or actually just have a neutral response or acknowledgment of their concern. Any advice? Thank you.

*your, not you’re

Hi all, interviewing for a position on an inpatient adolescent psych unit. I haven’t gotten specifics yet as to what the type of unit is/acuity, and this would be my first job in psych. (I have 9months in med surg so far.)

I am wondering what kind of questions I should ask, so that I can better understand this role. I am also wondering what safety considerations I need to be aware of to ensure I’ll be on a safe, quality unit.

Basically, what questions should I ask to make sure this place isn’t a bad place to work, or a bad place for patients to heal.

Thank you all!