As A Psych RN It’s Assess the Vibe, Not the Vitals

July 25th, 2012

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By , BSN, RN

When I was in nursing school, most of my classmates dreaded our clinical rotation in mental health nursing. They were disinterested, or nervous, or flat out scared. I didn’t get it. I loved my rotation at the county mental health facility—in fact I liked it so much psych nursing was my second choice if I couldn’t get a job in the OR.

Ten years down the road I still wonder what it would be like to work in psych nursing. With all that’s been in the news the last few days I found myself thinking about it again. So, I called up Terri Polick, a psych nurse with more than 20 years in the field, and asked her how she got there and what it takes to really find success in the field of mental health nursing.

”I was a history and poly sci major at Iowa State, focusing on middle eastern history and languages,” Polick told me. “A friend of mine went to China as one of the first American students to visit China right after Nixon (1972). She came back and couldn’t get a job. I thought I had to be nuts studying this. We didn’t even see the Middle East a major player then.

”I didn’t know what I wanted to do and I didn’t want to waste my parents’ money so I quit school. All the factories in my area were closing, there were no jobs. Every day I would look in the paper and the only jobs I could find were for certified nursing assistants. I went to my Dad and asked if I could borrow $40 to get my certification.

”After the 12 week course I was working in a nursing home and I loved it. I asked my boss if she would write me a recommendation for nursing school. Then I went and told my Dad I had found what I wanted to do. He said, “you won’t be rich, but you will always have a roof over your head and be able to find a job. “

Polick has been a nurse ever since.

Did you go straight into psych nursing?

”Oh, gosh, no! You remember “One Flew Over the Cuckoo’s Nest?” That came out in my junior year of nursing school. In my clinical for psych my first day on the unit was like that. Someone actually tried to choke me. You have to fast-forward 10 years before I came back to psych. I worked as a med/surg nurse, a neuro nurse, did a little of everything. I never worked in the OR and I never birthed a baby. I had done it all but never found my niche.

”One day my supervisor says I should try psych. My time management skills were awful and she said it was because I spent all my time talking to my patients, 'you are trying to solve everyone’s problems.' I was a square peg trying to fit in a round hole. I finally found my square hole."

In most areas of nursing we learn our job by learning a set of concrete skills, how to draw blood, how to place a catheter…how did you train for something like psych?

”I got attached to a nurse who had been in psych since Florence Nightingale was a little girl. On my first day on the unit I felt so odd. In med/surg you start your day by getting your patient’s vitals, checking IVs, checking wounds—physical stuff. On a psych floor you feel for the vibe. You check moods, put up your antennae. You have to get the vibe of the floor.

”You talk to people. How they speak tells you a lot about what’s going on: what is their volume, their cadence—you assess. You ask the night nurse if they slept, were they agitated last night, did they need meds? You need to know if they had visitors and who and how’d that go? In med/surg it’s a physical assessment. In psych it’s emotional.”

But, I hear those med/surg skills come in handy with some populations, or patients. How’s that?

”I worked with street people in Chicago, you know the people in tin hats living under the bridge. And, you know how winter in the Midwest can be. When they would get brought in the very first thing I would do was make them take off their shoes to check their feet for frostbite. And the people who live in camps or shelters, you have to check for TB. You do need those med/surg skills.”

These days Polick works for the Department of Defense providing psych services to active duty military and their families.

”The military has really changed, from the top down. They are being encouraged to seek help. There used to be a huge stigma in the military about mental health problems, people believed they wouldn’t get promoted if anyone knew they were having troubles. However, that has really changed. The military is learning from its own history and the leadership is really stepping up."

If a nurse or nursing student is interested in a career in mental health, what qualities do you think they need to have to be successful?

”You cannot be judgmental. You cannot be narrow-minded when you see someone struggling with their sexual orientation. Sometimes you will have patients who have abused children or done other things along those lines. You have to have a very big, open mind.

”You have to be open to different cultures, too. What may be very macabre or different to you may be healing to someone else. You have to be open to it."

How do you stay culturally competent with everyone? The U.S. is such a mixed bag.

”At least in metropolitan hospitals they try to hire nurses who reflect their population. In a lot of my hospitals I have been the only white American on the unit. You really have to be in touch with who your patients are.”

There are many who would say the military is it’s own culture, how did you learn about that area?

”I was mentored by my head nurse, a Lt. Col. in the Army and a Midwestern girl like me. She gave me a pamphlet on military culture, sort of “Military Officers for Dummies.” I learned about rank and protocol. “I have to say here, the military nurses I have worked with are the best educated nurses in the world. They have to be proficient in more than one specialty. I have worked with a lot of nurses over the years, I am old and jaded, and these are some of the best nurses I have ever met. I am always learning stuff working with them."

What other qualities make for a good psych nurse?”

"You’ve got to have a good sense of humor. You have to find some sort of humor in the intensity. You have to see the insanity for what it is." 

I’ve heard a lot of psych nurses are as “crazy” as their patients. Is this true?

"Everyone has their issues. There really is no one in this world that doesn’t have some kind of problem. A lot of times patients want to make it you versus them. The difference between us, and I’ve said this, is ‘I have learned to run my craziness, I don’t let it run me.'"

“You can be as crazy as you want in this country, I tell them. As long as you pay your bills, don’t break any laws, and don’t make too much noise.”

Do you encourage nurses or students to go into mental health nursing?

”I have on occasion said, I’ve seen how you handled that patient or situation, you used the nursing process, you were empathetic, you should consider working in psych.

"You know, psych has been until very recently the redheaded stepchild of nursing. We’re told we aren’t real nurses, you know, no bandages. But, now we are gaining legitimacy. In the military recently they ran a survey to see what skill their nurses have and what they need. Psych is where there is huge need. I think there will be many more jobs opening up in psych."

So, I’m guessing psych nursing is what you will do until you stop nursing?

"I will die with my Nursemates on—or I will be a no call/no show and I told my boss he will need to send the sheriff to break down my door. I have an aunt in her 80s who is still a working hospice nurse.”

Polick brings her insights into healthcare, and nursing in particular, to her blog site, Nurse Ratched’s Place. Polick isn’t crazy, she just plays a psych nurse in real life.

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