Psych Nursing

For those of you that don't know it, in nursing school you go through several rotations, much like students in med school do. In my particular program, our rotations are about 5-6 weeks of our 8 week classes. Fast paced, but enough time to get a feel for what you like or do not like about a particular area of nursing.

Thus far, I've been on an Orthopedic Unit, in a nursing home, on a Med Surg Unit, a Mother/Baby Unit, and currently I am on a psych unit in one of my local hospitals.

Ortho and Med Surg...meh...they're ok. I could do it. Wiping butts and pushing meds, helping patients (oh...excuse me...CLIENTS...) get cleaned up. I particularly enjoy giving injections for some odd reason. I think its the most nursey-nurse thing I've done yet, and there's something about the actions of putting the med in the syringe and giving the injection that I find appeals to me.

Mother/Baby? LOVE. I loved it. Healthy patients who, for the most part, are celebrating the addition of a new life to their families. Some sad stories, for sure. Despite the sad stories, and the methadone baby, born addicted to Percocet that I saw to most of my day in the nursery, and the little guy who was clearly born with genetic abnormalities who was transferred to the Children's hospital....I adored the nursery. I watched a baby be born and tended to many others that day. It was my favorite day in nursing school, and I am preparing to launch an all-out assault on the nurseries at the hospital where I work to allow me to precept there later this year.  

Nursing home? Please, God, no. Geriatrics is not my forte by any means. It was too overwhelmingly sad to me to see these elderly who had dementia, couldn't remember who or where they were....I didn't think it could get any more sad or overwhelming than the nursing home.

Until Psych.

The unit I'm on is divided into 4 sub-units. 1 regular adult unit, 1 child/adolescent unit and 2 special treatment units for acutely mentally ill patients.

I was on the special treatment unit for the most acutely ill this past week. It was a bad day. I was surrounded by patients who are so ill that I found it hard to believe that they could be helped in their current state. Very few--if any of them--were grounded in reality for more than a few moments at a time. One man on the unit has been institutionalized for 47 years. Forty-seven years of his life he has been an inpatient in a mental health facility.

At this facility, we sit on the unit, my partner and I, and color. On the other few units I've been on there, you get a crayon and a coloring sheet in front of somebody and they just start talking. Its amazing. I think its safe to say that after these next 2 weeks of clinical, I won't be coloring any time soon. My neck aches the next day from having my head bent over my coloring all day. My instructor is an art therapist, and she has a seemingly endless amount of coloring sheets.

In the last few weeks, I've had discussions with heroin addicts, bi-polar patients, schizophrenic patients--my schizophrenic patient was my favorite. He was physically imposing and scared the shit out of me half the day. Until he got a crayon in his hand. Then he told me about his life, his history of hospitalizations, the voice that talks to him constantly and doesn't allow him to sleep.

There are many reasons I'm finding this field doesn't appeal to me. I'm used to being up on my feet for 12 hours, checking on my patients, giving them meds, taking them juice, talking with them and their families. Physical exhaustion comes with the territory. But this class--this is a pure 12 hours of mental and emotional exhaustion. You constantly have to be vigilant. Don't turn your back on the client...make sure you know where their hands are at all times...don't ever stand directly in front of them, you have no idea if or when they will strike out. One patient spent half of the day pacing circles around the table where I was seated. He never spoke. I was unnerved.

These units are supposed to be therapeutic, but outside of the art therapy groups that we run for them, I don't see any of that. I see nurses and techs not interacting with the patients unless they're being told its time to eat or time to take their meds. Psychiatrists are in and out. They spend maybe a few moments with each patient, and they're gone again. I wonder how this is helping any of them, outside of the medications. It just doesn't seem right.

And here's the thing that keeps coming back to me. Most especially when I spent time on the regular Adult unit: that could have been me.

I've suffered with anxiety for as long as I can remember. I remember it as a kid, a teenager, a 20-something, and beyond. For most of my life, it came and went. Inconvenient, scary, but manageable.

Until.

My oldest was about a year old. The anxiety had kicked up quite a bit in the months after his birth. Probably a combination of being a new mom and the stresses that come with that, and a healthy dose of Post-partum Depression thrown in just for fun. When he was about a year old, I dropped my basket, so to speak. In a matter of a few months, I became so overtaken with anxiety that I could not function. I would have massive panic attacks any and all hours of the day--particularly while driving. I'd started a new job that was intensely stressful and I was isolated all day, being piled with more and more responsibility. One day I had chest pains and ended up in the Emergency Room. After x-rays, a CT scan during which I reacted to the contrast (listen to your patients when they tell you they're allergic to red dyes and iodine, please) and a blank look on a doctor's face, I left AMA. When I saw my own doctor she handed me a prescription for Xanax and a handful of Lexapro samples. My therapist wholeheartedly agreed that was exactly what I needed.

Except.

Taking medicine scares me. One of those fun phobias. I was terrified they would worsen the problem and allowed myself to get to the point where I walked out on my job, got in my bed, and stayed there. For about a month. Walking into the bathroom brought on intense panic. Walking outside? Forget about it. I was a mess. I wasn't eating much. Wasn't sleeping much. And still in abject terror when I thought about taking the meds. Incidentally--I now know that this thing I'm afflicted with is called Panic Disorder. Look it up.

Finally, my husband gave me an ultimatum: Try the meds. If you don't, I'm taking the baby and leaving.

The thought of being without my son was more unbearable to me than the thought of the meds. I took them. My sisters (also interestingly both on similar meds) cautioned me I would feel strange for the first few weeks and really want to stop taking them, but to keep on. They would work.

And they did. And it is the best thing I have ever done for my own health. That little white pill that regulates my serotonin levels has saved my sanity. It is my equalizer. It keeps my panic away and allows me to function as a normal human being.

So you can see how being on a mental health unit where no one has an equalizer may hit a little too close to home for me. One thing we're taught in nursing school is "know thyself." Examine your own thoughts and beliefs so that you can know what to put aside when you are working with patients. I do my best to put my own baggage aside, and I want to help as much as I can in the limited amount of time I have with these people.

So, I color and make collages, and encourage these very emotionally frail people to share with me the darkest corners of their minds, in the name of therapeutic communication.

And after this semester, I never want to do it again.