When I was a brand new graduate nurse, I wanted to get a good grasp of my new nursing skills and wanted my first job to provide that for me. I wasn’t sure if I wanted to go into a specialty or a position that would overwhelm me, like ICU. I decided to take a job on a Medical-Surgical floor. On the unit, I saw gastric sleeves, amputations, kidney stones, cellulitis, cancers, COPD, etc. and was able to practice and become efficient in several skills. The one thing I didn’t realize was the amount of psych I would see on a Medical-Surgical unit.
#1 They are patients, not a diagnosis.
First and foremost, when given a report and the patient has a psych diagnosis, do not automatically assume the patient. There is a wide range of patients, and not all of them will act like the textbook version of their diagnosis. Most patients, if not told, you may not even know that there were any psych issues at all. Learn to turn off your bias and treat the patient, not their diagnosis.
#2 Listen to the patient, don’t judge, and be self-aware.
This point, kind of, goes back to the first point. Think of it this way; if the first point is how you should think, then this one is how you should act. When interacting with the patient, listen to them. So many patients feel the hustle-and-bustle of the day. Everyone running in and out of the room with an agenda, no one hears them. I know that not every shift, you can pull up a chair and have a heartfelt conversation with every patient. But if they start a conversation, that could be them reach out to connect with one of their caregivers. A conversation just needs a few minutes to hear them out. While interacting, be self-aware of your face, tone, and body language. Keep in mind the type of message your sending to your patient. Being honest, friendly, and present will give you a lot more respect for your patient, and as I write this, I realized, take this point into each one of your patient’s rooms.
#3 If you feel uncomfortable, bring back up.
Okay. I know what you’re going to say, but what about the first two points. The majority of patients are not violent unless you work with a specific population. But, violence towards nurses is a thing. As someone who has been grabbed, scratched, and kicked in the head by someone in restraints. If the patient has a history of violence towards staff, or you see the situation escalating, or the person is acting or saying inappropriate things, either in a violent or sexual nature, bring in another staff member. I have had patients who known to grabbed at nurses and staff. I have seen co-workers go to the emergency room for bites, scratches, knife stabs, both butter knife and one they snuck in, punching, kicking, and spitting. If this is the patient you have, or your gut tells you this is a potential outcome, talk to your supervisor and coordinate with another staff member to go in with you. Keep the door open, leave an open path to the door, and be safe.
So even though I don’t work on a psych unit, you will come across a diagnosis fairly common among your patients. Keep in mind the way you think about the patient, the way you act, and come across to your patient, and if you feel uncomfortable, be safe and bring back up. Has there been a time you were completely wrong about a patient?