Three Lessons From a Psych Nurse to Make work Better

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Psych: NOT like the movies!
Psych: NOT like the movies!
Let's learn more from each other!
Let’s learn more from each other!

Some nurses aren’t very comfortable with psychiatry: the providers or the patients.

It’s not surprising, really: many people in all walks of life seem to think that way. It’s an area of life that remains a deep mystery to lots of people. In a similar way, some nurses and others seem to feel that psychiatric nursing, is different from the rest, something ‘else.’ Some folks worry that ‘psych people’ secretly analyze and judge them the way other nurses, I’m told, obsess over veins. People seem to imagine it’s 1950 still, when Freud ruled, symptoms (they thought) reflected deep unconscious ‘conflicts,’ docs with pipes asked folks on couches to “tell me about your about your mother”, that kind of thing. When folks imagined big tough guys in white and an ambulance around the corner, in case “we decide it’s in your best interest…” Scary!

Thankfully psych has come a long, LONG way since then. What can a psych nurse teach nurse in other specialties? LOTS, actually! Lots of useful tricks and tools that can make any nurse’s work easier and more fun. Let’s stick to three examples for now. Nothing Freudian, I promise! Nothing about mental illnesses or treatments at all:

1) In an emergency, bend your knees slightly. Keep your feet shoulder width apart.

Why?

Consider the alternative: feet together, knees locked, the way most people stand most of the time. You’re really easy to topple in that stance, and if you suddenly need to move, you have to bend your knees first. It’s a brief delay, but enough for you to get kicked, or a patient to fall or pull out their IV before you can intervene. Emergencies demand quick responses.

Bent knees, feet apart: this stance offers a stable base, harder to topple and quicker to move. It builds confidence when you need it, helps you stay calm, think clearly, make quick decisions, and stay in control: less apt to react impulsively and inflame a patient at the worst possible time. This simple stance reduces the odds of violence, AND makes you much safer.

Practice! It will only take a minute. Slide sideways a step as quick as you can, once from both stances. Notice how much quicker you are with the right stance.

BONUS POINTS: Don’t jump up, it’s a waste of energy, slower, and clumsier. Simply push-off with one leg, and push up with the other just enough to take your weight off the floor. You can slide that way, quick and easy, further than you might think. One step can easily take you well out of reach of an aggressor, in any direction you choose.

Remember: in an emergency, knees slightly bent, feet apart!

2) Consider the patient’s point of view. The more you do so, the easier and more pleasant your work.

Nurses and physicians typically think educating patients means offering facts. Health care training largely ignores how to teach, persuade, motivate, build trust and confidence, so folks lean on long-obsolete tactics like leading with facts. They simply don’t know any better.

If provider is right and the patient is wrong, then provider tells them so and expects them to agree. If they don’t, it indicates a patient flaw: pathology, resistance, or some such. The problem is, that’s simply not how it works, not at all! Hence the frequent failure to motivate and educate our patients. Hence the dismal treatment adherence we all see (if we look). Leading with facts is an extremely ineffective way to persuade, motivate, or teach. In sales, they call people who work this way “poor” or “unemployed.” In health care, we get paid the same if we succeed or fail to persuade, but I promise you, success is far more gratifying than failure, and effective tools offer easier work and more fun.

To improve your results, start with the patient’s point of view. Ask for it! Imagine their experience, and ask them if you’re right. Others often have a very different understanding of a situation than you do. What they known, think, and FEEL can save you far more time than they cost. Remember, feelings usually precede thoughts and decisions. Build trust, rapport, and comfort – Put THEIR point of view first – and you’ve made your job FAR easier for the duration. Put YOUR needs and ideas first, and you’ll pay for it. I see it often, people inflaming others and getting burnt, kicked in the shins – miserable!

3) Most of the things that agitate psych patients have nothing to do with their illnesses.

Impaired impulse control often makes people ACT on their anger more readily. What gets them angry, though? Research to date on agitation and violence in hospitals suggest that unit features are the best predictors of violence: temperature, noise, arbitrary or inconsistent enforcement of unit rules, perceived disrespect, waiting, etc. If you want to prevent violence, focus on the factors that cause it. Most of the things that aggravate and trigger patients are the same sorts of things that aggravate and trigger anyone. Also, much violence is a form of self-defense – as the patient sees it. Point of view, remember?

4) BONUS: People with psychiatric illnesses are vast in number – tens of millions in America alone – and they use more health care per person than average. Not just psych care, ALL kinds of care. What does that mean to you?

Simple: in health care, psych is everywhere. EVERYWHERE! Forget about avoiding it. You can’t. The sooner you get used to it and learn how to deal with these people better, with ALL people better in fact, your work life will improve, and you’ll become a better nurse. Ignore it and you’ll pay dearly throughout your career. Your call!

To sum up:

Smart is better than dumb.

More effective is better than more of the same.

So remember:

1) Bend your knees, feet apart.

2) Consider the other’s point of view.

3) People get angry because something angers them.

4) Psych is everywhere! Knowledge is power…

2 comments

  1. It is a relief to know that psych has come a long way. Unfortunately in Arizona where the wild wild west still prevails. It is not the case. But as far as the Board s abuse and for the dumbest reasons!, AND they ordered so many they got their legislature croonies to change the law , (before they went broke ) to order the nurse , CNA , LPN to pay for it. ~~~$1400. Unfortunately, they have a pattern and they kept using the same pattern probably because it worked, then the abuse of power they were 10 foot tall and bullet proof, cactus proof, rattlesnake proof Only in their own minds, But then along came MAry……………………….Eue euuuuuwwwww .

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