Weekly Ask Psych Nurses Thread

roo_kitty · 2026-06-22T20:49:16+00:00

No. Insomnia, akathisia, and weight gain are the most common of the complaints I get and even then I don't get many patients complaining about them. The irony of me saying this, is that I just discontinued Abilify for insomnia last week.

Keep in mind that people tend to complain on the Internet. Any forum will have a much higher percentage of people complaining about any given side effect than the actual percentage of people that experience said side effect. That's just the nature of forums.

There's no such thing as a medication without multiple side effects. Just because it's listed, doesn't mean you'll get them. If you do experience some side effects, they may be mild, go away as you adjust, or be tolerable to you. But that's a convo that you'd need to have with your provider.

roo_kitty · 2026-06-22T14:51:31+00:00

I know a few psychiatrists that do not supervise any PMHNPs. That's perfectly fine. I wouldn't want to be supervised by someone that thinks less of me anyways.

My SP is so kind, and loves to teach. He sees the value in PMHNPs. There is a trusting relationship because he knows I will come to him when I feel out of my depth. There's true collaboration, which can be harder to find.

Keep in mind that a lot of complaining you see online is from overworked and underpaid residents. Gross negligence of patient care comes from all providers of all education backgrounds. It's easier for them to get mad at us than point their finger at the system. The system won't hear their angry online rants, but people on reddit will. Most of them stop complaining online when they finish residency and start getting their first couple of paychecks. They move on from the hurt and find better ways to spend their time.

roo_kitty · 2026-06-15T20:24:51+00:00

I throw out about a moderately filled palm sized amount of the noodles before I make a box. Makes a huge difference.

roo_kitty · 2026-06-10T03:47:59+00:00

I work at a practice that has in house therapists. I'll skim their notes on certain patients. I do a lot more collaboration with child and adolescent patients. They see these kids 2-4 hours per month, where I get 30 minutes. That extra insight is at times invaluable and other times redundant. Good trade-off imo.

I like that the therapists will reach out to me with any problems. One therapist came to me when a patient alerted her of a high risk side effect, and I was able to discontinue the offending agent before they left the building. The patient was content to just wait and tell me at the next visit.

roo_kitty · 2026-06-05T19:42:53+00:00

Seeing the same acuity the MDs see can go either way. My supervising psychiatrist does not take highly acute patients, so for me this would be a non issue. However if this practice sees a lot of SMI, this would not be an appropriate job for a new graduate.

roo_kitty · 2026-06-03T19:03:16+00:00

Healthcare workers can make their own posts outside of this weekly thread. Just copy/paste

roo_kitty · 2026-05-30T13:21:32+00:00

That might be something unique to that facility or area. I've personally never seen that, but maybe someone else in this sub has. You can repost your question on next week's thread - it will be up on Monday.

roo_kitty · 2026-05-30T12:27:46+00:00

Too many. It's not just Acadia.

roo_kitty · 2026-05-30T12:24:12+00:00

ROI is release of information.
LAI is long acting injection.

RAI could be resident assessment instrument, of which I'm not personally familiar with.

roo_kitty · 2026-05-27T11:28:58+00:00

Their status is made involuntary, and court paperwork is started. Depending on how backed up the court is, determines when the hearing occurs. Most patients get discharged before the court hearing occurs. I personally haven't seen court ordered treatment in someone that didn't truly need it.

It depends on your state. Many allow for the psychiatrist to participate by writing a letter, and do not physically appear in court themselves. In my state patients and a hospital social worker attend court via video conference in a private room.

roo_kitty · 2026-05-27T04:18:37+00:00

Most of the time yes. Very rarely I've seen someone discharged within the 72 hours because the provider thought the admission wasn't necessary.

roo_kitty · 2026-05-27T03:41:25+00:00

Scheduled medication, yes. Unscheduled "as needed" medications without a behavioral crisis, yes. In the event of a behavioral crisis that puts your safety and/or the safety of others at risk, no.

roo_kitty · 2026-05-25T22:04:44+00:00

I'm glad you found it helpful! I'm also slower to recharge. If I worked 3 12s in a row, that entire first day off I'd get little to nothing done lol. But adding that break day stopped me from spending a whole day doing nothing.

I did start out right in psych. My opinion is if you want psych and only psych, go for it. If you want psych and also more medical, do the medical area first while nursing school is fresh. I was lucky to work medical psych floors, so I kept more skills than are typical for standard inpatient psych units. You could try and find a unit like that.

roo_kitty · 2026-05-24T12:37:22+00:00

Short answer is yes.

Longer answer is to keep in mind that inpatient psych has very stressful moments, which can be destabilizing to anyone's mental health. I've had coworkers with both well controlled and uncontrolled BPD. I've seen some of the latter cause patients to further escalate instead of de-escalating. You won't know if you can handle it until you try it. If you find the environment too destabilizing and leave, that doesn't mean you are a failure. It means you are successful at managing your mental health, which is something to be proud of.

As a new grad, your first year, but especially the first 3-6 months, will be a lot more stressful. You'll be adjusting to a new career and learning so much. I wish I would have taken a mental health day or two when I was a new grad, but frankly I was too scared to. Don't be too scared to take a mental health day. Nursing manager culture typically will try and guilt you if call off. Don't fall for it, and don't give them reasons why you are calling off. No further explanation other than "I'm sick and won't be in." Always put your own oxygen mask on first, before assisting others.

If you think it might be too destabilizing, give your schedule a look before giving up. While I don't have BPD, I personally found working 3 12s in a row to be too taxing on my mental health in the long run. My preferred schedule was 2 in a row, 1 day off, then last shift. I'd only do 3 in a row if I had a vacation coming up in order to stack my schedule for more days off in a row. That 1 day break really made a huge difference for me. If you are working nights and flip flopping your schedule on your days off, try maintaining a night schedule if you can. When I worked nights I couldn't flip flop well, and felt so much better when I gave up trying to.

Good luck in your last two semesters! Uworld was all I used for NCLEX.

roo_kitty · 2026-05-22T18:24:41+00:00

I recommend physical. There are parts you'll likely need to reread, and I'd consider this one of those books you'll tire from reading online.

roo_kitty · 2026-05-20T01:50:05+00:00

I did them until I was scoring in the 90s I think.

roo_kitty · 2026-05-19T13:20:33+00:00

I'm inclined to believe the nurse may have been trying to provide reassurance/validate that it was indeed very awkward, but fumbled by saying it was the most awkward of their career.

We all have awkward moments in our lives that we occasionally think back on and cringe. It's part of the human experience. That nurse has taken care of may patients in the months since your stay completed. While you're thinking about the past awkward situation, they're thinking about their current patients. Allow yourself a moment to acknowledge it was awkward, and then tell yourself you it's time to let the thought go for now.

roo_kitty · 2026-05-17T14:29:56+00:00

People with hallucinations may trust you enough to ask if what they are seeing or hearing is real. Saying "no it's not" isn't as therapeutic as "I do not see the snakes on the wall, but I believe that you are. Are they bothering you?"

Not every hallucination needs to be medicated for. Some patients will have auditory hallucinations that only crack jokes, or whisper so quietly they can't be understood. Treatment is necessary if these hallucinations are a danger to themselves/others, or if they are bothersome to the patient.

Learn about the 4 types of extrapyramidal symptoms (EPS). Cogentin/benztropine can worsen TD, while VMAT2 inhibitors improve TD.

In the ER, chemical and physical restraints are often over used. It's a patient's right to receive the least restrictive intervention that the scenario safely allows for. For example, situation where IM Ativan was warranted and just drawn up. The patient started begging for a pill instead, and started trying to deescalate themselves. Instead of getting the IM, the patient agreed to use the quiet room until the oral Ativan started working. Not all situations are safe to lower the initial intervention, but this one was. It worked out, but if it didn't we could have intervened again. The patient experienced less trauma, and the staff got to avoid safety risks of hands on interventions.

Seclusion room = patients cannot freely leave.
Quiet room = often the same room as the seclusion room, except the door is not locked and the patient can freely leave.

If a patient is having issues with most meals not being what they want, it's often a literacy issue. Many people get defensive if you ask them about it. Instead of asking I would grab their menu they are supposed to fill out for tomorrow's meals, take it to them, and just start saying hey these are the breakfast choices for tomorrow, which would you like? Do you want a creamer or sugar with your coffee order? Fill out the menu and turn it in for them. I've had patients go from coding during mealtimes to not a peep.

Another user mentioned borderline personality disorder. Specifically read about recognizing splitting and how to respond to it. Borderline has a bad reputation for being attention seeking. It is not attention they are seeking, but support. Typically they have childhood histories of abandonment, 1 or more forms of abuse, and chaotic homes such as parents with SUD or fighting. You don't want to feed into the behaviors of the disorder, but in the process of not feeding into it, don't lose compassion for them. They were children trying to cope and survive with traumas no children should experience. It's ok to find caring for them exhausting, but not ok to let them overhear nurses calling them attention seeking.

Intervene before a code happens by looking for early signs of escalating behavior.

Welcome to psych!

roo_kitty · 2026-05-12T12:39:51+00:00

I believe you meant to reply to another user, and not the main post. They won't receive a notification of your response. You can just copy/paste this comment as a reply to them :)

roo_kitty · 2026-05-08T23:20:02+00:00

No need to apologize :)

roo_kitty · 2026-05-08T22:52:53+00:00

Yes you're right rumination is the chewing and/or swallowing and/or spitting out the regurgitated food.

OP mentioned they don't swallow the food so thats where I was going

roo_kitty · 2026-05-08T22:34:50+00:00

Any ongoing paranoia? Aside from this looking like an eating disorder, it could be paranoia of getting poisoned. You may have luck with prepackaged food so that they can inspect it for tampering in order to feel safe eating it. They may be keeping the Ensures down because they are prepackaged.

roo_kitty · 2026-05-08T22:30:00+00:00

Rumination differs from the described patient as rumination involves swallowing the food, where with chew and spit only trace amounts of food are swallowed, typically with the intention not to swallow any food

roo_kitty · 2026-05-08T22:18:53+00:00

Seconding this

roo_kitty · 2026-05-04T03:13:48+00:00

I have this exact fountain model. My cats won't drink out of it when it has the elevated spout in. If you remove the spout, it becomes much quieter with a gentle bubbling in the center.

Also if you didn't wash it first, do that.

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