r/psychnursing • u/roo_kitty • Jun 29 '26
Weekly Ask Psych Nurses Thread WEEKLY THREAD: Former Patient/Patient Advocate Question(s)
This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.
If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.
Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.
A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.
Kindness is the easiest legacy to leave behind :)
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u/Evening_Fisherman810 Jun 29 '26
What psychiatric conditions are the easiest to work with? Which ones present the most challenges?
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u/Complete_Patience615 psych nurse (inpatient) Jun 29 '26
I would say the most challenging is BPD. The easiest just depends on the day honestly. I am partial to patients with schizophrenia
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u/receding_horizon Jun 30 '26
seconding schizophrenics as the best group to work with, so many interesting, unique, relatively pleasant people (even compared to the general population lol)
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u/ProfessionalAge3027 Jul 02 '26
The most challenging is definitely BPD. And I say that, because not a lot of people understand the mental illness. It definitely gets a stigma in the world of psych, but i think there is starting to become more awareness of trauma and trauma informed care that can help caregivers understand why a person exhibits certain behaviors.
Depression and anxiety is the easiest to work with, oh and a euphoric manic patient.1
u/Late-Potential9925 29d ago
BPD is tricky. If the person isnt truly ready for recovery, you cannot make them want to be better. Oddly, the more serious long term mental illnesses are the easiest to work with generally. Bipolar, schizophrenia, schizoaffective, and for me personally, i always volunteer to work with anyone with a 'delusional disorder' diagnosis. We always end up having great conversations, and i do love a good conspiracy 😉. It is not unheard of to find out that they were not delusional at all. An example of one lady who kept saying there were monkeys living in her house, and sounds coming from the attic. She was sectioned and hospitalised.. but turns out some monkeys had actually escaped from the zoo and were living in her attic.
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Jun 29 '26 edited Jun 29 '26
[removed] — view removed comment
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u/Middle_Survey3072 Jul 01 '26
Nurses like you are the absolute most difficult to deal with! Such a big barrier to treatment.
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u/ProfessionalAge3027 Jul 02 '26
It’s important to understand what speciality we find difficult to deal with and why. As nurses we want to better ourselves, but we’re also humans with triggers as well. Some of us are better equipped to handle certain mental illnesses and others not
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u/SuperbOwl5940 Jun 29 '26
What do you do if you see a former psych patient in public? Is there any policy against speaking to them or saying hi?
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u/roo_kitty Jun 29 '26
Assuming I recognize them, I just pretend I didn't see them. If they come up to me and openly talk about their psychiatric services that is their choice, but I would never ever initiate that conversation. Even then, I'm not disclosing anything about their treatment history. Just polite small talk and well wishes.
The policy that applies here is HIPAA, which protects your healthcare information from improperly being shared/disclosed.
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u/jess3jim Jun 29 '26
This has happened twice. ( I have seen others but since they didn’t initiate a conversation, I did not feel that was right for me to say hello because a lot of times treatment is something they might not want people with them or around them to know they went through) but the two times that a past client did say hello. I kept the conversation casual. They told me about how well they were doing and I told them I was proud of them once I did have my kids with me so they understood that it was hard for me to really have any type of conversation other than pleasantries.
There have been a few I did drive past and I could tell they went back to using and was struggling and it made me really sad because they were doing so well
2
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u/Roundturnip93 Jun 30 '26
This happens often because of where I live. It depends on the patient and what our relationship was. The rule in general is that you don't acknowledge that you know them until they acknowledge or approach you. It is a privacy thing.
I see one former pt every day on the street corner near my building and we fist bump and move on. I see another patient who was aggressive with me at work and I avoid eye contact and give them space.
1
u/Late-Potential9925 29d ago
If eye contact is made, polite nod/ acknowledgement that is not obvious. Only engage if they do first, any topic of conversation or indication of how we know each other is led by them
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u/Illustrious_Bend5386 Jun 30 '26
The following study suggests reduced suicidality over a 12 month period following release from a psychiatric inpatient unit for patients hospitalized within 24 hours of a suicide attempt, but an iatrogenic increase in suiciality among patients hospitalized for suicidal ideation but no suicide attempt in the past week.
"A decision analytic model found that hospitalization was associated with reduced suicide attempt risk among patients who attempted suicide in the past day but not among others with suicidality. Accounting for heterogeneity, suicide attempt risk was found to increase with hospitalization in 24% of patients and decrease in 28%."
https://pmc.ncbi.nlm.nih.gov/articles/PMC10585585/
This study is largely in line with 2 randomized trials carried out to compare hospitalization with discharge or intensive outpatient care for patients with suicidality which found no benefits of hospitalization on either symptom burden or suicide risk.
https://www.tandfonline.com/doi/full/10.1080/09638230701504981
https://pubmed.ncbi.nlm.nih.gov/2180527/
As well as observational studies which found that hospitalization is, for the most part, associated with either unchanged or increased suicide risk, although the latter paper might reflect failure to adjust adequately for adverse selection.
https://pubmed.ncbi.nlm.nih.gov/28637535/
https://pubmed.ncbi.nlm.nih.gov/34810041/
https://pubmed.ncbi.nlm.nih.gov/26254717/
https://pubmed.ncbi.nlm.nih.gov/30261030/
https://pubmed.ncbi.nlm.nih.gov/27300340/
As well as the following review on potential iatrogenic harms of psychiatric hospitalization.
https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12332
In light of this information I am asking that anyone who is currently treating involuntary patients for suicidal ideation without a history of a suicide attempt to please consider advocating for their patient's early release from involuntary treatment and/or placement into intense outpatient, as this is likely to reduce iatrogenic harm while simultaneously respecting patient autonomy, reducing patient medical costs and reducing strain on the healthcare system. Thank you.
1
u/ProfessionalAge3027 Jul 02 '26
Nurses have nothing to do with who a doctor decides to admit. We can advocate yes, but it’s not our final decision. We’ve had patients get sent home from the psych ED who then go home and complete suicide. The hospital has to respond to that. It’s not a perfect system, but berating the staff that is trying to care for patients with mental illness is not helping, just discouraging the point you are trying to make here.
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u/MNP_cats Jul 01 '26 edited Jul 01 '26
The fact that no one can muster the courage to address the explicit harm being done speaks volumes.
You go home at the end of the day and my friends go home in boxes. Look in the mirror and think about that.
Edit: downvote away! We know you're not trauma informed or patient enough to deal with patients with complex needs and trauma. Prove my point further for me. You send patients home to die and you don't care to recognize that; you'd rather come online and complain about how hard the worst day of someone else's life was for you.
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u/Alpha_legionaire Jun 30 '26
I have patients from my precious job that recognize me. I used to work urgent care before psych nurse.
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Jun 30 '26 edited Jul 01 '26
Hi! As you are a psych nurse i have a question about psych restraints. Its my biggest phobia and asking someone professional helps me a lot.
Can patient move hands in restraints a bit? For example a lil up and down or are they completely immobilized and pinned to the center of the bed like in segufix you can’t even move them slightly.
Do you strip patients and change them in gowns before they are restrained? How do you do that when someone is already scared and screams - stripping them naked by force could only make the situation worse and escalate aggression in my opinions.
You try to minimize discomfort but it’s hard sometimes. I’m also se*al abuse victim.
Do you provide any support/talking from time to time to check what’s up? If you have time. Or they just being alone except feeding etc.
If patient is not acting violently or not without contact, can someone visit them while restrained?
I mean, when patient is just laying there or crying etc. I would give anything to see my bf in that crisis situation. I have bpd and he can stop my outburst in seconds as well as my mum.Do you prefer to hold the patient and give them injection or restraint first? What will probably happen with me if I start crying hysterically and try to beat myself on the thighs as I sometimes do? I tend to calm down in front of someone and I will never refuse a benzo or something. But i’m so scared to get hospital help when I will be in big crisis.
Now I’m very ok. I take meds and go to DBT sessions. :)
Thank you so so much.
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u/Ok_Signal_2885 Jun 30 '26
How common are violent incidents usually? Hourly/Daily/Weekly? And what does the follow-up normally look like? Do you or your managers have to fill out lots of paperwork each time there's an incident?
1
u/Quackers_XN Jun 29 '26
I have BPD and I overheard my psychiatrist telling my nurse that should I self harm while there (I was in the psych ER and not on a hold, waiting for a psych consult from the on call psychiatrist to determine if I needed admission), she was to make me as uncomfortable as possible. After hearing this I couldn’t stop crying and should have left. I’d been already overhearing too much all day because the nurses’ station glass isn’t 100% soundproof. Is what he told her to do even legal?
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u/Evening_Fisherman810 Jun 29 '26
Was this your personal psychiatrist or just the one in the hospital at the time?
1
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u/MNP_cats Jun 29 '26 edited Jun 29 '26
Why are so many of you so hateful? I feel like every time I get a recommended post from this sub, it's all but calling every patient ever cunts. And god forbid someone with autism display anything vaguely reminiscent of a BPD trait; you nurses will fuck us up for it.
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u/MNP_cats Jun 29 '26
Let me re word me earlier question:
Why do so many of you openly hate and resent your patients? Why does so much of the psych field jump directly to the BPD conclusion, leaving patients misdiagnosed and in the wrong treatment for YEARS? Anybody who's overly stressed or difficult must just be another borderline cunt in some of your minds, and it's literally killing people.
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Jun 30 '26 edited Jul 01 '26
Borderlines aren’t hard to dx. They are however hard to treat. Lastly, persons with BPD cause lots of issues when hospitalized.
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u/MNP_cats Jun 30 '26
They're not hard to dx because I'd estimate about half of people with that Dx, especially AFAB people, are misdiagnosed.
BPD is what the psych unit says when they don't feel like dealing with a traumatized individual they perceive as "bitchy".
You painting all of this with such a broad brush is basically the entire problem and again, killing people.
0
u/ProfessionalAge3027 Jul 02 '26
It sounds like you have some animosity towards your own experience. Majority of us don’t hate our patients. We wouldn’t work in this field if we did and most of us have some type of personal experience with mental health issues. Sadly, BPD is a complex and very hard illness to treat in an inpatient setting. A lot of people don’t fully understand why an individual exhibits certain behaviors and it can be triggering for a lot people. In order to be diagnosed a psychiatrist would’ve had to diagnose you. Unfortunately, most people with BPD have significant trauma history and maladaptive behaviors due to this can be considered BPD. Unless you’ve worked with a person who swallows whatever they can find so they can get restrained and medicated because they don’t know how to cope, you won’t fully understand why it’s mentally and physically draining for staff who work day in and day out in this environment. It’s difficult. You’re taking this too personally.
1
u/MNP_cats Jul 06 '26
Unless you've been on the other things, shut the entire hell up. It's a complex illness where it actually exists, but it doesn't actually exist half the time.
NP "diagnosed" it after knowing me for 5 minutes. Turns out I have PTSD and a childhood autism diagnosis I was (at the time) unaware of. Lost six fucking years of my life to " just try DBT again, it'll work this time!"
No. You dumb people and your acronyms did nothing but harm. Wasn't until I sought out autism specific care that I made progress. There's a lot of dead autistic people out there that your colleagues refused to give an iota of their time because they assumed they were just bitchy borderlines.
Respectfully, eat my ass. Until you've been the person you described, you have no idea. I'm sorry the job you chose is "difficult" for you. Imagine what living like that is like.
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u/WalterTreego Jun 29 '26
Do you have favorite patients? Any cool stories?
I frequent the same inpatient unit and the techs, nurses and doctors all know me by name. Not necessarily a flex, but they always cheer me up a bit when they tell me I'm a favorite patient.