Hospitals are their own worlds, and psychiatric units even more so. Most of us don’t know much of what happens in these mysterious places, leaving us to pop culture and our own imaginations to try to figure it out.

For example, will these units be like Girl, Interrupted, or look like one of Carrie Mathison’s hospital stays on Homeland?

Psychiatric units are generally locked, but you, dear reader, have the keys – and you’re headed in. Here are six tips they don’t teach you in school.

1. Get the Right Gear

Good Shoes

Wear shoes that you can move quickly in and that cover your toes. We’re not physicians, so there’s little danger of something like a scalpel falling like there may be on a surgery unit. All the same, toes matter, so show your feet some love and protect them.

Lanyards

One of the first things you’ll get as a trainee is a set of keys, and you’ll need somewhere to put them, because you may have quite a few. If you’re a guy, you can put them in your pockets – lucky you. Regardless of your clothes, you’ll also need to display an ID badge, and you may want to wear it – and your keys – on a lanyard around your neck.

Here’s what not to do: don’t use the single-loop solid lanyard you got in college. Solid lanyards could easily be used to block your oxygen supply, and they wouldn’t be safe for a patient to have, either.

If your hospital doesn’t provide you with a safe way to display your ID or wear your keys, look online for breakaway lanyards, which have plastic interlocking attachment points that separate when pulled. My favorites have three breakaway points. If your alma mater does make breakaway keychain lanyards, that’s amazing.

Insider Tip

These same safety principles apply to jewelry and clothes. Don’t wear something to the hospital if you would be sad to see it damaged, or if it could cause you injury.

2. Stock up on Little Things that Make Your Day Easier

Don’t think twice about getting the supplies you need to stay organized, whether it’s your penchant for post-its or your seven-pocket folders. Bring what you need to help you care for your patients and learn as much as you can.

A Note on Black Pens

Some hospitals require that chart work be completed in black pen only, and these pens are usually in short supply. Find a black pen you like and buy a few. I like retractable pens because you can hook them onto your lanyard without worrying about losing the cap. My personal favorite is the Pilot G2 Retractable Gel Ink Rolling Ball – and no, they don’t pay me to say that.

Insider Tip

A clipboard can be helpful for jotting down intake notes, organizing loose documents, and it can give your supervisor an easy way to sign off on paperwork quickly.

3. Remember Those Keys

We just talked about them, and they’re critical. Keys are one of the few supplies you’ll need to physically do your job.

You may use your keys to get past two sets of locked doors to get onto the unit. You’ll use them to unlock individual treatment rooms, to re-lock group treatment rooms when you’re finished, to unlock the door to get into the nurse’s station and re-lock it behind you, and then to unlock the door to get out again and re-lock it behind you.

If you’re the kind of person who can never pick out the right key, or who can’t get the key to go into that lock just right, rest assured: after this year, you’ll be a key expert for life.

Insider Tip

If you have tricky keys, practice early and often so you can get through doors with confidence and efficiency.

4. Look Before You Leap

Inpatient units can become heated, and on rare occasions, a patient may have a physical outburst. Your job is to take the temperature on the unit as soon as you walk in. In fact, if there are windows that let you see onto the unit, use them to survey the scene first.

Is anyone’s behavior particularly erratic? Is someone unusually angry? If yes, the oxygen mask metaphor applies: first take steps to keep yourself safe, and then if you’re comfortable, take steps to keep the patients safe – like helping everyone get into an area away from any unrest.

Insider Tip

If you were given a panic button, test it with the safety department to make sure it works. If you don’t have a panic button, bring a whistle. You may encounter situations that are overwhelming, and you might decide to keep your distance to stay physically and mentally safe. There may be other times when you find yourself comfortable intervening in certain conflicts. Over time, you’ll learn what levels of patient conflict you’re comfortable with, and you’ll feel more confident acting accordingly.

5. Learn the Real Power Structure

There’s the person at the top of the totem pole – usually one of the attending MDs – and then there are the people who make the unit run. Sometimes they are the same person, but often that’s not the case. Your life will be easier if you get to know the people who actually make things happen.

If you are lucky, these folks will help you find your way. They know the history behind some seemingly illogical rule, and they know why you definitely shouldn’t sit in that chair. They are the ones who will arrange to save your patient’s meal if your therapy session overlaps with the beginning of dinner, and they probably know where to find the printer paper.

Insider Tip

Hospital hierarchies can be pernicious, so don’t underestimate someone’s institutional knowledge, intelligence, or clinical acumen simply because they have less formal education than you.

6. Tune Into Team Dynamics

Like all institutions, hospitals have their own politics, complete with shifting winds of allegiance, institutional mandates, and interpersonal alliances. The doctors and administrators in charge of the units have their own agendas, sometimes aligning, and sometimes at odds. Each team responds to these systemic pressures differently.

On top of this, each team has its individual members, who bring their own personalities that combine with the institutional demands. It helps to think of your team meetings as a process group. Your training will be easier if you can identify the pressure points and power dynamics at play.

Insider Tip

Recruit your co-trainees to help figure out your team’s unique dynamics: it will help you move among your colleagues – and get your job done – without stepping on any closed-toe shoes.

 

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Lara Friedrich, PsyD

Lara Friedrich, PsyD

Lara Friedrich, Psy.D., recently earned her doctorate from the Ferkauf Graduate School of Psychology, Yeshiva University. She lives in New York City and trained for two years on inpatient units there, with a practicum at a general public hospital and an internship at a state psychiatric hospital. (For grad students confused as Lara once was, NYC Health + Hospitals runs the city’s public hospitals, and the Office of Mental Health is in charge of the state psychiatric hospitals, which in New York State are called Psychiatric Centers.) She is a postdoctoral fellow at Rose Hill Psychological Services and at the William Alanson White Institute.
Lara Friedrich, PsyD

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