[ladylikeRN]

I am a RN and will be working contingent at a child/adolescent psychiatric hospital on a 54-bed unit that is usually staffed with three RN's, two of them being medication nurses. Can anyone give me any tips or info on what to expect in these type of facilities? I have worked in a pediatric hospital before, with some psych cases, but mostly med-surg. I start my orientation next week but just wanted some insight from psych nurses who have worked with this population in psych nursing.
Thanks

[medpsychRN]

I guess you can try it out. There isn't enough staff for 54 patients. Our ratio is at the highest 6:1 (RN- not including support staff).

[aloevera]

I agree, I don't like the staffing ratio...I worked at a private, psyche hospital on the adolescent unit...
If I had 1-5 pts. there would be me, (RN) and one MHT (tech)
if I had 6-14 pts. I would have at least 2 techs and possiblly more depending on the acuity of the pts. If I had any LOS, I would then have extra techs. These children can be so labile, one minute appear sad and depressed, quiet, then next minute be an outburst of anger/frustration, expecially during visitation with parents, or afterwards. You need to be very careful and ask a lot of questions as to how they handle their line of sights, is there a quiet room?
You didn't mention how many mental health techs you have, that is crucial....they are you major support system.....with 54 pts. I would hope that you have at least 7-8 with you and the other nurses.
I can't imagine that many adolescents on one unit. The most we have is 15, then we close the doors.
Hope all goes well with you, it is a very rewarding experience, I find.

[ladylikeRN]

Thanks for both of your posts. The PCS (techs) are said to have about 8-10 pts each amongst the 45. The other issue that I have is that the PCS gives the discharge instructions to the parents, even outlining meds that the pt goes home on. To me, this is something that should not be delegated. Also, the PCS techs does the initial assessment of the pt. before pt is admitted on unit by checking for marks, cuts, and.or any previous harm to self or by abuse. That makes me uncomfortable also. I will give it a try as the hospital oreintation is still going on and I go on the floor tomorrow. I hope I like it. However, the place that does the drug screen for this hospital giggled when I came in because they told me that they hire people there left and right. My boss even told me beforehand that there is a high turnover of nurses there because they don't like the psychiatric setting.

[aloevera]

No, I never heard of the techs doing discharges. I do them. I can't imagine how they handle the med questions that I receive from the parents quite often. The techs do the initial searches of the pt. upon assessment but I do the body checks for injuries, cuts, etc. along with my assessment. 8-10 pts. is a lot for one tech (especially if you have any line of sights.) See what happens, how things work, then you can maybe give some input as to how things might run smoother.
Good luck.....(we, to, are having staffing problems at present)

[ladylikeRN]

Thanks, I am trying to see what will happen here as I try to stay positive. My intuition is telling me to be leary though. This unit has a lot of new staff and the staff here does not seem to be very interactive with newbies. Another new co-worker and I were viewing charts until we toured the unit with the manager and most of the staff there did not even say hi or anything. It's weird. The manager then toured the unit with myself and the other new RN and paid more attention to the 40 hour a week RN than me since I am contingent. The manager even told me well I will see you whenever (because I do not have my other facility's work schedule until next week). Wish me luck and prayers..if this place does not work out, then I will stay on the unit at my part-time job.

[chaney123]

I've read all of your replies...I agree with everyone. I've worked in Adolescent facilities for about 15 years now...most of our facilities let the techs do the body checks but the nurses always do the discharges. The key to a successful unit is at least 5:1 staffing ratio with the majority of your staff being mental health techs, and a very structured environment. The strength of your unit is only as strong as your programming. A good behavior management program is key and consistency among all staff among all shifts is extremely. I've worked with adults and adolescents and now am a nurse manager for an adult and adolescent facility. We spend alot of time building a strong team among our employees - which is especially important with the adolescents in a "Code" situation (an agitated patient). If you don't feel that attitude on the unit you are working - it may be detrimental in the end. Good luck to you...if this place doesn't work out, don't give up on Child and Adolescent Psych...it's a very rewarding career choice!

[ladylikeRN]

Originally Posted by chaney123

I've read all of your replies...I agree with everyone. I've worked in Adolescent facilities for about 15 years now...most of our facilities let the techs do the body checks but the nurses always do the discharges. The key to a successful unit is at least 5:1 staffing ratio with the majority of your staff being mental health techs, and a very structured environment. The strength of your unit is only as strong as your programming. A good behavior management program is key and consistency among all staff among all shifts is extremely. I've worked with adults and adolescents and now am a nurse manager for an adult and adolescent facility. We spend alot of time building a strong team among our employees - which is especially important with the adolescents in a "Code" situation (an agitated patient). If you don't feel that attitude on the unit you are working - it may be detrimental in the end. Good luck to you...if this place doesn't work out, don't give up on Child and Adolescent Psych...it's a very rewarding career choice!

Thanks for your response, I think that I will follow my "gut" intuition and resign from this place because my intuition tells me that something is not right there. Also, they tell me that the afternoon is very busy but staffed with mostly new staff. The co-workers seem very standoffish and now I can see why other staff have ran away from working here. The staff here complains about the parents of the children as if it is some big deal. I worked peds but not psych, so I know that parents need that extra comfort level because it's their child for heaven's sake. I just have a more laid back, non-judgemental attitude and I don't fit here. I am also worried about my license because during the non-violent crisis intervention workshop, several moves were deemed grounds for firing staff. The guy just kept saying "if you do this, then you get fired". I have no clue if I will be able to defend myself while trying to calm an agitated patient in a way that does not appear to be mistreatment. I will try another child/adolescent psych facility. Wish me luck! Until then, I will continue working my telemetry unit until I find another child/adolescent psych unit to go contingent at.