Advice for new Psych RN please!

Thunderwolf, MSN, RN · Mar 21, 2006

I would recommend becoming more familiar with the psych terms used in psych assessment...as well as become more acquainted with how to perform a mental status exam. There is literature out there to help you. Go to the book store and buy a nursing psych book which should have most of this to get you started. A good psych drug book would be good if you do not have one.

Mental assessment breakdown/reporting is similarly done as in nonpsych (systems approach).

Affect, Mood, Attention, Concentration, Interaction, Interest, Eye Contact, Energy, Impulse Control, Thought Processes, Perception, Presence of Hallucinations/Distortions/Paranoia/Suicidal or Homicidal thoughts, plan, intent, Appearance, Sleep, Appetite, Problems with meds (side effects)...etc etc. Create your own report cheat sheet to help organize what you need to convey.

Other info which is often relevant is:

Admit status, If a Guardian is involved and who is it, Concerns regarding discharge, Specific monitoring and/or interventions for THAT patient, and Pertinent Labs.

In report, most nurses only want to hear the abnormals, important mental status changes in condition, and response to recent treatment/intervention. Explore this with your peers. It does take a little organization on your part when you initially start. What most nurses do not wish to hear is a report that drones on and on and/or goes off in tangents. Like nonpsych nursing reports, make your psych reporting objective. It will help you stay focused and on track.

finallyanRN · Mar 21, 2006

:thankya: Thank you so much Wolfie--I really appreciate your response and advice! I'm working on familiarizing myself better with psych meds and terminology, along with organization. I have a lot more to learn about this specialty, but I'm excited and loving every minute of it--I just don't want to feel incompetent in the meantime! :uhoh3:

rn/writer, RN · Mar 22, 2006

In report, most nurses only want to hear the abnormals, important mental status changes in condition, and response to recent treatment/intervention. Explore this with your peers. It does take a little organization on your part when you initially start. What most nurses do not wish to hear is a report that drones on and on and/or goes off in tangents. Like nonpsych nursing reports, make your psych reporting objective. It will help you stay focused and on track.

Excellent advice. Also, gather up any flow sheets you have on the unit and make sure you address any abnormal values connected with them.

If you have any down time on your shift, listen to other people's reports and take note of what they say and the order in which they say it. It's good to develop a pattern--the equivalent of a head-to-toe physical assessment--so that you don't miss anything.

Affect, Mood, Attention, Concentration, Interaction, Interest, Eye Contact, Energy, Impulse Control, Thought Processes, Perception, Presence of Hallucinations/Distortions/Paranoia/Suicidal or Homicidal thoughts, plan, intent, Appearance, Sleep, Appetite, Problems with meds (side effects)...etc etc. Create your own report cheat sheet to help organize what you need to convey.

You'll rarely use all of them, but you won't leave any out because you forgot.

Finally, keep track in your own mind what YOU want to know on report. Are there items which you end up having to look for in the chart because they weren't mentioned? Are there omissions that leave you scratching your head and saying, "Gee, it sure would have been nice if someone had thought to tell me that."

Check back with us and let us know how you're doing.

finallyanRN · Mar 24, 2006

More great advice--thank you Miranda!:) I've been studying psych meds and mental assessment information. I'm going to put together a report sheet also to hopefully help me get organized. I really appreciate your response and all the great info on this board--this really is a great resource!

CharlieRN · Mar 26, 2006

In general, I suggest that you give your next shift peers the kind of info you would find helpful yourself. Vital signs and other physical data is pretty useless unless the client has some unusual disablity that must addressed. I would want to know about any dangerous or disruptive behavior and the emotional status of the client. Any limits that have been set, particularly if they have ongoing consequences. The primary duty is to assure safety and these things impact safety. Ask for feedback on if you are giving the info that is needed.

Meerkat · Mar 29, 2006

Don't forget to add if any precautions have changed! (Such as Suicide Precaution I, II or Assault Precautions I,II)

lberghood · Mar 29, 2006

:thankya: Thank you so much Wolfie--I really appreciate your response and advice! I'm working on familiarizing myself better with psych meds and terminology, along with organization. I have a lot more to learn about this specialty, but I'm excited and loving every minute of it--I
just don't want to feel incompetent in the meantime!

Hi I've been a nurse 17 years and switched to psych almost 2 years ago. I still feel incompetent at times but that is just part of my makeup i'm afraid. It really does get easier, the advice here has been great and don't be too hard on yourself. I am sure that you are a great nurse especially if you are taking the time to come here and ask questions, how do you like your new position so far? i love mine but it is an adjustment and i am probaly going to take a new position shortly as a "patient care coordinator"(glorified name for shift supervisor) I've also found that some of the best psych nurses have a medical background and can often see something that someone without a medical background can miss. It seems to me that the best nurses i work with have excellent communication skills, are able to work as part of a team, have a good amount of empathy and campassion and take good care of themselves. Oh and they are very nonjudgemental. Best of luck to you! Lisa

Morgan314 · Apr 6, 2006

If the patient had any visitors during your shift, you might want to add your observations of how the patient interacted with his visitors, and his reaction or any comments he made after the visit.

Nana1206 · Apr 18, 2006

i would recommend becoming more familiar with the psych terms used in psych assessment...as well as become more acquainted with how to perform a mental status exam. there is literature out there to help you. go to the book store and buy a nursing psych book which should have most of this to get you started. a good psych drug book would be good if you do not have one.
mental assessment breakdown/reporting is similarly done as in nonpsych (systems approach).
affect, mood, attention, concentration, interaction, interest, eye contact, energy, impulse control, thought processes, perception, presence of hallucinations/distortions/paranoia/suicidal or homicidal thoughts, plan, intent, appearance, sleep, appetite, problems with meds (side effects)...etc etc. create your own report cheat sheet to help organize what you need to convey.
other info which is often relevant is:
admit status, if a guardian is involved and who is it, concerns regarding discharge, specific monitoring and/or interventions for that patient, and pertinent labs.
in report, most nurses only want to hear the abnormals, important mental status changes in condition, and response to recent treatment/intervention. explore this with your peers. it does take a little organization on your part when you initially start. what most nurses do not wish to hear is a report that drones on and on and/or goes off in tangents. like nonpsych nursing reports, make your psych reporting objective. it will help you stay focused and on track.

i am currently in nursing school and taking mental health this semester. thank you so much! this is great information!