Quote from Trinklee
I've wanted to become a nurse since I was five-years-old, but I absolutely love psychology. I wanted to mix the two things I like and become a psychiatric nurse, but when I ask people what psych nurses do they tell me that they just push meds.
Does handing out medication and doing paperwork really comprise most of the job? I want to care for the mental health patients, talk to them, maybe do fun things with them...am I planning on going into the wrong line of work?
EDIT: I am not trying to belittle anybody or come off as disrespectful. I just want to know what exactly psych nurses do to know if it's right for me.
From what I've seen?
Only at the State hospitals and only if you're LVN.
I work geri psych. You only do the med cart in you're playing med aide for the shift. We nurses tend to work it on occasion because the HR can't find a med aide to do the job. We handle bipolar disorders, personality disorders, depression, Schizo (various types), OCD, dementia, Alzheimers, Alcohol Dts., impaired cognitive ability (people in various stages of what used to be called MR)...
We do hospice care. We have a nurse who does wound care and trach care but it's easy to hop in there if you need to learn. The rest of us chart. Do mounds of paperwork. Peg feedings. BS/Insulin. Monitor mealtimes.
Basically, it's skilled nursing...WITH psych pts.
...and I'll be honest: sometimes, it's too much stimulation. You have to see and experience to believe it. It's not a boring job. I went to fill out applications at a regular LTC and I was weirded out by how quiet it was. LOL
It's a lock-down facility and just because they're elders? Ha! It means nothing! You hear me? Nothing! LOL
They're ornery, feisty and 80% are on antipsychs. Many don't want to take their meds, so that's an uphill battle. I've been called every name in the book. It's fine...we'll be BFFs again 15 minutes later.
We're breaking up fights and trying to simmer them down all day. We're no-restraint, too. So you really have to use your words. Therapeutic communication.
Most of the time, they're not trying to fight the staff. They're trying to beat the mess out of each other. Random things. Someone took someone's shirt, allegedly. It escalates. Someone thinks that someone else has their quarter. It escalates.
Next thing you know...two elderly ladies are in their wheelchair raining blows upon each other (or over-exerting themselves trying). LOL
Someone cuts the lights off, another tells us what he did, takes it upon herself to flip it back on and chastises him. He argues and reaches for the light. She throws a hook...and it's on!
Someone with dementia is wheeling in her wc trying to find her room and enters another by mistake. I said, "Ms ____, that's not your room!" Before I can move around the chairs, the resident in a wheelchair sees someone going in her room and takes off down the hall almost beating me to the room. I said, "Hold on, mama! Hold on -"
She yells, "Don't you tell me to hold on! I'm gonna beat the hell outta her!"
Got to the room. No one in there.
I said, "See- she's not in here. She didn't mean to come in here. She was only in your room because she was confused about where she was." She peeked in and sat there fuming. "Can you close my door please?"
I did and we walked back together. She says, "Next time? I catch her in my room? I'm gonna murder her...."
We're talking 60 and 80 year olds here.
I believe that there are probably more near falls in psych-geri than in the avg nursing homes, too. We have residents with dementia/alz. They get confused. Try to get up to go the bathroom...or go to work...or go home or ...'just because' and forget that they can't walk.
I've always heard about psych pts being doped up...but I've yet to see it. The bulk of our pts (besides their biweekly Risperdal IM) only have ativan...and it's definitely not enough to tranq a horse. We're talking 0.25 to 1 mg (with a medium of 0.5) and that's 'if' they even have PRNs.
Many don't...and I've often wondered why everyone doesn't have a 'calm-down med'.
Even the calmest pt can have a bad day and then it's just downhill from there. When I first began working there, we had a resident who was a happy little guy with bipolar dis.
Suddenly, he started refusing meds. Then his insulin. He's pacing. Eating constantly. Irritable. Called the police to the facility (to take his son in law to jail). Soliciting people for sex. Was outside in the courtyard trying to 'shower' in the rain (god's water). Threatened to kill one of the residents.
He was sent out and, hopefully, they can get him adjusted and back to his old self.
It's happening again with another resident. Not my assignment. She just up and started refusing meds. She's irritable, now. She's refusing insulin...and her BS was in the 600's some days ago. Her nurse (a new nurse) called her doc and he was just like, "Well, she's refusing insulin... What do you want me to do about it...?"
She said that she just held the phone, not knowing what to say. LOL
...and, believe me, we exhaust all opportunities when it comes to getting these meds down these pts. Some residents are more with it than others. Smarter. We put it in their food? They can tell. We put it in their drinks? They can tell. We have to restrict privileges (like smokebreaks) to get them to take their meds and NOT cheek.
The insulin, though, is not gonna happen. You might get a BS. Not the insulin...even if they're half-asleep and you just
took the BS.
Sneaking meds, that's not what you're supposed to do, I don't think. Pt rights and all?
For about 10% of the population, this is the only method of 'medicine administration' that works.
Hey... those with psych issues tend to have compliance problems, too.
Hello? That's half the reason why they're in a psych facility to begin with. They usually have impaired insight and can't manage/maintain on their own.
"I don't need it"/"It's poison. you're trying to poison me?! you're making my hair falll out of my head!"/"I'm not sick...you're sick."/"God said I didn't have to take it!"
Even the providers tell us to 'do what we must'.
Short of holding them down and/or pouring it in their mouths, we do! If we're not sneaking the meds in their food/drink or bribing them with food/diet soda? We're doing a lot of begging. "I'm not going to leave until you take it...." Sometimes, you can wear them down. They'll get tired of cursing.
We do deceive, also. "Does your heart still hurt, Ms ____? It's your eyes? Well - do you want some eye medicine? No, we don't have drops. This eye medication comes in pill form. It's 2 pills and 1 for each eye. Do you want the two pills for your eyes to make them feel better? Ok, here you go..."
(her heart doesn't hurt and nothing's wrong with her eyes.)
She rec'vd 1 mg ativan + haldol (I forget the mg.). The rest we bribed her with pizza and diet coke to take. Positive reinforcement.
But...the goal is to get the scheduled benzo's (ativan, clonipin). Then, perhaps they'll be agreeable when it comes to taking their insulin and other meds.
Bottom line? You either want these people better and experiencing a better quality of life or you don't. The providers don't/can't do much. They leave it up to us to make it happen.
These ppl need their medication and, I'm sorry, but...no one's going into ketoacidosis on MY
And that...in a nutshell...is what it's like to work at my facility.
The sun-downing is not to be believed. The day of the Super-Eclipse? The elders went bonkers. "I ain't taking no ******* pills!!!" LOL
Also? A pair of good running shoes? Not optional. LOL Much like velociraptors on the movie Jurassic Park? They case the place for weaknesses. They remember....
They're a ball, though. Even when they're raising he.ll...