Interview this week in Acute Adult Psychiatric Unit! - page 3

Good day Nurses! :wavey: I am a new graduate unhappily working in med/surg. The unit is not that bad, I just know it's not where I want to be and where I plan on continuing my career. Fortunately,... Read More

  1. by   kingvonnBSN2017
    On day shift, its 13 patients to 3 nurses and 2 techs and night shift, its 13 patients to 2 nurses and 1 tech. Does that sound like a safe ratio?
  2. by   GeminiNurse29
    Quote from kingvonnBSN2017
    What's the most difficult part for you in geropsych? Is it the medical tasks, the aggression? I'm curious, other than the high medical aspect in geropsych, what else is different compared to adults?
    For me, it's the aggression. By nature I'm pretty mild mannered and calm, and it can be unsettling at first to deal with combative patients. But at least with old folks, they have some underlying medical issue, usually dementia, behind their behaviors. For adults, they're more stable medically but you get a whole mix. Throw in the forensics aspect that I deal with and it can be a **** show.

    How medically complex are the patients you get? That ratio sounds kind of unsafe. And if you get admissions, it can be a real headache. We usually run with 2-3 RNs and 4-6 or 7 techs depending on if we have 1:1s, suicidal patients, -'d medically needy like we've had cancer patients and such.
  3. by   kingvonnBSN2017
    Quote from GeminiNurse29
    For me, it's the aggression. By nature I'm pretty mild mannered and calm, and it can be unsettling at first to deal with combative patients. But at least with old folks, they have some underlying medical issue, usually dementia, behind their behaviors. For adults, they're more stable medically but you get a whole mix. Throw in the forensics aspect that I deal with and it can be a **** show.

    How medically complex are the patients you get? That ratio sounds kind of unsafe. And if you get admissions, it can be a real headache. We usually run with 2-3 RNs and 4-6 or 7 techs depending on if we have 1:1s, suicidal patients, -'d medically needy like we've had cancer patients and such.
    The nurses told me that there are IVs, ostomy care, wound care, diabetes, htn, antibiotics, alcohol detoxification, things like that. Each nurse will have 4-5 patients, doctors are there until 5. The aggression is probably the hardest aspect of the unit, but I am so ready to learn how to care for the elderly with mental health issues and how to handle an aggressive patient. That's what I really want to accomplish, I am pretty sure it will take some time.
  4. by   HumbleBuddha
    Hi, worked as mental health advocate on psych wards in uk for 4 years now. Without Vipassana meditation no way I could stay calm and not personalise things. Keeps me grounded, grateful and client centred.

    Anyone working in this field needs some spiritual cleanser, be it Reiki, meditation or yoga. Important to detox before and after working day. Lots of processing done during sleep and morning meditation really helpful.

    Good luck with new job. Hope you find your fulfillment. You sound like a nice person with right attributes...
    Last edit by HumbleBuddha on Sep 20
  5. by   HumbleBuddha
    .....
  6. by   BigBrownPotato
    Hi. I have 3 years of experience in a Max Security Psych hospital. My tips for you are:
    1. Get a decent shoes. You'll be chased by some psychotic patient LOL
    2. Don't take anything seriously. If a patient insulted you just shrug it off. These patients are mentally ill.
    3. Learn how to differentiate medical and psych emergencies. Some are fake and some are real.
    4. Don't leave your pens around!!! (personal experience)
    5. Have fun! Take care of yourself and be sure to destress.
  7. by   PixieRN1
    I work geropsych. I really enjoy it. That being said, I get screamed at daily, called all profanities and measure of very personalized insults, get threatened physically daily, and routinely get swiped at or slapped/punched at, but I’m quick on my feet and dodge fists well. It’s very typical to have a hot cup of coffee thrown my direction a few times a week. Sometimes they develop a Incredible Hulk move and chuck a tray table at me.

    Remember, dementia and Alzheimer’s can happen in people’s 40’s, so you may have some burly, strong 50 year olds on your unit who are confused as hell but still physically able to take you out. Also, we get ALOT of indigenous, homeless folk who basically are violent on the street and end up threatening suicide to the cops, but they are over 59, so they get plopped on our unit...acting very violent and not so much suicidal.

    One doc calls this phenomenon the “avoiding jail, three hots and a cot”. They act out, end up chemically restrained, simmer out, and when they don’t demonstrate active suicidality, unfortunately, they get discharged back to the shelter. 30 hours later, yup, suicidal again, and back on the unit. Lather, rinse, repeat ad infinitum. The system is broken.

    Gero won’t save you from intimidating scenarios, crappy outcomes, frequent flyers, and people who are pulling a fast one. There is so much patient drama, the unit is nicknamed “The Young and the Restless Unit”. I mean, a elderly schizophrenic lady and a prone to violence 50-something year male with dementia trying to forge a romantic dalliance on night shift, only to both fly into a physical, violent rage when they weren’t allowed to get it on. Two codes for one unit at the same time with one nurse and one tech! Oy vey!

    I’ll be honest, gero is awesome. But you need a very thick skin and you need to be able to be firm, set boundaries, and enforce them. These are mentally ill adults and it’s very sad to see the state they are in and it’s not really a “warm fuzzy” unit. Gero’s can have borderline personality, raging bipolar, schizophrenia, antisocial personality, and most mental illnesses that the younger folks have; and sometimes you get to add dementia to that already challenging diagnosis.

    I’m NOT trying to scare you off, although it may seem that way. But if you quit over water in your face, you need to understand that that kind of behavior is quite common on gero. You learn how to keep your personal space safe, stay at a safe distance, and absolutely keep your personal emotions under lock and key.

    I love it because it’s fast paced, your moving all the time, I do enjoy adrenaline so the drama suits me, and I’m a bit of an emotionally blunted person, so threats and insults don’t get to me. It’s a nice blend of “sweet and sour” patients.

    I am concerned about the medical acuity you mentioned. The most invasive thing we do is IV fluids and antibiotics. We will do maintanence CPAP for sleep apnea if it’s not a new thing. If they need blood, a temporary foley, or anything more advanced, they move to a medical floor. Our ratio is too high to do much more safely.

    Our ratio is team nursing, so 12 patients, one RN, one LPN, and maybe a Tech if staffing is good.

    Good luck in your choice!
    Last edit by PixieRN1 on Sep 22
  8. by   NPvampire
    I've been in psych for 11 years now, going strong.

    #1 if you've ever read harry potter, "constant vigilance!" Never forget where you are or why the patients are there. They did not get to the hospital by an accident. They are there because they have a history of instability or violence to themselves or others. Do not assume because they talk sweetly or are intelligent, and so on that they will not beat/mess you up. It is like jail in some ways.
    #2 Avoid power struggles. The old saying - don't wrestle with a pig, you both get dirty but the pig likes it? Yeah, that applies to psych too, especially the axis 2 population. You will never win and it will only get ugly - 90% of violence I have seen was due to a power struggle that could have been much avoided. Know and use your hospital policies and stand by them.
    #3 pick your battles. You will learn when to intervene and when to let things go. I have also seen the worst violence start over trivial things that were not a threat that staff felt required that level of failed intervention. For example, consumer has a plastic paper clip and threatens to kill himself. He weighs 100 pounds and is a foot taller and 10 years younger than the fittest staff you have on hand that day. The staff attempted to rassle it away, and ended up with 3 grown men in hospital and woman with permanent kidney damage. Patient didn't get a scratch. He also didn't kill himself. That wasn't worth the threat.
    Now, second case, patient goes into seclusion and ties her clothing around her neck and is turning blue. That is where you will have to intervene, the threat is real, even if she went into seclusion for an attack on staff.
    #4 As in any nursing job, take care of yourself, and do not allow the employer to work you to death/like a dog!
  9. by   kingvonnBSN2017
    Thank you all for the wonderful advice, all of this is going to help me greatly! I was offered both position, but I accepted the adult unit. I am so excited to start my career in mental health!
  10. by   kingvonnBSN2017
    Actually, it's pretty funny. The patient who threw the hot water on me when I was a tech at another hospital, was a patient on the unit I interviewed for.
    But altogether, it seemed like a very good unit with good security. The patients are medically cleared. It's 19 beds and each nurse gets 4 patients.
  11. by   NurseNinja1990
    I'd be weary of geri-psych if I were you, but that's just from my own experience. Psych nursing tends to have larger nurse-patient ratios and, while they may be medically cleared, it does not mean that the comorbidities could act up at any time. Geri comes with falls, aspiration risks, skin tears, fractures, code blue's, you name it. I used to work geri but thankfully got into adult. Serious props to those geri psych nurses, it is a VERY difficult psych population.
    Best of luck!
  12. by   kingvonnBSN2017
    Quote from NurseNinja1990
    I'd be weary of geri-psych if I were you, but that's just from my own experience. Psych nursing tends to have larger nurse-patient ratios and, while they may be medically cleared, it does not mean that the comorbidities could act up at any time. Geri comes with falls, aspiration risks, skin tears, fractures, code blue's, you name it. I used to work geri but thankfully got into adult. Serious props to those geri psych nurses, it is a VERY difficult psych population.
    Best of luck!
    Thanks! I decided to accept the adult psych position. They are usually medically cleared and each nurse has 4 patients, on a rare occasion maybe 5. Does that sound good?

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