Just a vent... medical vs psych

  1. 7
    I am getting so fed up with the medical portion of our hospital. We are NOT a medical psych floor. Patients we have are SUPPOSED to be medically stable. When we send a patient to the medical side for something it would be AWESOME if all the testing was completed before trying to send back to us, in less then 24 hours. Oh the patient medically stable, what did the CT say, oh you havent even done the CT yet. Call back when its read and we will be up.

    Call the admitting doctor- are you aware so and so has a PICC line for daily infusions. Yeah, I didnt think they told you ( from our own ER, not a transfer, those we pick threw with a fine tooth comb to find out if the people are telling the truth). Getting report... an IV line- no? really what about the PICC, oh thats just for blood draws. Gotta love being lied to over the phone in report.

    Yes, I understand that I went through the same training as other nurses. Yes I can start an IV if needed ( but we do so few of them, is it fair to the patient to be pretty much a practice arm), we dont have monitors to keep tabs on them. Hell our patients dont even have standard call bells or electric beds.

    I understand that they are busy with their 5-6 patient assignment, but I may be passing meds to 24 patients. We have higher ratios because our patients are MEDICALLY STABLE. Any time there is a psych patient on a medical floor, its usually within 12 hours that the nurses and doctors are chomping at the bit to get them off their floor and over to us. But if one of our patients decide to get sick while there it is like pulling teeth to get someone transferred medically. Or if they are being aggressive in the ED, they want to send them over before they are medically cleared. Nope, sorry I need the results and the precert information. BTW you have the man power over there and a doctor right there to give orders, I dont.
    k-hole, NCmcMan, Wise Woman RN, and 4 others like this.
  2. 35 Comments so far...

  3. 5
    Mandychelle:

    May I say that I enjoyed reading your Post? You are quite the Spokesperson, stating your Areas of Concern in a Universal Tone that made your Perspective easy to identfy with.

    Your Post set me to thinking: It didn't use to be like this. I began my Psychiatric Nursing Career in 1984, and aside from some very minor Medical Areas of Concern, I did nothing intensely Medical my first 2 1/2 years of Nursing on the Psych Unit.

    Fast Forward to nearly 30 years to a Medical Center where I've worked for 10 years. A vast majority of the Patients I work with have a need for Medical Assessment/Treatment. We do Foley's, IV's, Tube Feedings, dressing changes, scans, flushes, along with various other forms of Medication Administration. Granted, I work primarily with the Older Adult Population who are more proned to illness than the General Population. Still yet and all, had I not had Surgery, Med/Surg, ER, and Home Health in my Repertoire by the time I came back into the Hospital Psych Setting, I fear I would be lost.

    I wonder if the Areas between Psych and Medical have blurred to the point that Those With Power have difficulty discerning the Difference. Whatever Diagnosis Those With Power choose to be the Primary Diagnosis tells them which Unit to send the Patient. And, we as Nurses on the Frontlines must Fight the Good Fight.

    There have been instances where Recidivistic Psych Patients with Valid Medical Conditions in need of Treatment have been Rubber Stamped and sent to the Behavioral Health Unit without so much as a Basic Workup. It's so sad when Profesionals put Opinions before Principles.

    I can identify with, commiserate, and applaud your Well Worded Post, Mandychelle.

    Dave
    Last edit by Davey Do on Jun 27, '13
    Orca, k-hole, Wise Woman RN, and 2 others like this.
  4. 5
    someone from the other side.... I am SO sick of having PSYCH patients on my medical/surgical floor. We ARE NOT equipped to handle these types of patients with 6 other sick patients as well. It's SO unsafe and I am FED up. These psych patients need to be on medical/psych floors until cleared to go to psych only. My hospital is too small... we don't even have a psych unit! SO I have a full assignment, most of the time 4-5 out of my 7 patients is confused, demented, yelling out, trying to hit me, thinks I'm arresting them, 1:1 for suicidal ideation....It's just not fair to us OR more importantly, these patients who need a different level of care.
    kalevra, calivianya, catladyRN, and 2 others like this.
  5. 0
    Quote from Irish RN
    someone from the other side.... I am SO sick of having PSYCH patients on my medical/surgical floor.

    Belinda is a Medical Nurse and she has a Similar Perspective to yours, Irish. There was even Talk at Our Medical Center of opening a Medical Behavioral Heath Unit. However talking was as far as it has ever gotten.

    It seems that Medical will always have the Comorbidity of Psychiatric Illness and Vice Versa.
  6. 7
    I have seen both sides......as the ER/ICU nurse with these patients sucking up valuable time and resources from "really sick patients. But I have been a supervisor of a large facility with an inpatient psych unit and I will tell you that the psych patient with medical needs is handled better on the medical side than the psych patient with medical needs in psych.

    The medical nurse has the skill set to handle the medical needs that the psych nurse does not.....having a psych patient in psych with a PICC line with 24 other patients that require intense observation for psych issues is a recipe for disaster, infection and trauma when the psych nurse is distracted by one patient. As nurses we have become very specialized......and just like a medsurg nurse can't care for a true ICU patient the psych nurse is challenged by the medical patient.

    I would rather have my families medical issues and equipment care for by someone who does it everyday than someone caring for the PICC line by someone who hasn't looked at a PICC line in 6 months. The mental healt issues are chronic...heal the acute first and the chronic may clear.

    I totally get both sides....but medical issues should be handled first before patients are sent to psych....unfortunately med/psych units are sucking holes of debt....I don't see a real med/psych unit in ther near future.
    sheauchan, nrsang97, Wise Woman RN, and 4 others like this.
  7. 8
    I think the key words here are "medically stable". Having a PICC line for daily infusions does not make one a medically unstable patient. Many patients go home with PICC lines and do the infusions themselves. Having medical comorbidities with psych issues does not necessarily mean the patient is unstable. Patients with foleys, patients who need dressing changes every day, even those on IV antibiotics after the first few doses may be medically stable, but still need medical procedures done. Like I said, many patients are discharged home and do these things for themselves. It has been my experience that many of the psych nurses freak out when they receive a patient with any medical problem, even if it is stable. I understand that they have meds to pass for 24 patients and flushing that PICC line takes a few extra minutes of nursing time, but keeping a psych patient with a stable medical condition in the ER for hours or days is unfair to the patient, the nurse and the other patients in the department.

    On a side note, I have had pysch nurses get mad when I bring up a pt who we medicated due to disruptive, violent behavior. They are upset because this patient now needs to be monitored more closely due to sedation. What would they do if they were the ones who had to sedate the patient. I have also had them get mad when I've brought a full blown psychoses to them on a stretcher, because the patient was so psychotic he couldn't follow directions to sit in a chair. They wanted the patient brought down to ER and medicated before coming back up. What?? Seriously?? Damned if you do, damned if you don't.
    sheauchan, pinkiepieRN, edie1, and 5 others like this.
  8. 4
    I often respond to RRT calls on our locked psych unit. Usually I love it. They call me for two kinds of calls. Acute medical issues. Those are fun cause whatever I "suggest" goes as far as the psych docs and nurses are concerned. If I say "this patient should be admitted to a medical unit" it happens. None of the docs or nurses on psych ever argue with me. The other kind of calls I respond to are for violent patients. Who doesn't love an authorized fight?
    The only frustrating this is that often an acute medical issue can be treated very simply and quickly on the scene but the psych nurses are VERY reluctant to do the simplest things. For example I responded to a call for a hypotensive patient. He was a very young and healthy man who for the last 36 hours had having a manic episode where he had refused anything to eat or drink and had been running back and fourth. His only medical issue was acute dehydration and exhaustion. I administered a liter of NS rapidly (I can give up to one liter of NS on my own RRT protocol) and his BP improved and his HR came down. I suggested he get another liter over a couple hours. This involved leaving him there (calm now) and the nurses monitoring an IV for 2 hours then D/Cing the IV. You would have thought I was asking them to shoot cardiac output numbers on a Swan. Eventually, after a lot of convincing and teaching ONE psych RN agreed to monitor the IV then D/C it when it finished. Transferring this patient to a medical unit to receive a liter of IV fluids would have been a terrible waste of resources. Keep in mind that those nurses were reluctant to handle the IV despite the fact that support (me) was only a phone call away should there have been any problems. I could give other examples. We (acute care RNs) are expected to care for psych patients who have acute medical needs. Seems to me that psych RNs should be able to take care of psych patients with the simplest medical issues to prevent the wasting of resources.
    sheauchan, pinkiepieRN, lemur00, and 1 other like this.
  9. 2
    Quote from Irish RN
    someone from the other side.... I am SO sick of having PSYCH patients on my medical/surgical floor. We ARE NOT equipped to handle these types of patients with 6 other sick patients as well. It's SO unsafe and I am FED up.
    But that is the thing psych patients get sick. And in our hospital they do get a 1:1 sitter. A lot of the issue is that the medical people aren't trained to handle the psych patients. Just like we arent trained to handle the medical crisis' that can happen.

    On any other floor if a patient developes new chest pain and a condition is called, nothing is said. When we call one I have to defend why we called a condition and I'm not allowed to say well because when I called you about it you decided to push it off to the next shift because YOU ( the hospitalist) does not like to come over to psych and the ER throws a fit when we send someone over there, even though its is policy.
    MrChicagoRN and macfar28 like this.
  10. 1
    Quote from Pudnluv
    I think the key words here are "medically stable". Having a PICC line for daily infusions does not make one a medically unstable patient. Many patients go home with PICC lines and do the infusions themselves. Having medical comorbidities with psych issues does not necessarily mean the patient is unstable. Patients with foleys, patients who need dressing changes every day, even those on IV antibiotics after the first few doses may be medically stable, but still need medical procedures done. Like I said, many patients are discharged home and do these things for themselves. It has been my experience that many of the psych nurses freak out when they receive a patient with any medical problem, even if it is stable. I understand that they have meds to pass for 24 patients and flushing that PICC line takes a few extra minutes of nursing time, but keeping a psych patient with a stable medical condition in the ER for hours or days is unfair to the patient, the nurse and the other patients in the department.

    On a side note, I have had pysch nurses get mad when I bring up a pt who we medicated due to disruptive, violent behavior. They are upset because this patient now needs to be monitored more closely due to sedation. What would they do if they were the ones who had to sedate the patient. I have also had them get mad when I've brought a full blown psychoses to them on a stretcher, because the patient was so psychotic he couldn't follow directions to sit in a chair. They wanted the patient brought down to ER and medicated before coming back up. What?? Seriously?? Damned if you do, damned if you don't.

    Re The PICC- it wasnt that the patient had a PICC, it was the fact that the admitting dr was not told about the PICC even existing ( we would have accepted anyway) and when we asked about an IV they said there was no access, without E-Charting I would have never known the patient had a PICC until they hit the floor. I'm pretty sure that is important information to pass onto the nurse getting the patient on a medical floor, so why not tell the psych floor.

    RE: Medicating - If you sending them to me, feel free to medicate. I will adjust my admission process to fit the situation.
    macfar28 likes this.
  11. 1
    Quote from PMFB-RN
    Seems to me that psych RNs should be able to take care of psych patients with the simplest medical issues to prevent the wasting of resources.
    True. We do run IV's at times on our unit so at least 1 RN per shift is comfortable with them ( just not starting them, and usually when ours need IV's even the IV team has trouble finding one. I have done more skills then I thought I did. The problem is we relearn the skill when the patient is there and then dont see it again for so long of a time. Like suctioning a trach- in 2 yrs weve had 1 trach patient. So while that patient was there, we all were retrained on how to suction a trach, but patient left, and havent dealt with one since. It really is a use it or lose it profession.
    sheauchan likes this.


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