Quote from Whispera
I've found that psych patients are often the "red-haired stepchild" when it comes to having their other medical needs addressed. Symptoms they are showing can be chalked up to behavior issues--even low heart rate and cyanosis! Sometimes medical needs aren't addressed when a psych patient is hospitalized for psych issues. Sometimes it's an attitude on the part of the medical staff that they're only there for psych things. Sometimes it's ignorance on the part of the psych staff. I think it's unforgivable for a psych nurse to not know how to work a glucometer or address abnormal glucometer readings! That's basic nursing knowledge. Shame on the nurses and facility mentioned by the previous poster!
I floated a hospital as the psych nurse consultant. Some things I heard people say and saw, that enraged me:
from a nurse to a doctor about a patient in alcohol withdrawal: "you don't want to do anything to medicate his symptoms, do you?"
from the in-house doctor who was called about a patient with extreme SOB and cyanosis: "he can get that taken care of after discharge."
when I went to see a suicidal patient in the ER, to evaluate him (this happened more than once): the patient was out of sight from the staff, with a bag of pills (or a weapon) beside him/her on the exam table. Staff also said, "good thing you're here--we're too busy to deal with your patient."
about a patient having seizures when medical staff was called for help: "it'll be awhile before we can get there. other people come first."
In all those cases, the psych staff, me included, did all they could for the patients. I'd feel ashamed of us if we didn't. Psych nurses need medical skills too. Medical nurses need psych skills. We are treating a holistic person and that means treating all conditions that are in the person...
(steps off soapbox)
Holy moley! I would run far far away from a facility like you described. I don't expect every nurse to know everything, but if you don't think cyanotic SOB pts or those actively seizing warrant immediate attention, then you don't deserve the title RN.
My four years of experience is in a large inner city ER that cares for a large population of those with mental health and substance abuse issues. My initial dream was to go into psych nursing but after becoming aware of the complete lack of funds, resources, and consideration of these pts, I realized that i would end up burned out within a year. I'm a nurse that will get fully involved with my pts well being, and tend to go above and beyond what is required of me. I knew that I would be constantly fighting a losing battle if I pursued that field, but have instead found ways to incorporate my additional knowledge of psychology in how I assess and respond to each pt I care for.
With that said, for some disgusting reason, our society and healthcare industry have deemed it acceptable to ignore the needs of specific groups of patient populations. The 2 most directly affected are mental health pts and elderly/long term care pts, and is evidenced by gross understaffing, unenforced regulations, limited funding, and lack of response when issues are raised. This is why many pts with psychiatric conditions or substance problems are in prisons or homeless, as well as the issues of ridiculous nurse to patient ratios that affect level of care available to each pt in LTC/geri psych facilities. The reason this continues to go on is that these pts can be so easily ignored. I mean, who will listen to some "crazy homeless guy", or "demented old lady"?
As for the Etoh liver failure pt, what med were you concerned with and why so? As for the other 2 nurses I hope you told them to concern themselves with their own pts and to never again cancel something you've ordered because you felt it was necessary. Plus with these types of pts you gotta keep in mind that they are least likely to be compliant with home meds, especially their lactulose b/c of the bowel effects, and can often be assumed to be intoxicated when really their ammonia levels are through the roof, and if living alone, can be unsafe.
As for the bipolar pts, as well as with the schizophrenic population, there is a high % of noncompliance and substance abuse for a few main reasons. 1. The antipsychotic meds put them in a fog, cause lethargy and extra-pyramidal effects, keep manics from getting that high with mania, cause significant weight gain, and are obnoxiously expensive. (I take seroquel for sleep and without insurance it was $700.00/mo before generic, and $550.00/mo as generic!)
2. These pts conditions are often poorly managed resulting in unemployment and requiring SSI, have little if any family support and end up homeless in the inner city where they won't be arrested. This surrounds them with high crime rates and drug use, so they resort to that lifestyle to survive.
3. The substance abuse is so high for two main reasons; self medicating and a result of depression caused by all of the factors listed above. Manics in depression are likely to use an upper (crack, coke, meth, pcp etc), to mimic that euphoria assoc with manic episodes. Manic pts and paranoid or hallucinating schizophrenics may use downers to either calm down, or use sedation to get rid of hallucinations (heroin, weed, opiates)
It's sad to think that our culture can so easily ignore the plight of others who in reality, need us the most, to advocate for, and protect as they are unable to do so for themselves.