medical care in your place of employment

[Umberlee]

I'm brand new to a psych facility and am feeling pretty nervous about my new job at this point. I was told when I was hired that although it isn't a "medical" facility, i.e. pts have to be medically cleared before they are admitted and we don't really have the capacity to do much in the way of treatments or diagnostics, that there are specialists who provide for the medical/physical side of things and then practitioners focusing on the psych issues.

I am pretty concerned about the quality of medical care our patients need vs. what they receive. There are two wings, one which is mostly psychotic patients who require extensive behavioral interventions and emergency meds frequently. The other wing is more for substance abuse/depressed/personality disorders. That wing sees a lot of post-suicide attempts and these patients seem to be fairly medically fragile to me.

I feel already like the family nurse practitioners (who are in the trenches as the first line for medical care) are mostly just "checking boxes" when it comes to their medical needs. They do an initial assessment and of course are there to field questions and concerns but I'm only in my fourth day of orientation and I've already seen two pretty scary situations in which patients could have actually died and the medical providers seemed to blow off or bungle the whole situation. These were things that were validated by actual physical findings but in both situations the NPs tried to play off the patients' obvious medical needs as being somehow being mitigated by their behavior and psych issues even it was very apparent that neither was "faking" or causing their own illness.

Are you confident in how your psych facility manages medical needs?

[Meriwhen, ASN, BSN, MSN, RN]

Usually by "medically cleared" they mean that they want the patient stable. This doesn't mean that the patient can't have medical issues--as you have seen, a lot of them do. But consider that unless you're working on a psych medical unit, you won't have the resources for doing invasive treatments (such as foleys, IVs, etc.), cardiac monitoring, or critical care.

I do know from experience that a lot of psychiatrists/psych NPs prefer not to handle the medical issues, instead referring it to a medical doctor/NP. Some psychs may handle minor complaints (N/V, HA, pain) and order appropriate meds, but anything more acute than that, they'll refer to medical. The medical staff will do whatever they are able to for the patient; if they can't handle it they will refer the patient to the ER or a medical facility.

Now, I've never seen the medical staff downplay a psychiatric patient's medical complaints--especially in the face of physical evidence--so what you say is kind of frightening. I wonder how much experience/knowledge these NPs have about psych.

[Hygiene Queen]

We come across situations all the time wherein we can't be sure if a situation is psych or medical.

We cover both angles by getting the internist involved.

We never just blow it off as a psych issue without ruling out anything medical.

I am confident in my facility.

[New Angel]

When in doubt, send them out!

[TerpGal02, ASN]

We have little capacity to deal with medical problems that are not minor and well managed, but we get medically unstable pts a few times a month usually because our referring ERs like to bend the truth to get rid of pts. I have been at my facility for 4 months and have seen what was called "mostly healed" self inflicted stab wounds that actually were infected and gaping, someone with "a few wheezes" that wound up being a full blown COPDer with says in the toilet, 2 pts with "well managed DM" that turned out to be fragile diabetics with blood sugars all over the map. Had to send one out who's BS was jumping from 450 to 36 within a few hours. We had a kid with through the roof CPK s/t tramadol OD that we had to send out, right now we have a w/o gastric bypass pt who's had BS numbers in the 30's. And we have wound up managing all OC it because when we send em out, our ED gives us a rash of hell fori sending them and usually send them back within a few hours when if they had come in off the street would have surely been admitted.