Need Advice: I Don't Want To Be A Crisis Clinician!

[psynursing]

Hello,

I am a psychiatric nurse that is the only nurse on a team of mental health case managers/clinicians (all of whom have backgrounds in social work). This team treats patients in their homes and goes out to provide mental health support and do a LOT of "social worky" stuff (taking care of finances, transportation, payeeship, housing, funding etc). My job is to take care of the medical/nursing needs - coordinating psychiatrist visits and medications and such.

My supervisor (who is also a social worker) wants to train me to 'go on crisis.' This is when a patient is having a mental health crisis after work hours, and needs a crisis assessment at the ER. The clinician doing the crisis then has to find placement for the patient if needed at a mental health facility, and basically be their case manager for the evening.

This is basically like being on-call, and whoever is 'on crisis' that day has to go out and do this.

My problem is, to be honest, that I really don't want to do this! I have a lot of things going on at home that I don't want to be spending hours on after work if a crisis should happen and I'm on call (plus, the training is all after hours and unpaid). Not only that, as the only nurse I'm kept pretty busy during working hours as it is.

So: is this outside the scope of nursing? IS this a social worker's job, not a nurse's? At my previous employment, they had crisis counselors, and none of them were nurses. It seemed the norm for it to be reserved for those with social work backgrounds. Can I rightfully say, "Hey, I don't want to do this, and not only that, I have grounds NOT to based on my profession?"

Chime in with your thoughts, please!

[MrChicagoRN, RN]

"So: is this outside the scope of nursing? IS this a social worker's job, not a nurse's? At my previous employment, they had crisis counselors, and none of them were nurses. It seemed the norm for it to be reserved for those with social work backgrounds. Can I rightfully say, "Hey, I don't want to do this, and not only that, I have grounds NOT to based on my profession?"

The answer to all 3 questions is no.

When I was a psychiatric home care nurse, I would commonly meet with those in crisis, or a pre-crisis state. The RN was the case manager, and would pull in the other services as needed. Supportive therapy, teaching, problem solving was the norm. Why shouldn't a nurse do this?

My big concern is what the role of the crisis worker is in regards to transportation to the ED & involuntary admissions. Unless you are able to become a Qualified Examiner, in the absence of overt statements, it may be difficult to hospitalize a client.

You don't want to do it, and that's fine, just say so. They may say, "nice knowing, ya."

[Psychcns]

Great opportunity for the right person. You should be paid, even for training. Maybe you could negotiate the hours and/or not do it too often.

[Davey Do]

Yeah, sorry, Crisis Response was within the Realms of the RN's Duties when I was part of an Assertive Community Treatment Team back in the late 90's.

I even got Flack from Administration when a Psychotic Client's Family called me ON MY HOME PHONE ON MY DAY OFF and wanted me to Intervene in a Situation. I advised the Client's Family to contact the Clinic or the ER, whichever they believed was Appropriate.

I also Set Limitations with Administration. That Position was one in which I was eventually Terminated. Good Riddance to them.

But, Good Luck to you, psynursing!

[elkpark]

Every outpatient clinic with which I've ever been familiar required all the professional staff to take turns being on call after hours for emergencies. It was a basic part of the job description/expectations.

[microserf]

Totally within scope. In fact, I am a "crisis clinician" myself and my primary responsibility is to attend to calls in the ER or on other units (consult-liaison). I work on a team of four (2 RNs, 2 MSWs) and both disciplines do the exact same work.