State Mental Hospitals

  1. I will be starting to work in a state run behavioral/nursing home type setting soon. Some of the pts have been in this facility for many years(mental retardation, Down's syndrome) and regular nursing home pts. Do any of you work in a similar setting? There will be 3 LPNs and 10 health service workers working on 4 units (total = 100 pts) I will be the only RN on nights. Any insight?
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  2. 13 Comments

  3. by   Energizer Bunny
    Sounds a little scary to me, but I sure would like to hear from others that work in state hospitals since this is something I have considered when I graduate.
  4. by   marymary
    Quote from NurseDixie
    I will be starting to work in a state run behavioral/nursing home type setting soon. Some of the pts have been in this facility for many years(mental retardation, Down's syndrome) and regular nursing home pts. Do any of you work in a similar setting? There will be 3 LPNs and 10 health service workers working on 4 units (total = 100 pts) I will be the only RN on nights. Any insight?
    I think that I would start off on days if possible. You have to work on your own on the overnight shift. The LPN's are your back but you are running the show, are you ready?
    :hatparty:
  5. by   Gator,SN
    A friend of mine works in a state mental facility and she hates it and it looking for other employment. She complains of being short staffed, especially when a pt. becomes frustrated or combative. She has been injured when punched and kicked by these pts. and the security guards are not allowed to "manhandle" them. Which means the nurses are basically on their own all the time with patients that have refused their meds for days and are now out of control or just want to fight. Patients fight among themselves, steal from each other and refuse treatments. She has to take them out to smoke sometimes on dayshift and she is a non-smoker. Not only does she have 20+ pts a night to keep track of, but the other staff as well. Many of the patients that are there are "institutionalized" and have been their for most of their life. Its very sad. They lack family support and visitors. Weekly counseling sessions do not provide much for these patients, so I'm not sure how much of it gets through to them.
    I did my clinical rotation for psych at this facility and I knew it was not for me. This locked ward was not even the worst that I saw while there. Some floors have all chairfast patients that are tube fed and can't do anything for themselves so they were put in front of a TV for hours at a time.......The only good thing I can say is that because its a state job, the benefits are very good though and the retirement plan is excellent and some of the nurses were very dedicated and tried very hard. Limited resources and lack of adequate staff make this a hard job.
    Good Luck Dixie. I hope that you can make a difference with these patients because it really is a sad place that needs caring professionals.
  6. by   marymary
    Quote from Gator,SN
    A friend of mine works in a state mental facility and she hates it and it looking for other employment. She complains of being short staffed, especially when a pt. becomes frustrated or combative. She has been injured when punched and kicked by these pts. and the security guards are not allowed to "manhandle" them. Which means the nurses are basically on their own all the time with patients that have refused their meds for days and are now out of control or just want to fight. Patients fight among themselves, steal from each other and refuse treatments. She has to take them out to smoke sometimes on dayshift and she is a non-smoker. Not only does she have 20+ pts a night to keep track of, but the other staff as well. Many of the patients that are there are "institutionalized" and have been their for most of their life. Its very sad. They lack family support and visitors. Weekly counseling sessions do not provide much for these patients, so I'm not sure how much of it gets through to them.
    I did my clinical rotation for psych at this facility and I knew it was not for me. This locked ward was not even the worst that I saw while there. Some floors have all chairfast patients that are tube fed and can't do anything for themselves so they were put in front of a TV for hours at a time.......The only good thing I can say is that because its a state job, the benefits are very good though and the retirement plan is excellent and some of the nurses were very dedicated and tried very hard. Limited resources and lack of adequate staff make this a hard job.
    Good Luck Dixie. I hope that you can make a difference with these patients because it really is a sad place that needs caring professionals.
    Out of curiosity, when the patients refuse their medications for "days" why did the staff not follow up and get a order to give IM from the doctor then? Why wait until it is out of control? I am going to work in a psychiatric hospital sometime this year. I will let you know what I find out from my experience in New Jersey.
  7. by   Gator,SN
    marymary,
    I asked the same thing and my friend said that it wouldn't have helped because they can't give an IM injection either if the pt refuses it.......????? She did say that sometimes they take away privileges when this happens......Maybe someone else who works in psych nursing can come on here and explain.
    Good luck with your upcoming job!!!!!
    Gator
    Last edit by Gator,SN on May 27, '04
  8. by   lucianne
    Everyone has the right to refuse treatment, even patients on psych units. If you want to force an IM med on someone who is not actively posing a threat to self or others, you have to go to court to get an order from a judge.
  9. by   Sharon Jean
    Sound like you're setting yourself up for disaster. Best of luck to you!
  10. by   FutureRNMichael
    Quote from lucianne
    Everyone has the right to refuse treatment, even patients on psych units. If you want to force an IM med on someone who is not actively posing a threat to self or others, you have to go to court to get an order from a judge.
    Outside Doctor Consult - two sources I believe - is needed to use IM backup's in Oregon.But, if there in the state hospital, they probably have some decision making issuses as it is.
  11. by   exhausted mom
    Quote from marymary
    Out of curiosity, when the patients refuse their medications for "days" why did the staff not follow up and get a order to give IM from the doctor then? Why wait until it is out of control?
    We have a 20 year old son who has been REALLY REALLY needing to get back on his meds. Seroquel. We just had the police admit him to the county psych ward in Martinez, CA. You mean they can't make him take his meds either? This is real bad news to me!
  12. by   explorer
    If the psych patient is under conservership or guardianship the patient can be forced to take the medication. If the patient refuses to take oral medication, it can be given IM.
  13. by   ms40
    I work at a state run facility for the developmentally disabled. 100% of our residents have guardians/conservators. The patient may refuse any med or Tx, but if as Explorer noted, the situation is serious enough, the meds can be given IM against the wishes of the pt. I am guessing that much depends on where you work, state and facility-wise. In TN, all the state ICF-MR (intermediate care facility-mental retardation) operate under a federal injunction (bad abuse and neglect in the past) and the rules are strict. To give IM meds we have to consult the behavior analyst or psych examiner who will assess the situation. The BA/PE then gives the okay to the MD/PCP to write the order to administer IM meds. At our facility, this intervention is almost always considered an emergency and we have a case conference with the interdisciplinary team the next business day to discuss the situation. I think that this proceedure is particular to TN and so it may not be the case in your state.

    I would suggest that you look up the laws in your state and also have a very good look at the facility policies before you sign up to be the only RN for 100 residents. The LPN's should have your back (I am an LPN) I always have my RN's back and he has mine, but we usually work one at a time . . .

    I would be concerned by the staffing ratios for the care providers. We have one tech to four residents at a minimum during the day. At night the ratio is one to seven (state law).

    Some questions to consider-What is the average level of adaptive and cognitive functioning? I have found that my pts that have higher IQ's, mild retardation as opposed to severe and profound, tend to have a greater propensity toward bipolar d/o 1 and antisocial personality d/o. This can be seriously problematic and potentially very dangerous.

    How many people require total care? Are you caring for people with g-tubes, j-tubes, trachs, etc? How many have self-injurious behavior? How many have a history of aggression/violence? What are the proceedures regarding restraints? How does the administration support medical and other staff? The list could go on and on . . .

    There are many wonderful and rewarding aspects to my work. My coworkers are, with a few rare exceptions, terrifically competent and passionate about serving this population. There are risks involved in any psychiatric setting though, so be careful. Let me know how it goes.
    Best of luck to you!:chuckle
  14. by   msrn
    I work in a state hospital for adults with acute MI; I love it and can't imagine doing anything else. We have a men's unit and a women's unit with 25 beds on each. There are 1 to 3 RNs and 3 to 5 MHTs to each unit during a shift which lasts 8 1/2 hours. As far as a pt refusing meds, the doctor can give a 'may not refuse order' (if it is determined that the patient may be a danger to self or others) which means staff can use a 'show of force' to give an IM injection. 'Show of force' means that MHTs and security are called to a private area such as the patient's room where the RN gives the IM. If the patient becomes violent or threatens staff, the RN may have the MHTs and security take the pt to the seclusion or restraint room; then, the RN must contact the physician and nurse practitioner to get an order. The LIP comes to the hospital to assess the pt and write further orders. I hope this is clear; it's been a long day .

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