I posted this message awhile back under "What's your day like?"
I am a psych nurse on an inpatient acute unit. I work 8 and 12 hour shifts. Generally I am the only RN on the unit - if I need backup, I call neighboring units or the supervisor (if he/she isn't too busy). My unit is usually full, 15 pts, and we run with 3 aides depending, of course, on acuity and staff availability.
I count and get report at 2:30 and am on the floor by 3:00. The beginning of my day is usually busy - orders and finishing up tasks leftover from dayshift. The Dr and PA-C have a tendency to write orders late in the day, so I may be working on admissions, discharges, med changes, referrals, following up on abnormal labs, etc. I deal with all medical and acute psych issues - everything from a scrape to chest pain to suicidal thoughts or aggression. I am the med/treatment nurse. I am also the team leader, so I deal with delegation and personnel issues on my unit. Somedays run smoothly and other days it seems all I do is set out fires and race the clock.
We are an admission unit and most of our admits come in the evening, usually I have one but I have had up to three in an 8 hour time span. If I have an admit, I complete a nursing assessment with the patient, deal with immediate medical/psychiatric concerns, take off admission orders, contact their family, and of course document every intervention and write up an initial treatment plan. I am engulfed by paperwork my entire shift - it seems for every intervention there is triplicate paperwork to complete. I love patient care, hate the paperwork - it's a necessary evil though.
There is a high level of unpredictability when dealing with psych admissions - I deal with patients with varying diagnoses, including medical, and crises (s/p suicde attempts, mood disorders, psychosis, homicidal ideation, dementia, etoh/drug withdrawal and personality disorders). I have worked with some awe-inspiring patients over the years and a few that I'd prefer not to meet again (to put it nicely
Some of our patients can't communicate their needs so assessment is critical. I don't think this can be emphasized enough with this population. It's easy to pass things off as a "psych issue" and then have it blow up in your face a few hours/days later. I follow my gut instinct if I can't pinpoint a specific problem - fortunately we have a great medical team who listen to staff concerns.
Somedays I am assigned the defib nurse if there is code in the hospital and other days I handle scheduling conerns for my department. There are many small tasks that I complete throughout my shift - I try to help the aides out as much as I can and vice versa. We work as a team and we depend on one another - I could not do my job without their help.
The last hour of my shift is usually the calmest, most of the patients are in their beds and the staff seem to unwind at this time. I finish up on my last minute tasks and try to spend a little time with staff in between doing things. It's my favorite time of the day, sort of a debriefing for us. Then the oncoming nurse shows up and I count/give report and try to let things go as I leave for the day.