WHAT AN RN DOES
1. Assess and admit pt to acute inpt psychiatric unit.This task will take about 2 hours including documentation(...And remember not all pts are visiting on a voluntary basis.)
2. Obtain appropriate orders from MD. Many units have standing orders for things like blood and urine specimens to be obtained ECG ,detox protocols etc. Most units admit 24/7. Each patient will need individual care. Many will be admitted with chronic illness such as DM, lupus,or HIV. Orders will need to be obtained to continue pt. on any med already prescribed. Often these orders will be obtained by phone and the MD will not see this person for 24 hrs. ASSSESSMENT SKILLS ARE CRUCIAL.You will see plenty of pts that need total care, at least until they are stabilized.
3.Delegate tasks to the rest of the team- meds to pass safety checks to do on all pts as often as q15 minutes,groups to run,(2-3 a shift except on NOCS
4.Co- ordinate care with other team members- Social workers to start discharge planning, physician to do H&P.(The MD that you call for orders will be the attending psychaitrist;however every one wil need to see a physician for history and physical),lab techs to draw blood(may have to draw your own, however) housekeepers to make the beds for new admit, order tray from the kitchen...
5.Obtain consent (or not) to speak with the patients signifigant other. (We in psych have always been very careful with confidentiality, prior to HIPPA.) Often one will find that the identified pt. is not the sick one
6.Keep the unit SAFE and running. "Safe" means no drugs, no weapons, no sexual activty, no gambling ,no pill cheeking, no fighting, limited verbal abuse, limits on demanding pathological behavior, somewhat like a cop with a heart of gold.
7.1:1 with assigned pts. A good way to achieve this is divide the number of clients by number of staff. Each staff will be assigned to spent quality time talking one on one with each patient assigned and documenting said conversation. The RN/ charge nurse will be assigned the most acute individuals. This can be a most therapeutic intervention, even at 3am.
8.Give report to the oncoming shift.
9.Complete an acuity assessment tool of some type, often thought of as a cruel joke.
10.Try to relax- it will all start again tomorrow.
WHAT DID I LEAVE OUT LADIES AND GENTLEMAN?