A dedicated psych staff in your ER?

Esme12, ASN, BSN, RN · Jun 14, 2014

Are you doing your thesis/capstone (or whatever they call it these days...LOL) on this?

BrooklynRN11201 · Jun 15, 2014

we have a totally separate ED for psych - but 9 times out of 10 they need to be medically cleared first, so we take care of them, get a psych consult, and try to move them to psych ED ASAP. it mostly works, but I honestly wish it were opposite - have a "regular" Dr and RN in the psych ED for medical clearance - most of the time they just take up space in the acute ED flipping out, traumatizing other pts, and it becomes this huge issue whether or not to medicate them because then psych might not take them if they're so sedated, etc. then you have Drs not wanting to put in orders for restraints and too few PCAs to provide 1 to 1 - it's a mess.

Guests · Jun 15, 2014

I think all EDs would benefit from having dedicated psych staff.

The way ours works is that they're initially evaluated in the main pods. The only specialty contact they receive is from a social worker who makes the determination whether or not they'll be placed on a hold. The ED doc medically clears them after a basic set of labs (drawing blood from screaming,thrashing people is always an adventure). Once they are medically cleared, and calm, they are moved to an "step-down pod" which holds psych patients, m/s boarders, and people waiting on beds.

There they are rounded on by psychiatry but the nursing staff is our regular ED staff with some m/s floats. We do have psych techs working in that pod to assist with monitoring and ADLs.

The biggest problem we have is with elopements because the pod is not locked down.

NurseStelri · Jun 16, 2014

Since this is my first semester of MS clinical, this is just a project (almost like a mini-capstone smashed into a semester, doesn't have to come to completion so to speak). But if I find that it goes well and there is a great need at my hospital then yes I'm hoping to make it my capstone :nailbiting:

NurseStelri · Jun 16, 2014

That is similar to how our ED works except our psych unit is a 6 bed locked off area at the front of our unit (and for my city that is not quite big enough so we always have overflow of psych into the medical ED, prompting the same issues you stated).

How large is your ED and how large is your psych ED?

That Guy, BSN, RN, EMT-B · Jun 17, 2014

I would love it. Ours get put in the penalty boxes as we call them and are medically cleared in there ( unless they are critical ) and once cleared by medical standards and sober, our psych team comes and evaluates them (psychiatrist or counselor) and then they are either transported or cleared for home from there.

foragreatergood · Jun 19, 2014

Our ED is considering utilizing a dedicated psych RN. We have recognized that these patients are often not well managed by the "average" ED RN. Some RNs just don't understand the basics of de escalating and maintaining peace with psych pts. I would almost bet $ that a psych RN would likely have a lower rate of restraint use and be able to communicate with this population more therapeutically.

All that said, Im not sure how eager inpatient psych RNs are going to be jumping at the chance to come to the ED and work!

PG2018 · Jun 19, 2014

There would have to be a large volume of psych patients to justify the expense. Tools are great. Cheap and easy. Sadly, all facets of healthcare are directed by the dollar. I think the idea certainly has merits, but it's definitely not practical everywhere...or even in the majority of ERs in my rural land.

margaret1439 · Jun 19, 2014

We have a psych team that evaluates a pt after they have been medically cleared but the primary nurse responsible for the pt is an ER nurse not psych nurse.

NurseStelri · Jun 24, 2014

Thanks everyone for your replies. PsychGuy you are correct, my hospital definitely has a large number of psych patients as out psych unit is almost always full. I asked around a bit and I guess my hospital has tried twice to implement psych nurses to come down from the floor and work with us in the ED but it "...never quite got anywhere." And I suspect it's because of all the reasons stated here. Ultimately I think I'm going to go into a different direction with my capstone/project Back to square one!! haha

PG2018 · Jun 28, 2014

Thanks everyone for your replies. PsychGuy you are correct, my hospital definitely has a large number of psych patients as out psych unit is almost always full. I asked around a bit and I guess my hospital has tried twice to implement psych nurses to come down from the floor and work with us in the ED but it "...never quite got anywhere." And I suspect it's because of all the reasons stated here. Ultimately I think I'm going to go into a different direction with my capstone/project Back to square one!! haha

Hey, I'd love to be detailed to an ER and help out when needed. The position sounds ideal. Do psych. Be in the ER. Potentially help out in the ER with stuff worth helping out on, i.e. not having to see all the crap that comes into an ER, and being sort of loose and floaty. The single most element I find most distasteful about nursing is that once you're hired into a job you're stuck there. I came from a previous career where I had an office, a vehicle, my own budget, and a lot of independence. It makes for long shifts being "stuck" without being able to leave.