Any Psych Mental Health nurses out there?

allnurses Guide · Nov 13, 2017

A fay in the life of Psych nursing - I love my job but it's very different from most nursing jobs. To do it well you have to have very good time management skills and an even temperament Nurse patient ratios are about 1: 15/17 I rarely have less than 12 patients. I work 8 hour shifts. I arrive, take report, do a headcount and room checks for contraband items and hold a community meeting. During this time I am also performing my initial assessments based on how the patients react to these activities. I have a psych tech or LVN to pass my medications. I meet with patients to complete my assessments. I attend Probable Cause and Reisse Hearings. I accept direct admits deemed to inappropriate to sit in the admitting department. I do discharges. I talk to relatives and parents and doctors all day long - then I give report and go home. I do a lot of heavy lifting but I do jump in on situations where patients become aggressive. I have been yelled at, called every vile name in the book, spit at, and patient's occasionally try to bite.

It's fun and I love it but it's not for everyone.

Hppy

pixierose, BSN, RN · Nov 13, 2017

It's interesting to note the differences, even between psych floors.

I arrive, take report (usu. 8 patients), and check in with various lab work (med levels, INR, CBC, BMP, etc) and tests recently done. Then I meet up with those folks (check in with their moods, do a suicide risk assessment for those identified with SI, do a focused assessment i.e. Respiratory, cardiac are the usual, etc).

Med administration takes some time.

I run a group in the evening.

I do a lot of admissions.

Room checks - every 15 minutes. Check in with my 1:1s.

Like Hppy, I talk all day long ... with patients, with families, with doctors and caseworkers. Our docs stay on the floor (which is really nice).

Lately there have been a lot of restraints needed on my floor, so there's quite a lot of moving, lifting, etc.

I definitely get yelled at, or a patient tries to argue with me (usually RE: meds ... they either want more or don't want them at all).

I complete the flowsheets, my notes, give report and punch out.

I enjoy it. It's a good mix of both medical and psychosocial.

Nature_walker, ASN, BSN, RN · Nov 13, 2017

I'm in psych ED. I punch in, get report, start triaging and med passes. Once that's squared away, I start verifying all the meds for my pts with their pharms. Get meds ordered. Our docs also live with us, so that's the easy part of my day. Deal with crisis as they occuring during all this. Help with restrains, help my techs if they need it, walk around the milieu to be present. Milieu management is a big thing for us. Then go back back, do triage or evaluations if I'm asked. Writer up shift notes on my people, hand off report, clock out. Wash, rinse, repeat the next day.

My unit is not equipped to deal with medical, that's why we are part of the ED, we just wheel them back over if there is a medical problem. We are straight up just mental and behavioral health. We are more or less just a waiting room for the ED, so we don't spend a lot of time with our pts. They either come into the hospital, or get sent back home after they get evaluations from our docs.

Like Hppy, I do a lot of talking during my day. I enjoy it a lot. It's a different world over here, but no day is ever the same! I have also done some in pt and that is a great change since I get to spend time with my pts and really get to know what is going on with them. I love the fast pace of the ED, but it's also really nice to sit in group and get to work with them in that setting too!

Lisacar130 · Nov 15, 2017

Day shift gets 5-7 pts, nights get up to 15. It's super easy compared to medical. No IV's and everyone's medically cleared before they are are accepted. I have also noticed there is a lot less pressure for good customer service, as it's a different clientele and you have to do limit setting. There is no catering to anyone.

B52, ADN, BSN, MSN, RN · Nov 16, 2017

I work night shift, 7-7, and the ratio varies. I might have to chart on anywhere from 2 to 6 patients in addition to med pass, admissions, chart checks, and phlebotomy, but I'm responsible for all patients on the unit. We have 10 patients on the geriatric unit, 17 on the mood disorder unit, and 18 on the thought disorder unit. There are usually 2 techs and 1 nurse on each unit. On rare occasions we have 2 techs and 2 nurses. We have to be vigilant in making sure deadlines are met for having involuntary patients sign voluntary, and for physicians completing the first and second opinions for patients who are involuntary. We deal with aggressive patients often. I've been punched, scratched, and called names, but never seriously injured. We frequently get patients who should never have been medically cleared, and sometimes they code. Psych nursing is frustrating at times, but I do like it.

Poofy7 · Nov 17, 2017

Day shift gets 5-7 pts, nights get up to 15. It's super easy compared to medical. No IV's and everyone's medically cleared before they are are accepted. I have also noticed there is a lot less pressure for good customer service, as it's a different clientele and you have to do limit setting. There is no catering to anyone.

Have you worked on a medical unit? You said it is super easy, but sounds like the night shift patient to nurse ratio is quite a lot for the nurse.

Poofy7 · Nov 17, 2017

I work night shift, 7-7, and the ratio varies. I might have to chart on anywhere from 2 to 6 patients in addition to med pass, admissions, chart checks, and phlebotomy, but I'm responsible for all patients on the unit. We have 10 patients on the geriatric unit, 17 on the mood disorder unit, and 18 on the thought disorder unit. There are usually 2 techs and 1 nurse on each unit. On rare occasions we have 2 techs and 2 nurses. We have to be vigilant in making sure deadlines are met for having involuntary patients sign voluntary, and for physicians completing the first and second opinions for patients who are involuntary. We deal with aggressive patients often. I've been punched, scratched, and called names, but never seriously injured. We frequently get patients who should never have been medically cleared, and sometimes they code. Psych nursing is frustrating at times, but I do like it.

Wow, 1 nurse for each unit! How does that work? I work on MedSurg and I get 5 patients max cause we are very busy.

Lisacar130 · Nov 17, 2017

Yup, I did 10 years of medical before going into psych. I know 15 patients sounds like a lot to a med/surg nurse, but honestly it is easy. At least it is where I work. I haven't seen a code yet on my floor, our ER great about really making sure they are medically stable. I have maybe 5-7 patients a year who I have to help go to the bathroom or need help with a brief, as they are almost always independent. There are more admits, I must say, but I can do it in under 1 hour... with usually NO distractions. They are medically stable so it just doesn't take that much time. The most "nursiest" thing I've done was I had to straight cath a younger guy once.

It depends on the unit and the staffing, but I can only speak to my own experience.

Poofy7 · Nov 17, 2017

Yup, I did 10 years of medical before going into psych. I know 15 patients sounds like a lot to a med/surg nurse, but honestly it is easy. At least it is where I work. I haven't seen a code yet on my floor, our ER great about really making sure they are medically stable. I have maybe 5-7 patients a year who I have to help go to the bathroom or need help with a brief, as they are almost always independent. There are more admits, I must say, but I can do it in under 1 hour... with usually NO distractions. They are medically stable so it just doesn't take that much time. The most "nursiest" thing I've done was I had to straight cath a younger guy once.
It depends on the unit and the staffing, but I can only speak to my own experience.

So what is the bulk of your tasks if not medical? Is it a lot of charting or therapy sessions?

B52, ADN, BSN, MSN, RN · Nov 17, 2017

It's not that bad because most of the patients sleep at night. We also have one nurse working 11-11. She does admissions when we're doing meds and she helps out if there are no admissions. The charge nurse also lends a hand when needed.

Lisacar130 · Nov 17, 2017

I work 11p-7a. We do some quick auditing, usually in peace and quiet. They usually are sleeping where I work by the time I get there. We are not supposed to wake them up at night where I work and if they sleep all night we do not wake them up in the morning (except the techs do vitals). The night shift charting therefore is minimal where I work. We do some goal charting in the computer but that is fast. The morning med pass (6-7AM) is very fast, even with 15 patients, because they are almost always independent and there aren't any IV's or anything else to do with them usually except for giving them their meds. Having a PT with a central line is rare, maybe a couple times a year for the entire unit. We are adult psych (18 and over) not a geriatric psych, so that makes it easier. I have heard that working with teens is more challenging.

If I don't get an admit, I'm done with my auditing and charting by 12:30-1:00am, depending on how many patients I have. Then I go online and google for the rest of the night until the morning med pass. If I get an admit, it is much easier than on medical. I sit in a chair in an office and they sit in a chair next to me. Most of the new admits have the same routine orders... so getting orders for new admits is easier too. It's just easier. I haven't worked during the day or evening so I can't say what that is like.