Beyond Meds and Charting

yea, in nursing school we students did all the talking, the MHP's did the groups, and the R.N.'s did meds, charting, and takedowns.

I think a lot depends on the facility where you work, the typical pt length of stay, how many patients you have, how much time is spent doing admits and discharges, what shift you work, and how you approach your shift in order to make time to talk with patients. During the day, patients are often in groups or nurses are sitting in when the docs see the patients. During night shift, you have a limited period of time to do meds and assessments before patients go to bed. Although I work nites, I make time to talk to patients when I feel I can make a difference, when they are awake at night and I have extra time, and of course when they are agitated and I want to attempt to deescalate the situation through discussion rather than resorting to meds/seclusion/restraints. From your post, I would suggest you consider a less acute unit such as a VA long-term stay unit, substance abuse units, or units that more oriented to suicidal patients than psychotic ones. You might also consider working days or eves on weekends, as many units are less structured at those times so that you have more access to the patients. You might also consider working at a mental health clinic.

I'm learning the art of therapeutic communication during med pass. =P I've been working as med nurse. I talk to people all day long; i just need to make it count. I was extremely disappointed starting this job due to lack of time for patients. I'm slowly building at making it work. There are days when I feel like all I did was jockey meds and do paperwork, making a difference to none. But there are also days, when I feel like my patient interaction enlightened both me and my patient. Thinking about it, I managed some pretty good conversations with patients today amidst mostly just passing meds. I think part of the art of nursing is managing to have and relish meaningful patient interaction despite being overworked and exhausted.

I don't do therapeutic communication the way it was taught in nursing school. Agree with inthesky, you often pick your moments while doing other tasks to have meaningful interactions with those who are capable of it and are willing to address issues. Some days you don't have those patients. While I enjoy those interactions immensely, I also greatly enjoy the challenge of working with the more disturbed patients.

With regard to the various therapy groups that the patients attend in a longer term setting...do R.N.'s play any role in them?

Ideally what I'd like to do is to be able to talk to my patients on a regular basis. I don't want to have to wait until a crisis situation arises before I intervene. I'd like to help them work on coping skills, listen to them, help them come up with new ideas, etc.

Am I in the wrong profession? Or do I need an advanced degree in nursing in order to carry out the functions I listed? Essentially...I want to feel like I'm making a genuine difference and that I'm making real connections.

I really liked the previous posters ideas about taking advantage of med administration to touch bases with the patients. I also liked the suggestion of working day shift and in a longer term care setting. I know that short term facilities are pretty much all about stabilizing them on meds and getting them out the door with a few referrals. Not my cup of tea. I'm a hands on person.

I want to get down in the trenches and do the hard work. Any more ideas? Or am I being naive?

we as RN's must talk and assess our pts. q shift....usually about 20 min. we also talk and get feedback during treatment team meeting, groups, and other times as well...yes, there is quite a bit of communication with our pts., some days more than others, depending on what other medical emergencies you may have, how many admits, how many discharges...it varies, but yes, we do have good therapeutic communication with them....

we as RN's must talk and assess our pts. q shift....usually about 20 min. we also talk and get feedback during treatment team meeting, groups, and other times as well...yes, there is quite a bit of communication with our pts., some days more than others, depending on what other medical emergencies you may have, how many admits, how many discharges...it varies, but yes, we do have good therapeutic communication with them....

Thanks for the information! I know that there is a big difference between nursing school nursing and real life nursing...I didn't want to fool myself into thinking that I was going to be able to do what I love doing just to find out my role is 80% charting/giving meds. I could do that on med/surg. I happen to like the psych population though.

Do you happen to know if R.N.'s regularly attend group therapy with the patients during the daytime? Seems like that would be a good time to assess what is going on with them. If so, do we ever lead the groups?

Thanks so much for the feedback!

Thanks for the information! I know that there is a big difference between nursing school nursing and real life nursing...I didn't want to fool myself into thinking that I was going to be able to do what I love doing just to find out my role is 80% charting/giving meds. I could do that on med/surg. I happen to like the psych population though.

Do you happen to know if R.N.'s regularly attend group therapy with the patients during the daytime? Seems like that would be a good time to assess what is going on with them. If so, do we ever lead the groups?

Thanks so much for the feedback!

Yes we can lead the groups....we do unless we are bombarded with new admits then we can ask a MHT to lead the group...I like to do that myself because you get so much info at that time..we do goals groups, med-ed groups, coping skills, anxiety/depression, etc.

We also attend their individual tx. plan meetings with psychiatrist and therapist....that is a very good, thorough meeting to gain much understanding of the pt. :heartbeat hope this helps...

i would have to add that as RN's we do not give the meds, the LPN's do that, so we have more time with pts. I would guestimate that about 30-40% of my shift is charting and other paperwork...

I actually have very similar goals. I'm actually planning on going back to school to get a psychiatric DNP. I feel like I will have more freedom and autonomy in what I do. Maybe I'll work as a clinical NP. Maybe I'll get licensed to do therapy (which is what it sounds like you want to do). Unfortunately, in my unit, the RNs don't run groups. The BHTs or therapists run the groups. I'm definitely not yet where I want to be, but I am finding ways to make what I have work for me and my goals =).

It sort of sounds like you want to be a psychotherapist, not a nurse. I work nites, and only spend 1 - 1.5 hours of my 12 hr shift on meds. There are nites I spend hours with my patients as I have the time and they are unable to sleep, and need extra staff support due to agitation or fall risk or other issues. While I learn a lot about the pts at those times, I have to be crafty to turn our conversations into meaningful ones. Many psych patients are not capable of the depth it sounds like you want. Again, maybe a mental health clinic or the longer-stay open unit at the VA would be good options to consider. When I was in clinicals, it appeared the RN on the VA open unit had tons of spare time and those pts would be more able to work at a deeper level. You might also consider CM in community health, as those jobs could involve group therapy, individual education, and home visits.

Actually when I had my three-month "so how is this job that you chose out of nursing school?" my response was "Seriously? A lot more paperwork."

Depends on what happens during the day, a patient visitor who isn't stable themselves ended up with 2.5 hours of paperwork and meetings with four different people to recount the event, make sure we were in the legal right, etc. (BLERGH!) or they're ill and need to go to ICU and you really can't focus on anything but getting/keeping them stable until there's a bed or an admission, I think our last count for paperwork was 34 pages and that definitely ties you up for at least an hour and a half, and that if they're communicating appropriately and you don't have to hunt down old charts or their auntie Mertle to get an idea of their history!

I'd say on a regular day, though, I get about 10-20 minutes per pt. to talk to them and get a good idea about how they're doing. We do a community meeting once per shift and we're to have an RN in those, and I always try to go because it helps a lot - are they agitated sitting still? What's their affect? Are they responding appropriately to questions? etc. We've been trying to develop nurse-led groups but they haven't been happening much - which is too bad, I liked doing them.