Could someone paint a picture for me, please?

Mandychelle79, ASN, RN · May 25, 2014

I have been trying to get a better sense of a psych nurse's job, but have been finding more abstract answers rather than how the day is spent.

Punch in, get report, enter unit, say hello to the patients I see, make the assignment sheet, talk to my 1:1, assesses my physical assessment patients, call the doctor, take off orders, enter orders, admissions, discharges, argue with the ER, take triages, redirect patients, put out small fires to prevent an inferno.

I work in LTC and I'm finishing a bachelor's in nursing. Im wondering how many patients a psych nurse is responsible for and what is the majority of your day spent doing?

Depends on the census and how the unit is staffed that day. It also depends on how the unit is run. We have a med nurse who gives meds to all the pts, so if we have 24 pts, she passes meds on 24 pts, if we have 18, she passes meds on 18. Last night I had 4 1:1, 4 physical assessments ( so charting on 8 pts) and then had an admission. I also assigned myself to 2 hours of checks. Oh and the dr made late rounds so had to deal with that too.

Do you often have to stay late?

Define often and how late do you mean. Im usually out within 15 mins of my scheduled ending time, but if we have a night where I have tons of admits and throw in a restraint and im leaving late. My coworkers are awesome though and will do whatever they can to help me get out of work earlier.

Do you feel understaffed or unreasonably unsafe?

Understaffed at times, on more like not the right type of staff. When we get a float most can only do certain tasks but the matra a body is body seems to be prevalent. Unreasonably unsafe, no. I can count on one hand the number of times I have felt unsafe on the unit and have fingers left.

Would you say you're compensated fairly and/or feel you could advance your career in psych nursing?

I make the same as the nurses nurses at the hospital with my experience. The benefits though make up for the lower than average pay. I can send my kids to a well known school in the area I live and only have to pay half price for their tuition. And my health benefits for my family are less that what I paid for myself elsewhere.

I don't know anyone personally who has worked in a psych hospital so I am hoping to gain an understanding to compare it to my current job.

Mandychelle79, ASN, RN · May 25, 2014

Oh and I worked LTC for 6 yrs prior to going to psych. The staffing ratio will seem like heaven to you and imagine your worst acting dementia patient, medicated.

That is one thing with the unit I work on that is so different from LTC ( where my mom works). Haldol 5 and ativan 2 is routine, my mom freaks with .25 of ativan and .5 of haldol.

spiderslap · May 26, 2014

Thank you very much for your responses!

Meriwhen, ASN, BSN, MSN, RN · May 26, 2014

Let's see, what do I do?

Get report; meet and greet my patients; perform both mental status AND physical assessments; help maintain the milieu; take provider orders; provide medications; provide education on medication, psychiatric illnesses and coping skills; admit new patients; assist patients with discharge planning and discharge patients when ready; transfer patients to higher/lower levels of care as needed; sit on 1:1s; deescalate patients including (if necessary) the use of emergency psychotropic medications, seclusions and/or restraints; deal with families when they visit/call; sit in on and participate in certification hearings as necessary.

Do I stay late?

No.

Understaffed or unsafe?

CA law limits me to 6 patients come hell or high water; I frequently have fewer than that. However I don't always have a LVN working the meds for me, and the tech is doing rounds, so most of the time I'm doing primary care nursing for those 6 patients. I don't feel unsafe because I and the rest of the staff have been trained in deescalation and crisis intervention techniques...however I also don't feel unsafe because I never let myself become complacent. I am always aware of my surroundings and patient conditions, and I act prudently at all times, even when things are calm and under control.

Compensated fairly?

Very. Again, it's California: land of unions (a mixed bag FWIW) and some of the highest wages in the country. In my first job not in CA, I was not fairly compensated.

Advancement opportunities?

Lots, both within and outside of psych. I'm choosing to remain in psych because I find it's more fulfilling and I get to interact more with my patients than in medical settings--I'm not a glorified waitress that is ruled by the call bell and overbearing family members. Where I am in CA has a LOT of employment and career opportunities in psych. Where I was living prior to this (again, not in CA), there were a handful of psych places to work at and I felt more limited.

vintagemother, BSN, CNA, LVN, RN · May 27, 2014

I'm still pretty new to psych and I'm a new grad. Ive been working in a psych facility for about 6 weeks.

how many patients a psych nurse is responsible for

On our long term psych rehab Unit, We have over 50 residents at capacity and we are almost always at capacity.

On our acute (72 hr or 2 week hold) unit, we have capacity of 16. Always full.

and what is the majority of your day spent doing?

On the long term side, passing meds/administering injectable meds, doing Tx, doing FSBS and giving insulin and PRNs takes up a big portion of the day. But the morning shift has 1 big med pass in the morning and a much smaller med pass at noon. All of your work is done by noon which leaves the rest of the day to give PRNs, order refills, etc. The noc shift is kind of like the morning shift, except the meds are tx are given in the morning just before we get off.

On the acute side, there can be 2-6 admits or discharges each day. I haven't worked on this unit without an oriented yet, but the med pass takes a minimal amount of time, but charting is q-day, so each day, I chart on about 6 residents. Medication changes occur daily (M-F) as well, so a lot if time is spent updating the MARs, updating the charts and ordering new meds. Even with all of this, there's a lot of down time from what I've observed.

I wish I could say I spend time with the clients, but depending on my shift, this doesn't get to happen very often. I love when I have the time to do patient teaching, which is a part of our "care plan" updating process.

Do you often have to stay late?

I only stay late on the LT side after PM shift because I'm new and my 2 med passes can take up the entire shift. Because I want meds given on time, my charting/documentation is what made me late. This is not the norm and the experienced nurses get the passes done with an hour or 2 extra after they're done with all the required tasks.

Do you feel understaffed or unreasonably unsafe?

I love my facility because I never feel understaffed or unsafe. We have a great team of aides as well as adequate staffing provided by our DONs. They staff a Charge nurse on the floor to assist with paperwork, doctor communication, assessments, admits, etc on the acute unit and we have an extra nurse on the long term side to assist with the same sorts of things.

We are also taught ways to stay safe. There are mandatory classes provided on how to physically restrain, we aren't supposed to enter resident rooms without another staff person and someone is always around to help. We learn how to position ourselves so we're not backed in a corner, the Aides are at our side when we pass meds, etc.

Would you say you're compensated fairly and/or feel you could advance your career in psych nursing?

I very much feel I'm compensated fairly. This job pays better than my first new grad job. I make more than some of my friends who've graduated and work in SNFs, but some make more than I do.

I'd love to advance my career in this field. It's very interesting to me, all of the different components that go into helping the clients fascinate me, I love the interdisciplinary process of addressing all the clients needs as a person--behaviors, meds, therapy,, groups, rehab, etc. The mind interests me greatly, as well. I just want to soak it all in and learn more alm the time!