What's a typical day like for an RN working in an acute mental health hospital?
May 12, 2007
no such thing as a typical day in mental health
May 17, 2007
Expect the "unexpected" because you never know what's going to happen and you have to be prepared for anything. Any patient can go off at any time and you have to be up for the job. Expect numerous admissions and discharges. Expect noise and chaos along with lenghty paperwork. There are many meds to pass and many patients to talk to. Plus several calls to the doctors. I think psych is the more difficult than the Med/Surg but I do like it better despite the challenges.
Has 3 years experience.
May 22, 2007
I do 12hr shifts. Anywhere from 5 to 8 patients per shift. Typically I go in for 7:30 on a day, take report, do a round on pts, start meds (if I'm on morning meds). That takes me to first break around 9:00. I get back, start seeing patients, start charting. Consult with psychiatrists and others on pts, takes me to lunch. After lunch more rounds and talking with patients. Giving prns and checking on pts throughout the day so far. Also may have had an admission/discharge/transfer to document. That takes a while. Crisis intervention in the mix for good measure. Doing orders as well. Afternoon can bring some quiet time depending on how people are doing. Time to read more in pt charts/old charts. Supper time! After supper, I usually do a last walk around to chat with folks, be sure they're ok and had any concerns addressed for the day. Do my final charting, write in report for the charge nurse to tape, check narcs, etc...hurray, I just survived a day in psych.
One glaring omission from my day, we don't do care plans. I guess that's unheard of, but they apparently stopped doing them a long time ago, found things were too unpredictable to plan. I wanted to develop interdiciplinary care plans, but it seems like a monumental task.
EDIT: Get notified that your temp position is up in a month, so better find a new job...:-(
May 25, 2007
Thanks for the info! I'm also curious what a day in the life of a Psych NP is like... I know there are many different environments, but if any of you have perspectives on this it would be appreciated!
May 26, 2007
I think I love psych nursing because no day is ever "typical". I'm in acute inpatient, and some days I look back on the day and think "wow". My last shift went something like this:
Handover, medications, meet and greet patients, check their environments for safety etc.
I was the ECT nurse for that morning, so up to theatres and into scrubs to assist with the ECT. Only one patient that morning, a woman with postpartum psychosis who believes with all her heart that she has killed her baby...she hasn't. Return to ward. When she is awake and stable post anasthetic, encourage her to shower, do her hair and sit in the sun for awhile. The seizure was excellent and I managed to get some IV fluids pushed through before she woke, so she is feeling good. Broach the subject of seeing her baby. She is starting to understand that she hasn't killed the baby. She talks about the devestating loss to stillbirth the previous year and we talk about that as a contributing factor to the onset of depression. She is not ready to see the baby yet and I let it rest.
A new admission - a terrified young woman with her first psychotic episode. She believes she is being photographed in the nude and clutches her coat tightly around her. A tearful call from her father and I arrange an family meeting with her, him and me later in the morning.
Followed around unit by man who assaulted me last week but who now thinks he's "in love" with me. Have to playbad cop and be very firm with him. Have been stalked one too many times and know this is what the best approach is. He becomes angry wanting me to say I am his girlfriend - I disengage.
Called to the assessment wing to see an 11 yo boy who I obviously cannot admit, but who I must figure out what to do with. He is in the back of the police wagon and the wagon is rocking..he is throwing himself against the inside walls. 3 cops don't know how to get him out without hurting him. Children's services come and they try to cajole him out. Decide to do the "mother" voice ... commanding... after 10 minutes he is at least listening. Then engage him in conversation throught he glass about his fake tattoo and the ninja on his shirt. He walks to the assessment room and we begin a couple of hours of tantrums etc. He discovers the code black button and learns that if he presses it people come running. Eventually find a unit suitable for him and he is taken there.
Family meeting with father and daughter...some education about psychosis and informing them both that she will need to stay with us for awhile. She begs her father to take her home, she is frightened. He is frightened. Wipe both their tears. Encourage him to sit outside her door while she showers, so she feels safe. She likes this idea.
Do a little DBT with a borderline lady in for a short stay. Go through some distraction techniques...disengaging when she is acting out, doing some planned engagement. Another woman absconds out the front door and heads for the traffic (followed a visitor out). Set off on foot at full speed. Call a code and have some assistance to bring her back to the unit.
Do some bed juggling to make way for new admissions. Attempt to do some reporting. Hear shrieking from afar and go to find out what is happening. There is a fight between two young males that needs breaking up and it is causing nearby females to scream. Quickly settled. Administer a couple of depots, take some bloods, make a few calls to pharmacy, case managers etc. De-louse another headlice victim. Do some obs.
Run to code alarm - a woman who is attempting to rip her arm open with a ballpoint pen. Extract pen, medicate, move to HDU for time out, some more DBT to do. Have a patient accuse me of stealing her underwear..."I can see right through you, I can see you are a liar" she says. Attempt to explain to a pt WHY he can't smoke, chew nicotine gum and wear a nicotine patch at the same time. Get call from chemistry saying a young Clozapine pt has a CK level of 640. Tell them to get a Troponin, check young man for NMS symptoms, then find doctor and ask, "would you like a Troponin"..thankfully she says yes as I've already organised it! lol Do an ECG, find some bundle branch blocking and report it to doc.
Hurridly try to finish some reports, interrupted constantly by requests for cigarettes, leave, someone wanting to look at the contents of their lockers, phone calls, patients coming to the window "just to chat" about various delusions. Reiterate to a young man why he can't ring his mother (she has a restraining order against him) ... he won't let up, perserverating ++. Think, "boy it must be lunchtime"...look at my watch and realise that the shift is almost over in a few minutes.... another day gone! lol
I love psych nursing.
May 29, 2007
wow, thanks so much for your reply! Glad to hear from someone who's so happy with their job. I'm curious -- what training did you get to have the skills that you have? You mentioned DBT -- do you have a masters in nursing or something else? Thanks!
Jun 1, 2007
No, not at all. With the DBT, I have a little training...just inservices etc, and have the workbooks etc. But mostly it is just experience, knowing particular patients well, knowing what works for them. Most of our borderline patients have pretty great management plans already in place, which are formulated over a period of time by their whole treating team, using DBT principles as a foundation. The sessions they have with me as an inpatient are just very short, simple versions of what they would do in the community, so they are getting the same kind of messages consistently whether in or out of hospital.
Jun 6, 2007
wow, very cool! I'm starting my program this fall, so it's interesting to hear perspectives from ppl who are experienced. Does the RN coursework tend to include stuff on psychosocial issues, or is that saved for the on-the-job training? This is for everyone: do most psych nurses work in acute inpatient units? thanks!
Jun 7, 2007
I'm sure the undergrad coursework varies from place to place, but when I was at uni, there was relatively little offered. It wasn't until I started working that I began to really understand the place of the psychosocial. However, use your clinical placements -- there is much to be learned there!
Psych nurses work everywhere -- not just acute. They work in rehab, drug and alcohol units, forensic units, out in the community, in the ER, privately...in youth and adolescence, adult, older persons, eating disorders...all sorts of places.
Best of luck!
Jul 8, 2007
I just read your post. I am interested in Psych nursing and your account of an average day is facinating!!!! I'm currently taking my Prereqs and I hope to apply to two nursing programs in the fall for fall 08". I've always been interested in Pysch and caring for and helping people with disorders of the mind my whole life. I can't wait to get started. I'm a 37yr old male and this is second career. It's alot of work but I love it. Thanks for insite into your world. CAN"T WAIT!!!!!!!!
Well best of luck as you study! We always need new nurses in mental health ... it is not for everyone, but if it is for you, you know it :-)
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