Dedicated Psych Nurses

[LoveMyBugs, BSN, CNA, RN]

How do your psych pts flow through your ED?

Our management is considering hiring a psych only nurse for our department to manage our pts.

Problem for us is we are pediatric 20 bed ED and only 3 beds dedicated to psych which sometimes we have 0 psych and sometimes up to 8-10.

We requested that we have a core group of nurses willing to have extra training to work more primarily with that population.

Thankful management is willing to hear us out and get some input

Wondering what other smaller EDs do with psych?

I am sure bigger EDs with separate pods could afford staffing with psych only trained nurses, which is where I think management got the idea.

Wondering what other smaller EDs do to make the ED stay easier for this population of pts?

[jdub6]

I must admit I have no experience with this scenario, but I want to say I think it is an EXCELLENT idea to have specially trained nurses who are interested in psych deal with the psych patients. Personally, I find myself with very little patience for borderline-types and no confidence dealing with aggressive psychosis. And I know I have heard many other nurses complain about dealing with psych issues on med floors. Since you will inevitably see psych issues in the ed I can't see a negative side to soliciting volunteers who are interested in psych to be trained to deal with it. Better pt care and satisfaction, and happier nurses.

In a small unit I would imagine these nurses would have to be cross trained, taking care of the med/surg pts unless a psych assignment was available and you would need a certain number so you would at least usually have one on staff-but if you can create a schedule so there are always triage-trained nurses, trauma-certified nurses, charge nurses, etc on duty I would think this would be a viable option. I would NOT want to require anyone to do it, so if too few current staff are willing perhaps they could add this to their posted open positions and give hiring preference to those with interest?

[buckeyeRNED]

I've heard discussion of this in my departent, but I'm not sure it will ever actually happen. We get very bogged down with psych patients at times. The other day, we had 14 psych patients, out of our 31 bed ER. I think we have a lot of system issues with the way psych patients are placed and the fact they have to sit in the ER until then. We typically have about 3-6 psych patients per day, and nobody jumps for that assignment. Personally, I've never aspired to be a psych nurse, and I think a dedicated MH RN would be better suited to handle them than I would.

[turnforthenurse, MSN, NP]

I've heard discussion of this in my departent, but I'm not sure it will ever actually happen. We get very bogged down with psych patients at times. The other day, we had 14 psych patients, out of our 31 bed ER. I think we have a lot of system issues with the way psych patients are placed and the fact they have to sit in the ER until then. We typically have about 3-6 psych patients per day, and nobody jumps for that assignment. Personally, I've never aspired to be a psych nurse, and I think a dedicated MH RN would be better suited to handle them than I would.

Sounds a lot like the ER I used to work in. 38 bed ER with 12-14 psych patients at times...and a lot of them were in holding, too. We only had 2 dedicated "psych" rooms for those patients. No dedicated psych nurse but before I left they were trying to push towards that goal. The nurse in charge of the patient would be responsible for making calls to all of the psych facilities in the area to try to find placement.

Currently in a 32 bed ER and surprisingly we do not get a lot of psych patients. I think the most I've seen holding were 4 and yesterday we only had 2 that were holding. We have no dedicated psych rooms. If the patient is a threat to themselves we get a sitter for that patient. We do not have a dedicated psych nurse.

Now where I will be working in a couple of weeks...24 bed ER with only 2 dedicated psych rooms but we have a dedicated psych nurse and MH tech that also help make the calls and facilitate placement for these patients within a psych facility if needed. I think that's fabulous.

[emtb2rn, BSN, RN, EMT-B]

We have 5 dedicated psych rooms that are in a locked pod separate from the main er. There are also chairs & recliners which allow for a total of up to 12 psych pts in this pod. There's a psychiatrist in unit m-f 8a-4p with tele-psych available all other times. The psych screenings are done (following er medical clearance) by masters level social workers with certification in mental health screening & assessment along with a psychiatrist when needed. The screeners manage placement. There are 1-2 rn's (depending on volume) and a tech. Every pt deemed a suicide risk has their own 1:1.

We all rotate through, some folks like it, others not so much. This is in a 50 bed total ed.