Do psych nurses really just hand out medication?

Energizerhoney · Jan 11, 2013

It really depends on your patient population, if its an acute u it or residential, Geri, etc. I work in a residential treatment facility. Yes, we do a lot of med passes, the therapists do a lot of work with the patients and the techs are the main "hands on" caregivers. Do I interact with my patients? Yes! I love my job. We have very few physical restraints. Psych nursing is NOT an easy job. It can go from 0-60 in a second flat...patients escalating, etc. As the RN you have to keep the unit under control, which is a lot harder than most people realize. Take 22 patients all milling about and one thing goes wrong and it can be a nightmare lol. It's a LOT of teamwork. I talk to my patients everyday. I play games with them, we watch movies, have med groups (a lot of pt's don't even know what their meds are for believe if or not or what the actual name of it is, "I need my blue pill"). So there is a lot of education that goes on. Some don't even know basic ADLs which most of us take for granted...so that's another way to interact with your patients. Some may think it's silly to teach an adult to brush their teeth or how to do their laundry! But these are some of the skills that are really important for them to be functioning members of society, and they have never been show. One of our nurses brings in beads to make bracelets with, board games, etc during the patients free times.Your patients really look up to you. They want to be treated as a person and not just someone who is nothing more than a psych diagnoses. I get cards and pictures they draw for me all the time. I really enjoy my job :)

MedChica · Jan 11, 2013

I've wanted to become a nurse since I was five-years-old, but I absolutely love psychology. I wanted to mix the two things I like and become a psychiatric nurse, but when I ask people what psych nurses do they tell me that they just push meds.

Does handing out medication and doing paperwork really comprise most of the job? I want to care for the mental health patients, talk to them, maybe do fun things with them...am I planning on going into the wrong line of work?

EDIT: I am not trying to belittle anybody or come off as disrespectful. I just want to know what exactly psych nurses do to know if it's right for me.

From what I've seen?

Only at the State hospitals and only if you're LVN.

I work geri psych. You only do the med cart in you're playing med aide for the shift. We nurses tend to work it on occasion because the HR can't find a med aide to do the job. We handle bipolar disorders, personality disorders, depression, Schizo (various types), OCD, dementia, Alzheimers, Alcohol Dts., impaired cognitive ability (people in various stages of what used to be called MR)...

Everything, mostly.

We do hospice care. We have a nurse who does wound care and trach care but it's easy to hop in there if you need to learn. The rest of us chart. Do mounds of paperwork. Peg feedings. BS/Insulin. Monitor mealtimes.

Basically, it's skilled nursing...WITH psych pts.

...and I'll be honest: sometimes, it's too much stimulation. You have to see and experience to believe it. It's not a boring job. I went to fill out applications at a regular LTC and I was weirded out by how quiet it was. LOL

It's a lock-down facility and just because they're elders? Ha! It means nothing! You hear me? Nothing! LOL

They're ornery, feisty and 80% are on antipsychs. Many don't want to take their meds, so that's an uphill battle. I've been called every name in the book. It's fine...we'll be BFFs again 15 minutes later.

We're breaking up fights and trying to simmer them down all day. We're no-restraint, too. So you really have to use your words. Therapeutic communication.

Most of the time, they're not trying to fight the staff. They're trying to beat the mess out of each other. Random things. Someone took someone's shirt, allegedly. It escalates. Someone thinks that someone else has their quarter. It escalates.

Next thing you know...two elderly ladies are in their wheelchair raining blows upon each other (or over-exerting themselves trying). LOL

Someone cuts the lights off, another tells us what he did, takes it upon herself to flip it back on and chastises him. He argues and reaches for the light. She throws a hook...and it's on!

Someone with dementia is wheeling in her wc trying to find her room and enters another by mistake. I said, "Ms ____, that's not your room!" Before I can move around the chairs, the resident in a wheelchair sees someone going in her room and takes off down the hall almost beating me to the room. I said, "Hold on, mama! Hold on -"

She yells, "Don't you tell me to hold on! I'm gonna beat the hell outta her!"

Got to the room. No one in there.

I said, "See- she's not in here. She didn't mean to come in here. She was only in your room because she was confused about where she was." She peeked in and sat there fuming. "Can you close my door please?"

I did and we walked back together. She says, "Next time? I catch her in my room? I'm gonna murder her...."

We're talking 60 and 80 year olds here.

I believe that there are probably more near falls in psych-geri than in the avg nursing homes, too. We have residents with dementia/alz. They get confused. Try to get up to go the bathroom...or go to work...or go home or ...'just because' and forget that they can't walk.

I've always heard about psych pts being doped up...but I've yet to see it. The bulk of our pts (besides their biweekly Risperdal IM) only have ativan...and it's definitely not enough to tranq a horse. We're talking 0.25 to 1 mg (with a medium of 0.5) and that's 'if' they even have PRNs.

Many don't...and I've often wondered why everyone doesn't have a 'calm-down med'.

Even the calmest pt can have a bad day and then it's just downhill from there. When I first began working there, we had a resident who was a happy little guy with bipolar dis.

Suddenly, he started refusing meds. Then his insulin. He's pacing. Eating constantly. Irritable. Called the police to the facility (to take his son in law to jail). Soliciting people for sex. Was outside in the courtyard trying to 'shower' in the rain (god's water). Threatened to kill one of the residents.

SMH

Basically...he's manic.

He was sent out and, hopefully, they can get him adjusted and back to his old self.

It's happening again with another resident. Not my assignment. She just up and started refusing meds. She's irritable, now. She's refusing insulin...and her BS was in the 600's some days ago. Her nurse (a new nurse) called her doc and he was just like, "Well, she's refusing insulin... What do you want me to do about it...?"

She said that she just held the phone, not knowing what to say. LOL

...and, believe me, we exhaust all opportunities when it comes to getting these meds down these pts. Some residents are more with it than others. Smarter. We put it in their food? They can tell. We put it in their drinks? They can tell. We have to restrict privileges (like smokebreaks) to get them to take their meds and NOT cheek.

The insulin, though, is not gonna happen. You might get a BS. Not the insulin...even if they're half-asleep and you just took the BS.

Sneaking meds, that's not what you're supposed to do, I don't think. Pt rights and all?

For about 10% of the population, this is the only method of 'medicine administration' that works.

Hey... those with psych issues tend to have compliance problems, too.

Hello? That's half the reason why they're in a psych facility to begin with. They usually have impaired insight and can't manage/maintain on their own.

"I don't need it"/"It's poison. you're trying to poison me?! you're making my hair falll out of my head!"/"I'm not sick...you're sick."/"God said I didn't have to take it!"

Even the providers tell us to 'do what we must'.

Short of holding them down and/or pouring it in their mouths, we do! If we're not sneaking the meds in their food/drink or bribing them with food/diet soda? We're doing a lot of begging. "I'm not going to leave until you take it...." Sometimes, you can wear them down. They'll get tired of cursing.

We do deceive, also. "Does your heart still hurt, Ms ____? It's your eyes? Well - do you want some eye medicine? No, we don't have drops. This eye medication comes in pill form. It's 2 pills and 1 for each eye. Do you want the two pills for your eyes to make them feel better? Ok, here you go..."

LOL

(her heart doesn't hurt and nothing's wrong with her eyes.)

She rec'vd 1 mg ativan + haldol (I forget the mg.). The rest we bribed her with pizza and diet coke to take. Positive reinforcement.

But...the goal is to get the scheduled benzo's (ativan, clonipin). Then, perhaps they'll be agreeable when it comes to taking their insulin and other meds.

Bottom line? You either want these people better and experiencing a better quality of life or you don't. The providers don't/can't do much. They leave it up to us to make it happen.

So...hey.

These ppl need their medication and, I'm sorry, but...no one's going into ketoacidosis on MY watch.

LOL

And that...in a nutshell...is what it's like to work at my facility.

It's loud.

The sun-downing is not to be believed. The day of the Super-Eclipse? The elders went bonkers. "I ain't taking no ******* pills!!!" LOL

Also? A pair of good running shoes? Not optional. LOL Much like velociraptors on the movie Jurassic Park? They case the place for weaknesses. They remember....

LOL

They're a ball, though. Even when they're raising he.ll...

Trinklee · Jan 11, 2013

Thank you both so much! I really appreciate you taking the time to inform me :)

gatigress · Jan 11, 2013

Where I have worked, we hand out medications. We hold groups, educate patients on whatever we need to educate them on. My fave educational topic is med compliance and follow-up care. I assess patients if they are feeling ill and do tons of paperwork. I spend time listening to patients and getting to know them and watch the progress of their treatment. I think it is amazing to watch patients progress in treatment and the way medication helps many people function. :) I love helping those people smile at the end of the day no matter how bad of a day they have had.

lasair · Jan 13, 2013

You know I am training to be a psychiatric nurse and from what I see it is up to you - you can do flip all for the people you are meant to be looking after or you can make one hell of a difference to their lives. It does depend on the setting that you end up working in and your way of looking at it. from what I see there is no way of defining what a psy. nurse does unless you know the type of people and setting because we take on a lot of different roles - But I love it, you need to be creative, be able to educate and be educated, willing to be a friend, go back to the basics, be organised and have fun - the joy in seeing someone progress is just simply amazing and will change who you are.

Cougar1113 · Jan 13, 2013

I am a FT Psych RN in an inpatient acute care facility that is alwasys busy. YES we do more than just pass meds! We have pts that need wound care, pain monitoring and treatment, Pts with cardiac history that sometimes run a very high bp with Shortness of breath and have to go to the monitoring floor. Elderly pts that need more assistance and care. Our "psych" patients can have an extensive list of other health problems. You have to have good nursing skills to catch stuff like this because there are times you won't see much of it for days and other days that is all you will see. Psych is not an easy field, because you not only have to deal with the medical problems but you also have to deal with the behavioral problems that can make dealing with the medical ones a real challenge. However I personally love working in psych. :cat:

4Bnut · Jan 15, 2013

I've wanted to become a nurse since I was five-years-old, but I absolutely love psychology. I wanted to mix the two things I like and become a psychiatric nurse, but when I ask people what psych nurses do they tell me that they just push meds.
Does handing out medication and doing paperwork really comprise most of the job? I want to care for the mental health patients, talk to them, maybe do fun things with them...am I planning on going into the wrong line of work?
EDIT: I am not trying to belittle anybody or come off as disrespectful. I just want to know what exactly psych nurses do to know if it's right for me.

We need good phy nurses. I have 2 daughters that are nurses. They say its just babysitting. It is NOT. This population of pts are very fragile, the need caring, epithic nurses. On a daily shift you talk with your pts, have groups, educate them on their disease etc....

Alisonisayoshi, LVN · Jan 16, 2013

From what I've seen?
Only at the State hospitals and only if you're LVN.
I work geri psych. You only do the med cart in you're playing med aide for the shift. We nurses tend to work it on occasion because the HR can't find a med aide to do the job. We handle bipolar disorders, personality disorders, depression, Schizo (various types), OCD, dementia, Alzheimers, Alcohol Dts., impaired cognitive ability (people in various stages of what used to be called MR)...
Everything, mostly.
We do hospice care. We have a nurse who does wound care and trach care but it's easy to hop in there if you need to learn. The rest of us chart. Do mounds of paperwork. Peg feedings. BS/Insulin. Monitor mealtimes.
Basically, it's skilled nursing...WITH psych pts.
...and I'll be honest: sometimes, it's too much stimulation. You have to see and experience to believe it. It's not a boring job. I went to fill out applications at a regular LTC and I was weirded out by how quiet it was. LOL
It's a lock-down facility and just because they're elders? Ha! It means nothing! You hear me? Nothing! LOL
They're ornery, feisty and 80% are on antipsychs. Many don't want to take their meds, so that's an uphill battle. I've been called every name in the book. It's fine...we'll be BFFs again 15 minutes later.
We're breaking up fights and trying to simmer them down all day. We're no-restraint, too. So you really have to use your words. Therapeutic communication.
Most of the time, they're not trying to fight the staff. They're trying to beat the mess out of each other. Random things. Someone took someone's shirt, allegedly. It escalates. Someone thinks that someone else has their quarter. It escalates.
Next thing you know...two elderly ladies are in their wheelchair raining blows upon each other (or over-exerting themselves trying). LOL
Someone cuts the lights off, another tells us what he did, takes it upon herself to flip it back on and chastises him. He argues and reaches for the light. She throws a hook...and it's on!
Someone with dementia is wheeling in her wc trying to find her room and enters another by mistake. I said, "Ms ____, that's not your room!" Before I can move around the chairs, the resident in a wheelchair sees someone going in her room and takes off down the hall almost beating me to the room. I said, "Hold on, mama! Hold on -"
She yells, "Don't you tell me to hold on! I'm gonna beat the hell outta her!"
Got to the room. No one in there.
I said, "See- she's not in here. She didn't mean to come in here. She was only in your room because she was confused about where she was." She peeked in and sat there fuming. "Can you close my door please?"
I did and we walked back together. She says, "Next time? I catch her in my room? I'm gonna murder her...."
We're talking 60 and 80 year olds here.
I believe that there are probably more near falls in psych-geri than in the avg nursing homes, too. We have residents with dementia/alz. They get confused. Try to get up to go the bathroom...or go to work...or go home or ...'just because' and forget that they can't walk.
I've always heard about psych pts being doped up...but I've yet to see it. The bulk of our pts (besides their biweekly Risperdal IM) only have ativan...and it's definitely not enough to tranq a horse. We're talking 0.25 to 1 mg (with a medium of 0.5) and that's 'if' they even have PRNs.
Many don't...and I've often wondered why everyone doesn't have a 'calm-down med'.
Even the calmest pt can have a bad day and then it's just downhill from there. When I first began working there, we had a resident who was a happy little guy with bipolar dis.
Suddenly, he started refusing meds. Then his insulin. He's pacing. Eating constantly. Irritable. Called the police to the facility (to take his son in law to jail). Soliciting people for sex. Was outside in the courtyard trying to 'shower' in the rain (god's water). Threatened to kill one of the residents.
SMH
Basically...he's manic.
He was sent out and, hopefully, they can get him adjusted and back to his old self.
It's happening again with another resident. Not my assignment. She just up and started refusing meds. She's irritable, now. She's refusing insulin...and her BS was in the 600's some days ago. Her nurse (a new nurse) called her doc and he was just like, "Well, she's refusing insulin... What do you want me to do about it...?"
She said that she just held the phone, not knowing what to say. LOL
...and, believe me, we exhaust all opportunities when it comes to getting these meds down these pts. Some residents are more with it than others. Smarter. We put it in their food? They can tell. We put it in their drinks? They can tell. We have to restrict privileges (like smokebreaks) to get them to take their meds and NOT cheek.
The insulin, though, is not gonna happen. You might get a BS. Not the insulin...even if they're half-asleep and you just took the BS.
Sneaking meds, that's not what you're supposed to do, I don't think. Pt rights and all?
For about 10% of the population, this is the only method of 'medicine administration' that works.
Hey... those with psych issues tend to have compliance problems, too.
Hello? That's half the reason why they're in a psych facility to begin with. They usually have impaired insight and can't manage/maintain on their own.
"I don't need it"/"It's poison. you're trying to poison me?! you're making my hair falll out of my head!"/"I'm not sick...you're sick."/"God said I didn't have to take it!"
Even the providers tell us to 'do what we must'.
Short of holding them down and/or pouring it in their mouths, we do! If we're not sneaking the meds in their food/drink or bribing them with food/diet soda? We're doing a lot of begging. "I'm not going to leave until you take it...." Sometimes, you can wear them down. They'll get tired of cursing.
We do deceive, also. "Does your heart still hurt, Ms ____? It's your eyes? Well - do you want some eye medicine? No, we don't have drops. This eye medication comes in pill form. It's 2 pills and 1 for each eye. Do you want the two pills for your eyes to make them feel better? Ok, here you go..."
LOL
(her heart doesn't hurt and nothing's wrong with her eyes.)
She rec'vd 1 mg ativan + haldol (I forget the mg.). The rest we bribed her with pizza and diet coke to take. Positive reinforcement.
But...the goal is to get the scheduled benzo's (ativan, clonipin). Then, perhaps they'll be agreeable when it comes to taking their insulin and other meds.
Bottom line? You either want these people better and experiencing a better quality of life or you don't. The providers don't/can't do much. They leave it up to us to make it happen.
So...hey.
These ppl need their medication and, I'm sorry, but...no one's going into ketoacidosis on MY watch.
LOL
And that...in a nutshell...is what it's like to work at my facility.
It's loud.
The sun-downing is not to be believed. The day of the Super-Eclipse? The elders went bonkers. "I ain't taking no ******* pills!!!" LOL
Also? A pair of good running shoes? Not optional. LOL Much like velociraptors on the movie Jurassic Park? They case the place for weaknesses. They remember....
LOL
They're a ball, though. Even when they're raising he.ll...

OMG do we work together lol! I'm an aide while in nursing school! Nikes! Essential!

OMG

macfar28 · Jan 27, 2013

I work in an 80 bed free standing acute care behavioral hospital. Our average length of stay is 5-7 days. I'm based on our adult unit which has 50 beds and I do pass meds often but there is much more to it! I spend time with my patients, actively listening and supporting them. Some shifts I do feel more like a waitress than a nurse (just with the frequent needs/requests) but at the end of the day, I know I am helping them.

As far as charting goes: we recently went to elctronic medical records only which actually increased our number of assessments (tabs to chart on) but it is not to the point where I am trapped at a computer.

It sounds like this is the perfect career choice for you. Best of luck!

lindaholder · Oct 29, 2014

I am a new psych RN and I have to do a med education for a group tomorrow and feel kind of overwhelmed. I noticed you said that you like the topics med compliance and follow-up care. What and how do you structure this for presentation to the group. I work at an outpatient facility and the patients come 5 days a week for 6 hours a day and I think this may be a good topic for them.

thanks

Meriwhen, ASN, BSN, MSN, RN · Nov 1, 2014

I know this is an old thread, but OP: look through the other threads in this form and you'll soon learn that psych nurses are far from just medication dealers :)