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For all the night shift Psych Nurses...

Posted

I just resigned from my med-surg oncology position after 8 months due to pregnancy complications, but after the baby is born, I was really thinking about applying to work in this psychiatric hospital in my town. The shift would be perfect so we wouldn't have to put our baby in daycare from 6 pm to 6 am, but my question is...

Can you describe what a "typical" night shift is for you? I realize psych is most likely NEVER typical and always different, but ideally, how should your night go, perhaps as far as charting, med pass etc?

I've never been on a psych unit at night time and am so curious! THANKS SO MUCH!:D

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

Typical 12 hour MN shifts duties:

Visitors

HS meds

Documentation

Admissions

Dealing with behaviors

MARS reconciliation

Chart stuffing

Sound boring? Unstimulating? If you're ready to check out of the Mainstream, this too could be a career choice for you. I made the change and haven't looked back.

I am excited! I just hope a position is still available in six months or so...I'd love the environment change!

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

If you're expecting quiet nights that you can breeze through...you're not going to get them in psych :) A lot of nights are on the peaceful side, and a lot of nights are as busy as the daytime. Discharges are occasional--you will get far more admissions, often TDOs or transfers from ER/hospitals. Some patients, particularly the psychotic and the sundowning elderly, seem to come alive at night to keep you entertained.

After bedtime, the meds during the night shift are largely PRNs or orders you have to call for. There is more admin stuff: audits, reconciliations, preparing files, etc. Charting is just like you'd chart for the day...if you're lucky, a lot of your notes will be "Patient resting with eyes closed."

It's definitely different and definitely interesting, but there are some risks depending on your specific patient population. I'd suggest you try to get a PRN/per-diem position in psych first just to sample it and see if it is something you could be happy doing.

I usually work 11-7:30. We do...

Charting... usually minimal because we only chart on issues that come up during the night

Stuffing charts

Doing rounds

Checking orders

PRNs

Passing AM scheduled meds

Prepping patients for AM procedures

Admissions

Putting out fires/contacting MDs for said fires

And if we have time, cleaning/stocking.

The big ones are admissions. Because its the skeleton crew, we have to do intake, perform insurance verification, get preauthorizations for insurances, page the on-call MD, put in all our own orders, put together new charts, and sometimes do the valuables, check-in, and body searches if no nurses aid.... besides the adimission in and of itself. To get preauths for certain insurances, we can be on the phone giving clinical for a whole hour...

Usually it's pretty quiet, but it can quickly go to the other extreme. However, most of the work I get tied up in isn't traditionally the nurses' role... Sometimes it's frustrating.

Thanks for the responses thus far!

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

You also might facilitate a group or two before the patients go to bed...some nursing focus group and/or and a wrap up group. I found the 6-11pm time period to be very interesting. I got to spend time with patients and get behind the masks they wear to learn more about them and their illnesses. I also got to see how they interacted with other people. It's also a time they act out. When Davey said you'll be dealing with behavior, don't underestimate how intense the behavior might be.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

The big ones are admissions. Because its the skeleton crew, we have to do intake, perform insurance verification, get preauthorizations for insurances, page the on-call MD, put in all our own orders, put together new charts, and sometimes do the valuables, check-in, and body searches if no nurses aid.... besides the adimission in and of itself. To get preauths for certain insurances, we can be on the phone giving clinical for a whole hour...

Wow, cleback, you've got your work cut out for you! I didn't realize how good I have it. At the Facility where I work, the MN Intake Staff verifies insurance and gets preauths. Sometimes an RN is working Intake, and can even get Admission Orders!

The next time one of my Peers complains about doing Admissions, I'm gonna direct them to your Post!

You have my respect.

Dave

IdrilRN, BSN, RN

Specializes in Psych. Has 12 years experience.

Our "typical" 11p-7a night goes a little something like this. Report, 24hour chart checks, getting the late night stragglers to bed, promoting sleep, passing out HS meds if they didn't take them around 9pm. Intakes, the crisis workers get the authorizations from the insurance companies, admissions, (we get about 3-4 per week on the night shift). Doing rounds every 1/2 hour, usually we have a tech for that if our census is above 10. Stocking supplies, talking and or medicating anxious insomniacs. Telling a med seeker why calling the doc at 3am for their 3 percocets they always take at home,is not going to happen. CIWA's or COWA's if they need to be woken up for it. Medicating said detox patients if they are scheduled at 0000 or 0600. The am med pass can vary greatley depending on the meds they are on. Usually it would be for scheduled librium or ativan for the detox patients. Thyroid meds, lasix or hydrochlorithiazadide. Getting some one ready for ECT. Once we three to get ready. Unlocking the showers for the people. Surfing the net, reading, knitting, watching the sunrise. We are usually lucky our people sleep most nights. But if they don't then it's very busy becuase they are a behavior issue so medicating them or if need be seclusion or restraints, then they need a 1:1. Now that is at the 14 bed hospital short term crisis stailization unit. When I was at the state hospital..........

Thanks for all the information!

Do you want long-term care or acute care? Kids? Adults? Mix? Psych prison?

Dangerous line of work. And have you thought about how your body will do on nights? When will you sleep? Can't sleep if have to care for new baby when you go home or before you go in to work.

Sleep is terribly messed up for Night workers, unless you are a natural night owl.

Best wishes.