Frustrated and confused

TheCommuter, BSN, RN · Mar 27, 2008

I worked at a small community psychiatric hospital 2 years ago, and nurses were not restricted in the ways you have described. We could change dressings, do blood glucose monitoring, administer oxygen, initiate CPR, give respiratory treatments, and more.

atomic1976 · Mar 27, 2008

your post is ironic because i was just about to start a new thread titled: "are there any non-medical psyc units out there?" sorry to glom in on your thread, but it seems related. i am a fairly new nurse , i first got my b.s. in psychology in 2001 then found out i couldn't make enough money to repay my student loans so i went to an accelerated bsn program and graduated in dec 2006. at the psyc floor that i worked on, we didn't start iv's but we ran them. we straight cathed, inserted foleys, flushed and used picc lines, had pts on telemetry, packed wounds, etc. i actually found this frustrating and confusing because these patients demanded so much medical attention that we were unable to address the psychiatric needs, which are supposed to be the primary reason for admission to a locked unit. it would be like a nurse on cvicu spending half her shift talking to her patients about how their mothers didn't love them... in my opinion, it is best practice for psyc nurses to be just that: psyc nurses. it is a very unique specialty and i feel that patient safety as well as our licensure is put at risk when we are given medical patients. if you are not dealing with med-surg on a daily basis, the risk for error increase greatly. now of course i agree that in the situations you mentioned, there is no excuse for such ignorance of basic nursing skills. but seriously, i am asking where do you work because it sounds like the kind of floor i'm interested in. i live in a smaller city and the three psyc floors in the area all have significant med-surg overlap. i am interested in travel nursing but i want to know about units that are strictly psyc and discourage the admission of medical patients. could fellow psyc rn's please let me know of such floors you have worked on? thanks so much, this is a great forum.

i recently started as a new psych nurse in a big free standing facility that's part of a big medical center system. we're not allowed to draw blood, start ivs or do anything remotely medical except a simple dressing change. i was apalled today when i changed the dressing of a patient who had a partially closed granulated wound who was supposed to have it dressed with "steri-strip and 4x4". even the docs didn't know that the darned thing needed cleaning and cleaning wasn't even mentioned in the order. when i went to change the dressing, the steri-strip was still affixed to the sticky backing. the backing was affixed to the wound and all was covered by a 4x4. i had a heck of a time explaining to the patient that the backing was not supposed to be part of the dressing.
another nurse was reprimanded for applying o2 to a pt. who's pulse ox was 75% on room air on the basis that there was no order. when we call a code, it will be 7-10 minutes before the code team is fully assembled because they have to come from the hospital across the street. i don't get it. are we supposed to just sit on our hands and wait for full arrest so we can do cpr? i'd hate to get hauled into court on that one.
when a patient checks onto a psych unit, does that mean he checks his right to medical care at the door? the nurses are not encouraged to learn medical management and those nurses who are competent at medical management, are extremely limited in their scope of practice.
why?

sweetieann · Mar 27, 2008

I work at a psych hospital on an eating disorder unit, we we see a good mix of medical problems that are secondary to the toll this psych. illness has put on the pt's bodies. We do run IVs and antibiotics, but we do not start the IVs or draw bloodwork. I've actually run IVIG on an immunosupprsssed pt who happened to have anorexia. We do dressing changes. We have a fair amount of tubes for feeding in these patients.

aloevera · Mar 31, 2008

I work in a psychiatric hospital and we do address some medical needs.

We can administer O2, insert foleys, draw blood for STAT draws, check glucose levels for diabetic pts, change dressings, etc.

When pts. are detoxing there is always a chance for medical problems to arise, but this is not the majority of our nursing care.

The majority of our care is to tend to the pts. psych needs.....

Not all mental health pts are going to be in perfect health and we do have an MD on staff along with the psychiatrists. When in doubt, send them out.....we transfer to local hospital for further medical needs.

DaMale Nurse · Apr 4, 2008

As for my pscy area, there are three different "units" with 3-4 "wards" each. There is a Forensics unit(Court Committed Insane(60pt), and 15 day eval and treat(30pts)), an Adult unit (2 30pt wards for chronic(ie longer than 3 months) 2 30pt wards for admissions), and a Geriatric unit(3 wards w/ 30(1 30pt for admissions, 1 30pt all male, 1 30pt dementia), 1 ward w/ 12 for DD). In my hospital if any pt is not medically stable they are not admitted at all. If they are medically active (ie, over 55 or diabetes w/ complications, COPD (non-O2), CHF) they are taken the the Geriatric Wards only. No medically active patients unless it is very minor on the Adult or Forensics Unit.

They expect all nurses to be able to assess medically active patients and do the med/surg skills, but frankly there is on average about 2 IV's per year and about 1-2pts on O2 in the hospital at a time.

Anyhow, I think they do a good job making sure we as nurses are not swamped down w/ medical stuff and the area's that are allot of medical (the dementia ward) there is always allot of licensed staff who are more familiar w/ medical stuff.

elkpark · Apr 4, 2008

In my opinion, it is best practice for psyc nurses to be just that: psyc nurses. It is a very unique specialty and I feel that patient safety as well as our licensure is put at risk when we are given medical patients. If you are not dealing with med-surg on a daily basis, the risk for error increase greatly.

That's a nice thought, but I'm afraid the reality of psych treatment is that those days are gone and they're not coming back. The US has always trained and licensed RNs as generalists (unlike some other countries), and there is no such thing in the US as a nurse who is "just" a psych nurse. If one has the letters "RN" after one's name, s/he is accountable and responsible for all the same basic knowledge and skills as every other RN. (One of my biggest "pet peeves" over the years has been psych nurses who say (about medical procedures/treatments needed by clients), "Oh, I don't do that, I'm a psych nurse ..." :rolleyes: )

I've been a psych nurse for a long time, and I've seen really scary things happen on psych units because people weren't "up to speed" with medical stuff. IMHO, good, strong basic med-surg skills are vital in psych settings (inpatient and outpatient), because the RNs are the only staff members in an interdisciplinary psych team who are likely to notice medical issues with clients and insist they be dealt with appropriately. Third party payors have really clamped down on admissions to psych units over the last couple decades, and current SI/IS standards mean that the reality is that people aren't going to get admitted to an inpatient setting unless they're pretty severely ill -- either severely ill psychiatrically, or with serious medical issues in conjunction with their psychiatric sxs. I think we're going to see more med-surg "overlap" as time goes on, not less.

Hannelore Lieser · Apr 4, 2008

Kitty, I'm sorry you are working in such an environment. Not all free standing psych units are like this. Psych nursing is a speciality that encompasses all disciplines--you have to know a little about everything and really care about your patients. I'm horrified by your experience. But at the same time, I know that, as a nation, we often treat our mentally ill as if they were non-persons. We're rather behind the rest of the world. I get pretty frustrated sometimes, too.:sasq:But, in the end, one has to do the right thing. I've found that I have to deal with situations as they come up--I can't take them home with me--it really gets depressing if you do that. My only concern is that I do the best that I can for my patients--that's my obligation. I try to be diplomatic, but I do what I have to do.

aloevera · Apr 4, 2008

atomic 1976- if you want to move to the Southeast on the coast, I would highly recomment my hospital. We do minimal medical care, basic stuff such as diabetic pts, once in a while a foley (rare), once in a blue moon dressing change (rare) and our LPN's (med nurses) generally take care of that....the RNs are charge on the unit and address pshyciatric issues for the majority of the time...we actually are hiring at present, let me know if you want name of hosp., town, etc.

psychED · Apr 4, 2008

Hello there frustrated psych RN. First and foremost you are the pts. advocate. The ANA Code of Ethics speaks to select items that are sacred. I would speak with the pts. MD, then go up the chain of command to voice my concerns. Being a psych nurse means that you do not perhaps hang IV's but you do everything else including getting the patient to an area for medical care apart not available in your own area. I have fortunately worked in a psych unit that fostered the RN's to keep up their medical skills and the ED is 3 floors up!!! Free standing facilities usually have access to emergency care close by, right? Anyway, the pt. comes first and we all must do what is ethically correct in the pts. best interest.

wonderbee, BSN, RN · Apr 5, 2008

Thank you all for your insightful replies. My unit is a general adult unit and we have a couple of TBI patients too. Although an acute facility, these patients have been here for months. They are total care. They don't meet the criteria for the geri unit r/t age. We have brittle diabetics with skin care issues, COPDers, a couple of end-stage kidney patients, a CHFer and those with multi-system organ involvement. There are those on isolation precautions, etc. There's no way to get around it, these patients need a lot of medical care in addition to their psych care.

Unfortunately, all this medical care takes time, particularly the skin care issues. We are not staffed for this. As the acuity goes up, there's less time to pay attention to all the issues these patients present with. There's just enough time in a nurse's 8-hour shift to do med passes, chart and do some 1:1s and little more. I am going to have to be bold at some point here and speak up for staffing concerns, a dangerous thing for a newbie. We're all thinking it but no one wants to bring it up to management.

RN007 · Apr 6, 2008

atomic 1976- if you want to move to the Southeast on the coast, I would highly recomment my hospital. We do minimal medical care, basic stuff such as diabetic pts, once in a while a foley (rare), once in a blue moon dressing change (rare) and our LPN's (med nurses) generally take care of that....the RNs are charge on the unit and address pshyciatric issues for the majority of the time...we actually are hiring at present, let me know if you want name of hosp., town, etc.

I'm not looking to move but would still like to know where you are ....