Med/Surg nurses - how much psych do you see?

[humerusRN]

Psychiatric and behavioral health patients have literally doubled in the 6+ years I have been on my unit. I work in a children's hospital on a med/surg floor, and it has gotten to the point where sometimes we will have nearly half of our beds filled with psych patients. The frustration comes from many things... 1) we are not psych nurses. We do not have training as psych nurses. Due to this, we often find ourselves in unsafe situations. I have been bitten, scratched... you name it. People think pediatrics is a "safe" space because our patients are smaller - but I'm telling you I have seen a homicidal 6 year old that made the hair on the back of my neck stand up... 2) these patients are not medical patients and therefore aren't getting the help that they need. They may see our inpatient psych team a few times... but since we are an inpatient facility, they really can't get the care they need until they are able to transfer out and in to an inpatient facility. This can take weeks to months! 3) (and this is the selfish reason) - these kids usually need a 1:1 sitter (as they are in for suicide attempts, ideation, homicidal ideation, self harm, etc), which means we could have 10 sitters on the floor at once on a bad day. The hospital never has enough staff to cover the demand, so we often have to pull our own staff CNAs to cover these rooms which then just ads more demands to our already busy days. :/

I know in other environments, these patients sit in the ED on a stretcher for days and weeks... and that's not right either.

Every time I see another horrible news story... I think to myself how broken the mental health system is in this country. The resources we have are absolutely taxed!!!!

I wish there was a magic answer.... I am sure I am not alone - I know that this has to be an issue among all levels of med/surg floors!

[pixierose, BSN, RN]

You're correct, the mental health system is broken in our country.

I think of it as ... I feel extremely lucky that the kid in that bed isn't my own. There are so many children that come in through the pediatric ED that I work at per diem that are there for SI ... no child should ever have those thoughts running through their head. My heart breaks for them.

And then the kiddos who are aggressive ... or who are there for HI ... so many have already been through placements and now they're waiting for the next step ... which can take weeks.

There simply isn't enough inpatient placements.

To be honest ... I'm actually really glad to hear that they are in a room at your hospital. They languish in the ED for weeks where I am. No exercise. No sunlight. No therapy. Just waiting.

I can imagine it to be frustrating. I started out as a psych nurse. I now work on a neuro ICU FT, peds ED per diem. No one signs up for this, yes. But ... psych is everywhere. Even as a psych nurse, I still got bitten and scratched. I think as long as your charge nurse tries to share the patient load amongst everyone, not just the same nurses getting the same patients, that can help prevent some burn out.

[ThePrincessBride, MSN, RN, NP]

Short answer? Too much. My NCLEX review instructor had a nice saying in regards to psych patients: all psych patients start off as med-surg ones.

At any given day, there is a least one if not two sitter cases with many other patients on one or multiple different psych meds. Many have little to no access to mental healthcare as there is such a shortage of providers in this country. Not to mention, the stigma.

Many come into med-surg due to self-destructive behavior and have to be medically cleared before they go to an inpatient psych ward... which are filled to the brim.

All nurses have to be psych nurses, however. You can't separate the body from the mind or treat one and forget the other. Psych patients are everywhere: in labor and delivery, in oncology, nephrology, cardiology, PP, OR, etc. They are ubiquitous.

When I was a sitter, I had to sit in a high-risk OB. Reason? Homicidal behavior. The HROB nurses were ill-equipped to handle this kind of patient, but since the mother was having pregnancy-related issues, they needed to learn how to care for her.

Psych nurses....you all are amazing! -from a somewhat compliant psych patient

[Sour Lemon]

I work with adults, but when I work in med/surg, I always have at least one psych patient and often up to three. They tend to be noncompliant with regard to their medical care, so they land in the hospital frequently.

[Nature_walker, ASN, BSN, RN]

I work in the psych ED at my hopsital. We are one of the only ones around that has a child psych unit. They come from everywhere to try to get into it, but it is always full, so they often get stuck in the psych ED waiting for a bed to open. It's so sad. I feel for the kids that get stuck and the parents who keep saying "is this it? Isn't there someplace else?" So they look at the same waiting room for days while they wait for a bed to open. Like a PP said, often they have had multiple placements and there is no where else to go. Where I am we can't do anything medical, so if there is a medical issue, they go back to the ED and get admitted to the medical side of the hospital with psych consult.

The system is broken and the stigma is a huge part of it. When we have students visit us and they say they want to go into any other nursing field we always remind them that psych pts are everywhere, and while they are learning about psych just be open to it because you will see it again no matter where you go.

[Triddin]

We get a lot of med-surg patients with psych issues but I don't think I've had a pure psych patient with no medical issues

I agree there is still a lot of stigma with mental health and the resources aren't there to support the

[Meriwhen, ASN, BSN, MSN, RN]

Given all the times I have to go to do psych assessments for patients on med/surg, critical care and other units, I think it's safe to say there's a fair amount of psych patients outside of the psych unit :)

[humerusRN]

Yes - we have been told that our hospital is somewhat of an exception to the rule... admitting these kids inpatient to wait for placement instead of sitting in hallways on stretchers for days. A huge part of our frustration is our lack of training and resources. I know a lot of nursing skills.... but I can't safely put a kid in a psych hold! I don't have real deescalation training (which would be super helpful!). We are fighting for more of this with our administration, and it sounds like maybe it is coming. We will see.

I wish we could really offer these kids the real psychiatric help that they need... but apparently the amount of red tape is astronomical... to be considered a "psychiatric unit".

[vanessaem, BSN, RN]

Regular hospitals units, chiefly, ED, ICU, and Med-surg units are turning into babysitters for the psyche population. Not to mention the time it takes out of my shift caring for a psyche patient. Taking care of one psyche patient is like taking care of five to ten patients. This takes away from the time I need to spend with my other patients and my other responsibilities. Where I work, many times it's nothing physically wrong with the patient, only mentally. I don't mean to be insensitive but I'm getting sick of it.

Politicians need to focus on building more psychiatric facilities as opposed to more prisons. They also need to address the broken mental health care system.

[pixierose, BSN, RN]

Yes - we have been told that our hospital is somewhat of an exception to the rule... admitting these kids inpatient to wait for placement instead of sitting in hallways on stretchers for days. A huge part of our frustration is our lack of training and resources. I know a lot of nursing skills.... but I can't safely put a kid in a psych hold! I don't have real deescalation training (which would be super helpful!). We are fighting for more of this with our administration, and it sounds like maybe it is coming. We will see.

I wish we could really offer these kids the real psychiatric help that they need... but apparently the amount of red tape is astronomical... to be considered a "psychiatric unit".

I don't blame you for being frustrated with lack of training and resources; there shouldn't be a problem with you attending an 8-hour CPI intervention training, for example.

But thank you for all that you do with the limited resources you have.