Gero-Psych... good resources and essentials

[perfectbluebuildings, BSN, RN]

Hi... I have the possibility of soon starting work on a geriatric psych unit... it is connected to a larger hospital and takes patients mostly 55 and over who have medical problems that would not be accepted at a "regular" psych unit. The interviewer told me that the majority of the patients will have some form of dementia, and are there to be diagnosed and get meds stabilized, or sometimes are in the last stages of their disease and need constant care and help for the difficult terminal symptoms of their diseases. There are also patients with exacerbations of depression (particularly new widows/widowers), bipolar disorder, and schizophrenia. With added comorbidities of diabetes, COPD, serious fall risks, and of course any other comorbidity that is possible.

The nurse/patient ratio is 1:8, both on days and nights; it's a 16-bed unit so 2 nurses, 2 CNAs and one HUC at all times.

They mentioned that these patients still require a decent amount of medical care, such as IVs, sometimes blood transfusions, occasionally a chest tube but not often and usually one that has been in awhile and not draining much; of course diabetic care, and assessments of each patient each shift. But that they are relatively stable, medically.

There are lots of auxiliary services such as a social worker dedicated specifically to this unit, occupational therapy, physical therapy, recreational therapy, etc.

In addition, if there is a patient who begins to decompensate physically, it is possible fairly easily to transfer them to a higher level of care, since this unit is part of a larger mostly medical hospital.

I really liked the manager and the nurse that I interviewed with; they seemed laidback, realistic, and professional, and people I would feel comfortable working with. On a brief tour of the unit I felt very "at home" like it's a place I really could work and do well, and that they care quite a bit about their patients. I got the impression that it is a busy, difficult unit, but also a good place to work. There was a calming atmosphere, pleasant and like people were happy to be working there... not a stressed, uncomfortable, bad atmosphere.

OK after describing all of that, I know there are some of you on here with geriatric psych experience. I did do a search and read all the threads that I could find, which were very helpful. I would be going from acute care pediatrics to this unit, so some similarities but a lot of differences as well; a lot of things to learn. Some further questions I do have after reading all of those threads:

-What books/online resources would you recommend I study regarding this population?

-What are the most important skills to have working gero-psych?

-What types of medications should I become familiar with?

-Is 1:8 a doable nurse/patient ratio with this population? It is much less patients than traditional psych units I have interviewed for, and (mostly) higher number of patients than on a general med-surg floor. I'm thinking it will be doable?

-Just, any recommendations, thoughts, pearls of wisdom that you can give me. I do not have the job yet but I am hopeful, and I want to start learning now just in case I do get the job.

Thank you all!!! Sorry for the length of this post; I am just excited and very curious/interested!!!

[GeminiNurse29]

I'm a float and spend a lot of time on the geriatric psych ward which often doubles as our medical ward. The rest of the hospital is a mental institution and only this ward is civil. We have 17 beds total, 2 nurses, and 4-6 techs (depending if anyone needs a 1:1). The Geri ward is frankly more physical and difficult at times than the forensics units, which should tell you something. Your patient population sounds even higher acuity medically than the ones on my unit, so I'm surprised it's only 2 CNAs (we've had ALS and cancer patients and ran with 3 RNs before as well as 7 techs. What happens if someone is, say, suicidal and needs a 1:1? That leaves 1 CNA and 2 nurses to care for 15 patients. And do you get admissions at all hours of the day and night? That may leave 1 RN and 1 CNA to care for everyone else if there's an admission. Of course, your patients may be less aggressive than ours. Our geriatric ward gets the worse of the worse, the most aggressive patients that no other facility can handle or wants to handle. Honestly, you couldn't pay me enough to be a regular nurse on that unit. God bless my coworker's that are regulars on it though.

Just some food for thought...

[perfectbluebuildings, BSN, RN]

Thank you for your thoughts/advice!!! I'm going to try to pay strong attention and ask lots of questions during my nurse shadowing experience, and try to see if the acuity is "doable" or not. Thanks a lot for your helpful answer!!!

[southshore2014, APRN]

Hi perfectbluebuildings!

I'm a new grad that will be starting on a similar floor in a month. I don't have any advice for you, but I share your concerns about acuity and resources. I hope things work out for both of us!

[SwampCat, BSN]

How weird, I did two years in child psych and just transferred to the "older adult" unit.

That staffing is unsafe in my opinion. We have pts with stable med issues (maybe an iv a few times a yr) and for 22 pts there are 4 nurses and 4 techs (2/4 nights) and when I pick up eves I feel like it is nonstop. I can't imagine having medical issues thrown into it

[perfectbluebuildings, BSN, RN]

Thank you!!! I'm going to pay close attention and try to be very objective tomorrow in seeing if this unit seems understaffed or anything like that. I will be shadowing a nurse for four hours. If it seems like it's too much stress or not a good fit, I don't have to take the job, that's what I keep reminding myself. There are other nursing jobs out there, and if this one doesn't work for me/doesn't fit my abilities and limitations, that doesn't mean I'm not going to find something that does work.

[WillyNilly]

The staffing is unstable. If someone codes on the unit it pulls both nurses in the room which then leaves the aides on the floor alone. If there is a companion case who covers the case while someone takes a break?

The age age group can be more physically demanding and at times more violent towards staff and others due to disease processes. Please be aware before doing it. Good luck!