gero-psych...nothing but a nightmare!

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The largest number of patients I have on evenings is 5, depending on the census. A mental health worker ususally takes one of my patients for individual contact and charting. When the census is high (23-28) and depending on the number of people who are 1:1 (dementia patients are 1:1) we would ususally have 9-10 staff. On gero psych, their ratio is usually 1:3. Their unit is a pod and all patients are in the milieu which makes monitoring a little easier. I do know they will use poseys. Their census runs at 14. Hope this helps.

We have a 14 bed unit staffed with 2 RN's and 1 tech. The poor tech is run ragged trying to do EVERYTHING while we give meds and chart. Only one of these patients is ambulatory, all in diapers, need to be spoon fed, etc. We have begged management for at the very least 1 more tech. No way, they say. It's extremely frustrating! I wish I new "where" to complain to get something done.

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We have a 14 bed unit staffed with 2 RN's and 1 tech. The poor tech is run ragged trying to do EVERYTHING while we give meds and chart. Only one of these patients is ambulatory, all in diapers, need to be spoon fed, etc. We have begged management for at the very least 1 more tech. No way, they say. It's extremely frustrating! I wish I new "where" to complain to get something done.

Sounds like you need help...writing your resignation!! It's too bad you are so understaffed. No matter what field of nursing you're in, without adequate staffing it no longer is enjoyable or rewarding. Is this a hospital setting?

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Sounds like you need help...writing your resignation!! It's too bad you are so understaffed. No matter what field of nursing you're in, without adequate staffing it no longer is enjoyable or rewarding. Is this a hospital setting?

You are so correct! It's no longer enjoyable OR rewarding. The sad thing is I use to love my job, but am being forced to resign due to money hungry management with no heart. So long as they can keep their costs down and the Medicare money rolls in, I don't see things improving in the future. I can leave but the patients are the ones who will continue to suffer. It's too bad there are not some rules or regulations to insure quality care for this population.

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Specializes in med/surg, ortho, rehab, ltc.

Hi MisPlacedTexan,

Have things gotten any better for you at work? It sounds like your staffing ratio is dangerous for both pts and staff. I'm considering a move from LTC to inpatient psych. Would you mind telling me who owns your facility? Is it HCA/Columbia or Tenet?

Take care of yourself.

You are so correct! It's no longer enjoyable OR rewarding. The sad thing is I use to love my job, but am being forced to resign due to money hungry management with no heart. So long as they can keep their costs down and the Medicare money rolls in, I don't see things improving in the future. I can leave but the patients are the ones who will continue to suffer. It's too bad there are not some rules or regulations to insure quality care for this population.
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Hi MisPlacedTexan,

Have things gotten any better for you at work? It sounds like your staffing ratio is dangerous for both pts and staff. I'm considering a move from LTC to inpatient psych. Would you mind telling me who owns your facility? Is it HCA/Columbia or Tenet?

Take care of yourself.

No, things didn't get any better.....perhaps worse. I tried to talk to the DON about my concerns...staff/patient ratio, dangerous work environment, etc. It fell on deaf ears so I submitted my resignation. Since I resigned, a psychotic female was admitted, has assaulted several staff members, seriously injuring three of them, AND assaulted several patients. Still no new hires. I feel like I left just in the nick of time, but I feel for my former co-workers.

The facility is a community based, not-for-profit 200 bed hospital.

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Please tell me ANY redeeming qualities of working in gero-psych. I'll attempt to be kind. I am so sick of screaming, incontinent, hitting, kicking, biting patients. I plan to resign Monday morning pronto! How do you help this population when they don't even realize they are of this world? All I can see is it's a surefire way for the hospital to suck Medicare dry, while the nurses are overworked, underpaid and understaffed. :angryfire

O my goodness!!!!!!!!!! Iwork in a''geripsych'' unit also .we get pts that the nsg. homes ''kick out''supposively for sexually inapproiatelly behavior. They actually bag these pts personal belongingsup and dump them and we have to find them aplace to go!!!Alot of mornings i leave here and hate to think of coming back.But i am still here.We also have pts. with demenita.incontient,etc.... right now we have one man with c-diff and he is also a screamer..

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I have to agree. I helped set up our "older adult" program, but I would not work there. And ours is not that bad because admissions is supposed to screen out any patient who does not seem likely to be able to change and benefit from a short term program. We don't take non ambulatory patients either, but that is only because management finally had to face the financial burden of making a acute psych unit over into a place where they could be safely cared for.

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Of all the different types of psych nursing I have done, geri-psych is my least favorite. But here I am again (sigh), working on a 10 bed Geri-Psych unit due to relocation and lack of other options for mental health nursing. My last job in a different state was working as a clinical case manager for a Behavioral Health Managed Care Company. It was the best job I ever had, treated with respect, professionalism and given autonomy to make decisions based on my experience and education. How completely different it is to work for a hospital, same old story. I happen to love patient care and try to treat them as I would want any of my elderly relatives to be treated. We have one RN, one LPN and one tech and I spend my time racing against the clock trying to complete the endless paperwork, deal with physicians and family members and provide good patient care. I almost always leave late and know it's just a matter of time before administration complains about the overtime. What other profession would put up with this? The administration has no idea what a typical day is like and it's sad that the staff I work with are tired, stressed and overwhelmed. Burnout is just around the corner for most. Psych units should not be staffed like medical units as the care and acuity is completely different and most medical units are understaffed anyway. I plan to prepare a document to present to the DON with a list of duties and responsibilities for each staff describing a typical day/shift hoping against all odds that she may notice that even a super heroe could not keep up the pace. Unfortunately something has to give, either incomplete and sloppy charts or sunstandard patient care with the ultimate end being a resignation and loss of a dedicated nurse.

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I have only been an LPN for about 6 months now and i recently transfered to a gero psych unit where i had previously worked as a CNA. i absolutely love it. I think out patient to staff ratio is pretty good. we can only hold up to 18 patients but usually have 7-12 patients, with 7 patients we can have 1 RN, 1 LPN, and 4 CNA's. The type of patients that they are does make things difficult when you get some that are combative, or paranoid, and refuse the care and meds that you are trying to give them, but i truely love the elderly, and the only reason i didnt go to work at a nursing home was because of there patient to staff ratio. i cant imagine having to pass meds to around 40 + patient and also be able to give good patient care. I agree that this job isnt for everyone, you have to have a lot of patience, with the patients as well as the family. this isnt the job for someone who just want to get paid, they have to love what they are doing or they wont last.

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My first psych job was on a geri-psych floor and I loved it! Maybe it was the staffing, on evening we had 7-9 pts per RN and 3-4 techs. We were a restraint free floor and had a lot of screamers, non-ambulatory, total cares, and wanderers who had some form of resp problem, tube feed or other medical issue. Oh and of course your regulars of a psych unit: borderlines and schizophrenic of course. We were pretty busy all night long but I always got off on time. I think the team you work with also has a lot do with it. Our lil evening shift was like a family. Of course we had problems here and there but our leadership was pretty responsive to our concerns.

That being said geri-psych is definitely not for everyone. If you don't like the basics of it, wandering, screaming, confused pts then don't do it. You can only fake it for so long before care becomes compromised. That's true of any setting and of burn out in general I think. Just my two cents!

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Specializes in Psych.
O my goodness!!!!!!!!!! Iwork in a''geripsych'' unit also .we get pts that the nsg. homes ''kick out''supposively for sexually inapproiatelly behavior. They actually bag these pts personal belongingsup and dump them and we have to find them aplace to go!!!Alot of mornings i leave here and hate to think of coming back.But i am still here.We also have pts. with demenita.incontient,etc.... right now we have one man with c-diff and he is also a screamer..

I work in an inpatient psych unit that treats geropsych pts and we used to have a psychiatrist (now deceased) who had the guts to tell the nursing homes that liked to pull these dump-and-runs you are describing that if they EVER refused to accept a pt back after treatment on our unit, he would no longer take any admissions from them, ever. Here lately, our surviving dr's are getting better at standing up to these ltc's and our social workers are helping out as well (a lot, actually). I believe that this type of behavior (dump and run) is fiscally and ethically irresponsible and those facilities that do it should be subject to investigation. I understand that they are obliged to take action whan a resident puts others at risk, but, come on, get creative. Change the plan of care, find a specialized facility, whatever. Recruiting a hospital to do your placement work is just plain lazy.

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Cheers to the doc taking a stand against geri patient 'dumping' in the hospital. Nursing homes are notorious for this unethical behavior. The sad part is, oftentimes with the right care/meds, most of these patients can get back close to baseline, so no reason not to take them back.

~IMBC

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