Geropsych?

SwampCat, BSN · Nov 16, 2016

One of the great things of geripsych is you don't lose all med/surg skills. I will go and help out on the geri floor now and then and it is always busy! It appears to me that morning is the same as afternoon which is the same as night. A lot of sundowning. Med passes often. Quite a bit of reality orienting.

Davey Do · Nov 16, 2016

Yeah. What Swampcat said. Think of gero psych as short term care facility (nursing home) with behavioral health as the focus.

I will also suggest that you do a search at he bottom of the forum page, kingvonnBSN2017.

Good luck to you!

B52, ADN, BSN, MSN, RN · Nov 16, 2016

Frequent code blues and rapid responses happen on the geri psych unit. Get ACLS certified if you aren't already, and become familiar with the crash cart.

Davey Do · Nov 18, 2016

Frequent code blues and rapid responses happen on the geri psych unit.

I don't want to come off as being smart aleck or challenging* RNdh but it sounds like the geri psych unit you're referring to admits medically unstable patients who really need to be on a medical floor.

All of the geri psych patients I've worked with have been medically cleared. This does not mean they don't decompensate, but the vast majority don't require code blues or rapid responses. In my 13 years working at the facility where I am employed, I've called but one code blue and maybe a few rapid responses. Any medically compromised patients are closely monitored and dealt with before the situation becomes life-threatening, as I've had several patients transferred to medical without emergency intervention.

I'd be interested in learning more from your perspective, RNdh.

*doesn't everyone who prefaces a comment with this phrase come off sounding smart aleck or challenging anyway?

B52, ADN, BSN, MSN, RN · Nov 18, 2016

You're right, Davey Do, the patients on our geri psych unit are "medically cleared" on paper only. Sadly, it's all about filling empty beds.

Davey Do · Nov 18, 2016

Oooooh. So it happens all over, eh RNdh?

We have had patients "medically cleared" patients sent from ER that were almost immediately transferred to medical. Sadly, it seems once the ERP sees a hx of psych, the patients get streamlined.

It's one of the reasons I enjoy working gero psych. I'm no crackerjack medical nurse, but can tell this from that, monitor the patients, inform the hospitalist or NP, and act accordingly. A few of us psych nurses have prevented emergency situations merely through basic assessment, monitoring, and reporting.

I'd like to go into detail, but I'm too modest.

Heh!

B52Bomber · Nov 23, 2016

I currently work psych home care and I'm consulted to do psych evals on various patients (primarily geriatric patients) for possible depression, increased agitation or other behavioral issues and even to determine if they have dementia. At first, it was enjoyable, but lately it's become relatively routine and I often feel ineffective, exhausted of resources, and negativistic due to the progression of the dementia disease process. Some patients are stable and progress slower over time, while others I've admitted to hospice weeks after opening them to homecare. Also, at this stage in their lives many have POAs making their medication and mental health decisions and because of psychotropic risks/side effects many families refuse to use any meds for behavioral management and then you unfortunately watch while the patient is agitated, sometimes verbally/physically aggressive, and eventually refuses or stops participating in ADLs including eating. Overall, geropsych is not my area of interest and I don't feel there is much room to grow or learn (other than addressing other medical co-morbidities as well) but for now they need the help and there's not many willing to advocate for them! Hopefully you have a more valuable experience!

motor_mouth, MSN, RN · Dec 3, 2016

I work in an inpatient dementia unit. Our average patient is coming in for aggression. ADL's are usually interesting and can take upwards of 3 people to toilet one person in the beginning. Getting scratched, hit, kicked, spit on, etc. isn't unusual. When I first started, IM's were rare on the unit but they are becoming much more common.

Definitely agree with Davey Do and RNdh about medically "stable" patients. Medically stable for the hospital and medically stable for us are definitely two TOTALLY different things!

Davey Do · Dec 3, 2016

Reading B52Bomber and motor mouth's posts reminded me of the reason why I chose to work the midnight shift on geriatric psych- the time I get to spend with patients.

Day and evening shifts are hectic with all the duties, doctors, programs, meals, visitors, etc. etc. that quality downtime is sporifice.

For example, I recently spent an hour and a half with a psychotic patient in the quiet room. I truly doubt I could have afforded that amount of time on the day or evening shift. Even though I had to do the therapeutic hold thing, it lasted all of maybe a minute. Just sitting and talking and playing what MrChicagoRN ingeniously refers to as "mental chess" is a high point in my job.

Utilizing learned techniques to deal with situations is also a perk of this work, population, and shift. Here is a thread about a technique I learned and utilize that, had I not been working the MN shift, I may have never discovered:

https://allnurses.com/psychiatric-nursing/phosphene-induced-sleep-844093.html

The MN shift can also sometimes be exciting. Here's a thread with examples of exciting situations where I thanked God for good coworkers who were integral in times of crisis:

https://allnurses.com/psychiatric-nursing/thanks-be-to-936942.html

I feel blessed to work with the geriatric psych population on the MN shift. My heart goes out to those whose jobs are a constant stuggle just to get thing s done.