Help! I need perspective.

[Bunny RN]

Hello,

I need perspective on a few things, especially from experienced psych nurses.

My unit is supposed to be for patients with serious and persistant mental illness (major depression, bipolar disorder, schizoaffective, schizophrenia).

What we actually get is bipolar disorder, schizoaffective, schizophrenia, LOTs of personality disorders, addicts, dementia, geriatrics, violent mentally retarded/developmentally delayed patients, autistic patients, and patients with active medical issues and a history of psych issues (but not active psych issues) that the medicine units don't want to deal with.

We are getting increasing numbers of dementia patients and violent MRs. Between the dementia patients and MRs we have anywhere from two to four total care patients at one time and not all of them are on 1:1s. We don't get more nurses when our acuity increases.

Recently, we had a renal patient, with a history of psych issues, spend four months on our unit because he was difficult to find placement for. The final weekend of his life, my manager had to fight like hell to get him transferred to a medicine unit. He died five days after we transferred him to a medicine unit.

I feel like I am working in a group home/dementia unit/hospice/geriatric unit/CD treatment facility.

We also get a lot of verbal abuse and have a lot of violence from our patients. One of our dementia patients, who left last week, bit staff, kicked staff, punched staff, and had to be put in restraints and/or given prns numerous times. Today, my meth addict, HIV+, med seeking, personality disordered patient threw her beverage at my charge nurse while we were explaining to her why she could only have 1 mg of ativan instead of the 2 mg she thought she should have. I wanted to just quit and walk out at that point.

I am new to nursing and this is my first nursing job. I have been on the floor since March. I work .8. I thought I would be working with patients who have mental illness, not dementia, not renal failure, not autism, and not developmentally delayed. I expected some verbal abuse and some psysical acting out, but it has been more than I thought it would be. This is not what I signed up to do. I am hating patients and I don't like feeling this way. I have started looking for other nursing positions, but the job market here is tight and I'm not sure what I want to do next.

Help.

[KYPsych]

Hi Bunny. Sadly, your facility sounds strikingly similar to mine. The trend over the past 5 years has been for group homes and smaller psych facilities to close and their patient populations are stuffed into the larger, long-term psych hospitals.

It was a rarity to have MR patients on my ward a few years ago. Now there's as many as 13 severe MRs crammed into a ward with substance abusers, personality disorders, dementia patients and the chronic mentally ill. The most frustrating part is that each category of these patients have completely different needs in terms of treatment. Over time it seems like we've become more of a warehouse for the unwanted than actually a psychiatric hospital and no population is getting the treatment they need.

Violent MRs and dementia patients should NEVER be mixed with a general psychiatric population. Their needs simply cannot be met effectively when you have 20-30 other kinds of psychiatric patients on a ward. Restraint/seclusion rates skyrocket when you mix these vastly different kinds of patients.

I feel your frustration. I'm a "seasoned" nurse and sometimes I feel like pulling my hair out and running for the hills. If you decide to stick it out at your facility, you might consider going before your administration and suggesting a separate ward for geriatrics or MRs. If your facility is anything like mine, your restraint/seclusion data would show that MRs and dementia patients are driving up your rates dramatically.

[aloevera]

I can imagine your frustration.....not exactly what you had expected to find in a psych hospital....

I cannot say that I know what you are going through...I am in a psych hospital on the mental health unit and our pts. are all bi-polar, major depressive d/o, schizo, PTSS, lots of borderline personalities, etc. I have only seen a few MR pts. on the unit...only one or two dementia in the past 4 years...

I don't understand how your facility is able to mix all those different populations together on one unit....I would think that the dementia unit should be separate just like we keep our violent, suicidal pts. separate from the others. This is a safety issue involving all the pts. on the unit. Maybe discuss your concerns with nurse manage, DON, or whoever you can talk to.....good luck.....hope you get things resolved..If not, there are other facilities you may be able to look into..

[Leahr]

We have the same populations described by BunnyRN with a lot of the same issues. To all that have posted to this thread, are your units divided? We have one 12 bed unit for DD, one 12 bed for geropsych, another unit with 12 beds for habitual non-compliants and another 24 bed for general adult (this is where I work). This eases some of the tensions, but the same issues persist as BunnyRN described.

[wonderbee, BSN, RN]

Bunny, I wish I had words of encouragement for you. Mental health treatment centers are the poor stepchild in the health care system. Underfunded and misunderstood, shoved away in some mysterious corner, forgotten and outclassed by medical facilities that want to get as far away from this population as they can at any cost. State hospitals in my areas are closing sending severely mentally ill pts into the community where they decompensate and wind up back in acute care. We as their nurses share the fate of the mental health system and, in some way, the patients as we decompensate in an increasingly impossible violent setting. Sometimes I think I'm locked up on that unit too.

My unit sounds very much like yours with a nearly identical population. Staffing is not based on acuity but rather on the numbers. The sad truth is that there's nothing wrong with your perspective. The patients are poorly served under current conditions. I pray God I never end up in such a place. I guess if there's a perpective I can add it's this, keep them safe, keep them alive. Watch your back. PTSD for health care workers of this population is very real and poorly, if ever, addressed.