I've just had two week of hospital clinical experience at a subacute mental health ward (shizophrenic, depressed, BAD, drug-induced psychosis patients etc). Prior to my experience, all the mental health education I had was a three hour tutorial class, which primary discussed mental state examination and the class asessment. We didn't cover communication in class, but I wasn't too concerned because I figured it would be like my children's nursing prac where I would see lots of interactions between clients and staff.
For the entire two weeks I barely saw the staff interacting with the patients... The main interaction seemed to come when it was time for meds. It seemed like everytime somebody was upset, nurses dished out the diazepam (Valium) and other PRN meds like it was lollies. At lunchtime there would be no RNs on the floor, both RNs took their break at the same time so I would get labile, anxious or delusional pts asking for their meds. As I hadn't seen anybody de-escalating the patients before I had no idea what to do and the patients would just get worse and worse until the RNs got to the floor. I found that time always made me feel frustrated, as I felt like I couldn't do anything. I've discussed this with my facilitator and she admitted this wasn't the best facility to have students. I'm concerned about working in mental health later to find the same sort of situation.
I guess I could just be an idealist, but I had hoped meds would be a last resort and that there would be more talking to create a therapeutic environment. Is this what psych nursing is really like at most hospitals?
Specializes in telemetry, med-surg, home health, psych.
Alovera, it does sound like a rewarding place to work. Our facility used to use RNs in the milieu and LPNs gave the meds until someone found it more cost effective to replace the RNs with milieu therapists, many of whom had no or little training in psychiatric situations previously. The RNs replaced the LPNs in the med room. Now our RNs interact with the patients only when it is time for meds or deescelation/PRN meds are needed. Yep, we're the ones who sit in the room behind the glass most of the day.
That doesn't sound half bad !!! Yesterday we had 2 RN's, 35 pts...
5 discharges, 4 new admits, 1 code (take-down lasting about an hour)
we stayed over 2 hrs. to finish admits so the night nurse (she was by herself) didn't have that to deal with....she had her hands full I am sure !!!
It's not that we have under-qualified staff, we just don't have enough staff !!!!! Our therapists are Master-Degree, but they do not seem to have that much interaction with the pts....clearly not as much as I would think they should...one group a day, individual sessions maybe one or two the entire time the pt. is there...(from 7-30 days)
At our facility, each nurse has a max of 8 patients - both days and nights. And we have an admit nurse. They want nurses to be more involved with patients, so are making changes so that they have more time for that. But most of our groups are run by mental health workers, who do not even have to have a degree in anything. Not saying they don't do a good job - don't know as I'm not there to observe - but jeez couldn't they hire MHW with at least a BA in Psychology?!
Specializes in telemetry, med-surg, home health, psych.
At our facility, each nurse has a max of 8 patients - both days and nights. And we have an admit nurse. They want nurses to be more involved with patients, so are making changes so that they have more time for that. But most of our groups are run by mental health workers, who do not even have to have a degree in anything. Not saying they don't do a good job - don't know as I'm not there to observe - but jeez couldn't they hire MHW with at least a BA in Psychology?!
Wow! I would love to have 8 pts....and you have an admit nurse also???
That sounds wonderful....An admit takes me from 1 - 2 hrs.
I agree, what is the point having a MHT running a group ?????? Do your MHT do any of the charting??? They would seem to know the condition of the pts, it seems....We have to do all charting (all 35!!) We do run groups if we have time, which is more often than not, but if we don't have the time, we can assign a MHT to do a group...I still think that the therapists should be more involved than they are at my facility...But the psychiatrist sees every pt. every day (5 min.).so at least they are able to talk with them....
Aloevera, our admits take 3-4 hours to do all the tasks involved! All nurses and MHW chart on all assigned patients every shift. MHW also chart the groups. Our psychiatrists do not see the patients every day, something I would like to see changed.
I havent been out in the field yet so it was great to read all of these posts. My clinical experience consisted of us sitting in a room with patients the ENTIRE time interviewing them. I never saw meds given out. But then we were with clients that wanted to sit with us. So I guess in this way,we were separated from the rest of the population. We were so wrapped up with what was going on in this room that I didnt think, at the time, of much else. Our preceptors had it set up this way to focus on interviewing .......maybe we missed out on what really goes on.
Specializes in telemetry, med-surg, home health, psych.
I havent been out in the field yet so it was great to read all of these posts. My clinical experience consisted of us sitting in a room with patients the ENTIRE time interviewing them. I never saw meds given out. But then we were with clients that wanted to sit with us. So I guess in this way,we were separated from the rest of the population. We were so wrapped up with what was going on in this room that I didnt think, at the time, of much else. Our preceptors had it set up this way to focus on interviewing .......maybe we missed out on what really goes on.
Your preceptor had you doing the most important part of psych nursing :wink2:
Therapeutic communication IS psych nursing.....the meds and all the other stuff will come later, I am sure....you may or may not give meds as you have read in the posts...different facilities are not all the same....
Learning to talk with borderlines, paranoid schizophrenics, Major depressive disorders, pts. with suicidal ideations, etc. IS what psych nursing is all about.....you are seeing first hand what psych nursing is....
this is indeed a very sad use of milieu on a psych unit. staff really need to be making frequent rounds "among" the patients. med rounds really need to be viewed as just "another activity" of the day...not the activity for staff to interact with them. how depressing.
think of it this way too.
by engaging patients frequently on the unit, you are better able to assess patient needs and address them. you also become better attuned to your patients and keep the environment safer, evaluating when that deescalation needs to happen now, way before it snowballs into something bigger requiring a code with all hands on deck.
yes, if the milieu is such where all the nurses sit behind the desk away from the patients most of the time and only interact when passing meds, it is a poor use of the therapeutic milieu...and a poor use of psychiatric nursing.
psychiatric nursing is not just passing meds (although you do have to be knowledgeable of the meds you pass).
Specializes in telemetry, med-surg, home health, psych.
:argue:
"A monkey can sit behind the desk and pass pills"
I couldn't agree more !!! As I stated, the most important part of psych nursing is in assessing and talking with the pts. That is what they are in the hospital for...not to roam around on their own and attend a group with a MHT...!!!!! The med pass is important, for sure, but our med nurse only has time to pass the meds, not do any assessing or interacting with the pts. Our RN's on the floor are the ones that do that. As a med nurse once told me " I am not a psych nurse, I am a med nurse."
As I stated, the most important part of psych nursing is in assessing and talking with the pts. That is what they are in the hospital for...not to roam around on their own and attend a group with a MHT...!!!!! The med pass is important, for sure, but our med nurse only has time to pass the meds, not do any assessing or interacting with the pts. Our RN's on the floor are the ones that do that. As a med nurse once told me " I am not a psych nurse, I am a med nurse."
Just curious, cuz I have thoughts and opinions on nursing education and am wondering what a psych nurse's perspective might be. How well does general RN education prepare an RN to be a fully interactive psych nurse (and not 'just' a med nurse)?
My BSN program had one 5 week psych rotation. Some of us worked with geriatrics, some with adolescents, and some on a general psych unit. We had a 10-week lecture course on psych nursing. Of course, we wrote care plans and had lots of focus on therapeutic communication. Still, it doesn't seem to me to be a whole heck of a lot of training. I imagine much is learned on the job.
We also had quick and dirty overviews of developmental stages, a wide spectrum of psych issues, family dynamics, cultural considerations, etc. Compared to the several upper division psych courses I took as electives, what we covered in nursing school was pretty cursory.
On the other hand, nurses have LOTS of training in safe medication administration and have covered a wide range of health conditions that may be seen as comorbidities in psych patients. As I noted before, a good nurse doesn't just pass out pills; the same as a good pharmacist doesn't just pass out pills. They assess the patients, their comorbidities, potential drug interactions, educational needs, any adverse effects, etc.
In other words, given the formal training of nurses, it would seem that nurses would be better prepared to administer medications than to play a major role in the therapy going on in psych units/facilities. I don't necessarily see why a decently trained mental health worker (say 10-18 weeks of focused lecture and clinical experience along with some basic intro to psych coursework) would be considered inferior to an RN to engage in therapeutic communication, to lead groups, etc. It's just that with the psych nurse, the facility gets a "2-for-1" deal.
Also, do you think an LPN is prepared enough to be a med nurse in a psych facility? To engage in therapeutic communication?
Specializes in telemetry, med-surg, home health, psych.
LPN's are the med nurses in our facility and they are so busy with the med passes and taking off the Doctors orders that they could not possibly have the time to do any assessments or therapeutic communications with the pts even if they wanted to... Now if, when giving a med, they notice a problem they go straight to the RN to assess it.
The RN's must assess and interact with each pt. each shift...A 6 page nursing note requires quite a bit of time and evaluation of each pt. If they see something that needs to be addressed with the psychiatrist or MD, they will do a consult for that...
Our MHT's do not receive any training for communication with the pts.
They are responsible for daily wts, vitals, searches on new pt., escorting them to cafeteria, doctors offices, groups, etc.
Just curious, cuz I have thoughts and opinions on nursing education and am wondering what a psych nurse's perspective might be. How well does general RN education prepare an RN to be a fully interactive psych nurse (and not 'just' a med nurse)?
My BSN program had one 5 week psych rotation. Some of us worked with geriatrics, some with adolescents, and some on a general psych unit. We had a 10-week lecture course on psych nursing. Of course, we wrote care plans and had lots of focus on therapeutic communication. Still, it doesn't seem to me to be a whole heck of a lot of training. I imagine much is learned on the job.
We also had quick and dirty overviews of developmental stages, a wide spectrum of psych issues, family dynamics, cultural considerations, etc. Compared to the several upper division psych courses I took as electives, what we covered in nursing school was pretty cursory.
On the other hand, nurses have LOTS of training in safe medication administration and have covered a wide range of health conditions that may be seen as comorbidities in psych patients. As I noted before, a good nurse doesn't just pass out pills; the same as a good pharmacist doesn't just pass out pills. They assess the patients, their comorbidities, potential drug interactions, educational needs, any adverse effects, etc.
In other words, given the formal training of nurses, it would seem that nurses would be better prepared to administer medications than to play a major role in the therapy going on in psych units/facilities. I don't necessarily see why a decently trained mental health worker (say 10-18 weeks of focused lecture and clinical experience along with some basic intro to psych coursework) would be considered inferior to an RN to engage in therapeutic communication, to lead groups, etc. It's just that with the psych nurse, the facility gets a "2-for-1" deal.
Also, do you think an LPN is prepared enough to be a med nurse in a psych facility? To engage in therapeutic communication?
What are your thoughts, psych nurses?
I also feel that a mental health worker with the proper training would be perfectly capable of doing therapy etc with patients/clients just as well if not better than nurses. However, with that said, I saw on some of the posts that some of these mental health technicians dont have any training at all? Thats ridiculous! I personally take offense to that, you dont do therapy etc with people without some type of degree...thatd be like practicing nursing without a degree. What are the requirements to become a mental health tech? I can understand why any nurse would be a little peeved about that. However, if these mental health techs have at least an associates degree I dont see why they are looked at as inferior because they have the same amount of schooling as most nurses (not to mention that thier 2 years of school strickly focus on mental health and as stated before nurses dont get a whole lot of training in this area). Personally, I think anyone that spends time with patients/clients on a daily basis as much as nurses, mental health techs, etc do could use more training in mental health. In my opinion, a 10 week crash course just isnt enough to be prepared to deal with some of the serious psychological issues that are prevelant in individuals on a psych floor. Shoot, I have a masters degree in counseling and I still get taken back by things sometimes. I cant imagine how Id feel if I had no training at all or only a few weeks, let alone how the patients/clients might feel.
:argue:
aloevera
861 Posts
That doesn't sound half bad !!! Yesterday we had 2 RN's, 35 pts...
5 discharges, 4 new admits, 1 code (take-down lasting about an hour)
we stayed over 2 hrs. to finish admits so the night nurse (she was by herself) didn't have that to deal with....she had her hands full I am sure !!!
It's not that we have under-qualified staff, we just don't have enough staff !!!!!
Our therapists are Master-Degree, but they do not seem to have that much interaction with the pts....clearly not as much as I would think they should...one group a day, individual sessions maybe one or two the entire time the pt. is there...(from 7-30 days)