Just a vent... medical vs psych

[Mandychelle79]

I am getting so fed up with the medical portion of our hospital. We are NOT a medical psych floor. Patients we have are SUPPOSED to be medically stable. When we send a patient to the medical side for something it would be AWESOME if all the testing was completed before trying to send back to us, in less then 24 hours. Oh the patient medically stable, what did the CT say, oh you havent even done the CT yet. Call back when its read and we will be up.

Call the admitting doctor- are you aware so and so has a PICC line for daily infusions. Yeah, I didnt think they told you ( from our own ER, not a transfer, those we pick threw with a fine tooth comb to find out if the people are telling the truth). Getting report... an IV line- no? really what about the PICC, oh thats just for blood draws. Gotta love being lied to over the phone in report.

Yes, I understand that I went through the same training as other nurses. Yes I can start an IV if needed ( but we do so few of them, is it fair to the patient to be pretty much a practice arm), we dont have monitors to keep tabs on them. Hell our patients dont even have standard call bells or electric beds.

I understand that they are busy with their 5-6 patient assignment, but I may be passing meds to 24 patients. We have higher ratios because our patients are MEDICALLY STABLE. Any time there is a psych patient on a medical floor, its usually within 12 hours that the nurses and doctors are chomping at the bit to get them off their floor and over to us. But if one of our patients decide to get sick while there it is like pulling teeth to get someone transferred medically. Or if they are being aggressive in the ED, they want to send them over before they are medically cleared. Nope, sorry I need the results and the precert information. BTW you have the man power over there and a doctor right there to give orders, I dont.

[Orca, ADN, ASN, RN]

When I worked for a freestanding mental health hospital, our admitting personnel (who were not nurses) often did not ask the right questions. I arrived at work one morning to find a patient on four liters of oxygen - telling me that depression wasn't his primary issue. He had a list of medical problems as long as your arm. Twenty minutes into my shift he coded, and we were unable to revive him. I found out later that before coming to us he was in a hospital about 100 miles away, so our intake people agreed to admit him sight unseen with just a telephone report. Of course, the hospital staff were careful to omit things that might have caused us to decline the admission. He made the statement "I don't want to live like this", which the hospital staff interpreted as suicidal ideation and they called our intake line. Our intake people failed to ask basic questions, such as whether there was anything running into him or out of him and whether he was on continuous oxygen. Any of this would have told them that depression wasn't the main thing that he was dealing with.

[Catalin, BSN, RN]

The thing about Psych is that we don't have doctors or the equipment like Med/Surg does. When I worked M/S, we had different doctors throughout the day whether it be at 3PM or 3AM. We don't have IV machines or any equipment. We needed to remove stitches that were already there when a patient arrived and we didn't even have a suture removal kit. We really don't have much and aren't prepared to handle it in case things go downhill.

[Heylove, BSN, RN, EMT-B]

On 6/27/2013 at 2:11 PM, Jammin' RN said:

My psych professor always said, "Every patient is a psych patint." LoL.. she was a real trip!

Why is this funny? It's true, no matter if the patient comes in a "psych patient" or not. Every patient deals with the psychiatric issues of becoming hospitalized, whether it's anxiety from being hospitalized and not able to be with their family, go to work, take care of family members, depression of their disease process, confusion of hospital procedures, their privacy and modesty ultimately in the hands of others. And this is just for adults. Imagine the fear that children face while hospitalized?

It's not funny at all, it's the truth.

[hppygr8ful, ASN, RN, EMT-I]

On 6/27/2013 at 2:26 AM, Irish RN said:

someone from the other side.... I am SO sick of having PSYCH patients on my medical/surgical floor. We ARE NOT equipped to handle these types of patients with 6 other sick patients as well. It's SO unsafe and I am FED up. These psych patients need to be on medical/psych floors until cleared to go to psych only. My hospital is too small... we don't even have a psych unit! SO I have a full assignment, most of the time 4-5 out of my 7 patients is confused, demented, yelling out, trying to hit me, thinks I'm arresting them, 1:1 for suicidal ideation....It's just not fair to us OR more importantly, these patients who need a different level of care.

just a note of clarification dementia is not a psych diagnosis it's medical one and it does a disservice to the patient to send them to psych unit where they could be seriously injured. Our facility doe snot accept dementia patients because we can't care for them appropriately - they need to go to dementia care facilities which unfortunately not covered by Medicare/Medicaid.

Hppy

[futurepsychrn, ADN]

Let's deal with real facts here. There is a real danger in having a patient with a PICC line or an IV on a psych unit. Perhaps the patient is used to the PICC line and won't bother it, however, how about that psychotic patient on the same unit that is intent on doing the most damage they can do? How about the violent patient that erupts at the least little imagined slight? How about the suicidal patient that will do whatever it takes to "end it all?" While the person with an IV or PICC line may be just fine with it, it is a liability and safety issue for them and every other patient on the floor, not to mention the staff. I understand that staff that doesn't work in psych don't see the big deal about it, I get that, however to the staff on the psych unit it's a huge deal. I have suggested that maybe a couple of days cross-training in both positions could benefit both sides. Just my opinion.