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Just a vent... medical vs psych

Psychiatric   (16,961 Views 41 Comments)

Mandychelle79 has 2 years experience as a ASN, RN and specializes in Psych.

9,190 Visitors; 771 Posts

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Orca has 24 years experience as a ADN, ASN, RN and specializes in Corrections, psychiatry, rehab, LTC.

1 Follower; 25,974 Visitors; 1,784 Posts

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.

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Catalin has 3 years experience as a RN and specializes in Psych/Med Surg/Teaching.

852 Visitors; 22 Posts

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. 

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Heylove has 1 years experience.

4,107 Visitors; 195 Posts

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.  

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

5 Followers; 32,064 Visitors; 2,740 Posts

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

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futurepsychrn has 3 years experience as a ADN and specializes in Pschiatry.

3,996 Visitors; 164 Posts

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.

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