Landed a dream position in psychiatric nursing!

PRNQueen · Aug 13, 2012

Nights have less staff: minimal docs, no soc workers, no visitors (or at least they are leaving shortly after shift starts). Expect that folks with alzheimer's and dementia may be sundowning or just up all night. No cocktails of meds seems to be the great solution for this. We still get admissions and prep discharges and give lots of meds. LOTS of calling the docs in the night for Emergency meds and occasional restraints. Nights were a good place to learn because it's a lot less crowded at the nurses' station and you can sometimes get a moment to ask a question.

algebra_demystified · Aug 13, 2012

You're going to be doing a lot of paperwork and error checking/correcting. You will be reviewing charts to see whether care plans have been written. You will be second-checking medication orders to see whether they have been transcribed from the physician's orders page to the medication administration record correctly.

If you're on an electronic medical record then your time should be used more efficiently than if you're on a paper system.

You will be checking thermometers on various refrigerators and recording temperatures. You will be checking restraint equipment to ensure that units are stocked. Maybe you'll be checking medications to see whether something needs to be ordered for the day shift. You might be setting up medications for the day shift to pass, or you might be pulling early AM meds to pass yourself. Thyroid medications are typically passed by the night shift in my humble experience, your facility's policies may be different.

You may be responsible for combining day to swing, and swing to noc shift reports into a comprehensive report that goes to day shift so they have a heads-up for what's coming.

You may be documenting fall risks for patients who are loaded up on benzos or antipsychotics. You may be documenting sundowning. Night toileting assistance requirements. Stock and inventory for the upcoming day and swing shifts. If you count controlled medications you may want to leave a message with the pharmacy if they need to stock something for upcoming shifts.

As a new staff, I would offer to help swing shift with passing late medications, doing late dressing changes, late toileting, rounding on patients to give the MHTs or the swing shift nurse a chance to do last minute documentation. Once you help swing shift wrap up, it's time to hustle patients to bed by hook or by crook. Be aware that some patients may stay up late to do artwork or visit another galaxy for a while as they stare into space in the day room with their headphones on.

As a new staff, I would offer to round on patients once or twice a shift to give your MHTs a smoke break or whatever. Do a good check and make sure to figure out how to tell whether somebody is alive.

Go through the shift handoff communication stuff and see what you can add to your AM report.

Always be at least 15 minutes early and eager to help with end of shift stuff. Stay 15 minutes late and offer to help day shift get up and running. Do the blood glucose checks or something to help out day shift.

Guess what? When it's time for somebody to leave day or swing shift, they may look to a new nurse who has done a crackerjack job helping out on days or swings to fill in. Make sure that both swing and days look at you as an asset.

You won't get much patient interaction on night shift, so take that time to learn your hospital's policies and procedures. Learn your state's nurse practice act. Study the psychiatric medications and why they are prescribed. Read charts on your downtime and get to know the MDs and other nurses through the documentary trail they leave behind.

Good luck.

Meriwhen, ASN, BSN, MSN, RN · Aug 13, 2012

You will have less patient interaction on the night shift...but if you think that every single night they're all going to be sleeping peacefully, think again. Generally, it's a tamer pace, but nights can have their moments, especially since patients can and are often admitted through the night. After all, the police can't hold their 5150 or TDO patients in the cop car until the day shift shows up, and psychotic breaks don't follow the clock.

PacoUSA, BSN, RN · Aug 14, 2012

Good for you! My heart was never in psych, so yours would not be my dream job ... but if it makes you happy that is what matters, kudos to you! Nights are great, patients sleep most of it, at least the ones that can. I prefer it to days, which get too hectic for my taste.

patekgtech · Aug 14, 2012

Congrads on the new job. You will like night shift in the psych unit. You don't have the interuptions of dayshift like, doctors, transfers, visitors and patient interactions. The thing about night shift is to maintain your safety. Never let them get between you and your escape(the door). Don't take the docile patient for granted. He can explode on you in a second. If things are too quiet, go take a walk around and check on everybody. They are like kids. If they are too quiet, then something might be going on. Just check to be safe! Don't wait until the end of the night to do your charting. When you do that, usually all H*LL breaks loose and you regret it. Watch out for romantic encounters between patients. Talk to your supervisor about how to handle this. Watch out for your amblers, people who like to walk the halls at night for one reason or another. Just send them back to bed. Learn to control your voice tone, facial expressions and your responses to people. They will act off of your behaviors. Don't take life too seriously! Relax! I fought the Battle of Hastings alongside a gentleman one night. He came into the Dayroom and announced the battle while I was charting. I told him to go ahead, I'll be right there. I finished writing my paragraph and went to check on him. He was in his room quietly watching TV. No Sweat! Keep an eye out for OCD pts. It's a behaivor they can't control, but can hurt themselves with. Had a pt that developed a red rash around the buttocks. No one could figure out why. Was it bacterial or mental response to stress, we just didn't know. The pt was a OCD fixated on cleanliness. He stole a bottle of CONCENTRATED cleaner from the housekeeping cart to clean his toilet seat and wasn't rinsing it properly. He had it stashed in his closet under some clothes. Another Medical Mystery Solved. Like I said, don't take yourself too seriously. And do be leary of the QUIET patient, because you don't know what he is about to do. The one in my face yelling at me, I know exactly what he is up to! Make sure they SWALLOW their meds. Don't leave the cup there and TRUST THEM! You'll do fine. Just keep ur head on straight when everybody else is losing their's and u shall survive! Stay OFF the Cellphone and focus on your surroundings! Distractions can get u or ur pt hurt!