very little patient interaction

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Posting in general, as the psych thread can be a bit slow. Plus there may be old psych nurses who don't follow. Anyways... I just started in psych. I was wondering how common this is. I have noticed that there are nurses who rarely leave the nurses station, which is in a locked room. So they don't really see the patients. If they are doing med pass, they will see them when they come to the window for meds, or if they knock on the door to ask for something. But essentially they come in the nurses station in the morning, and don't leave except for break and to leave at the end of the shift.

I am coming from an entirely different area, so this is a whole new world to me, so not judging. Just curious as to how normal this really is? They give report the patient was cooperative, calm, etc. But they never really interacted. I guess this is just coming from the MHA??

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
Although this is rather common in a lot of psych units, I find what you described particularly disturbing; especially during the day. As a traveler I worked in different specialty areas including psych. I admit that it can be hard but that is why we are there. To help these patients. Can you imagine being that sick an completely isolated from the world, including the people who are sworn to help you? I can't. I think it does less good to the patient's overall well being. Perhaps that's just me. I wouldn't pick up on such extreme bad behavior if I were you, although i suspect you care - since you are concerned.

A nurse ought to be prudent at al time, judicious with their time and words, and above all else, be caring. What part of that is unclear to that nurse?

Try asking her for advice on how you should interact with patients. Perhaps Queen Bee will get her butt off the chair and show you the correct way to do things. I'm so ashamed people like her are in our profession!

I do wonder if a lot of this has to do with the fact that a large portion of the staff have been doing this for 20+ years. One of them did make a comment that she loves her true psych patients, but there are quite a few who are there drug seeking, saying they are suicidal in order to get through the door, and the first thing they ask for is their meal tray, etc. They are burned out with those.

Don't get me wrong, some of them seem great. Being that I have only been there a week, I am keeping an open mind. This may not be the way everyone runs. There are 4 units, and I have only started to orient on one. So we shall see:)

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There are likely two reasons why the nurse(s) aren't interacting.

1. There is so much documentation and paperwork, little time is left to actually "see" the patients.

2. The nurse may well be afraid of the patients.

I worked in an acute psych unit previously. I did see nurses avoid even eye contact with their pts till med pass. The pts were often acutely psychotic, and threatening in behavior and mannerisms. As well, the pts were in a way, in charge of us. They didn't ask for their meds, they demanded. And PRN was a joke. 1 mg of Ativan PRN q 4 hrs meant exactly 3 hrs 55 min later, that pt would be banging, not knocking, banging at the unit window demanding his Ativan. And so it went. Was crazy!

Think hard about what you are about to get into. You may feel like I did. Less a nurse, more the Candy Man!

Good luck,

Mark

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I work a lot in psych.

I disagree that this is common nurses don't interact with patients. These nurses in my opinion, are just slack.

I always spend much of my time interacting, counselling & dealing with my patients (& their families' problems). Some nurses in psych seem to think they can get an easy shift by just doing notes and meds etc.

Remember, u don't have to be like this! Be pro-active, get out there and start talking to ur patients. Really listen to them, talk to their families, ask re their life, work, welfare, problems, past history, etc. Psych nursing can be very interesting and satisfying once u get that interaction and good communication happening.

It's your job, your license and your work life. You don't have to be a sheep and follow the others - ensure ur the best nurse u can be for ur patient.

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Specializes in mental health, aged care/disability care.

Like GoldenGirl22, I spend most of my shift with the patients so I can assess their mood, and get a fix on how they are travelling that day but there are some of the staff who have little contact.

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I also started in psych which is the specialty I wanted, first a 13 week contract at a state facility, now at a small acute psych facility that used to have a prestigi0us rep but now on the wane and awaiting takeover from a hospital network. I work nights, so I savor opportunities to interact with pts since most sleep thru my shift.

There are people there who have been doing this too long but never had any other job and do many petty lying things to make others look bad and themselves look good. They rarely spend time with pts unless they have to get some work done. There's a lot of paranoia about the takeover, and some of my coworkers have more boundary issues than the patients.

I have a preceptor who does nothng but give negative feedback and nitpicks, yet I see her make huge mistakes.The other day my preceptor told me I am too social with the patients, I need to be more medical (FYI she does not socialize with the patients, she's kind of cold). She saw me talking to a detox patient who was anxious about 1) coming off meds, 2) wants to quit smoking and 3) is anxious about discharge and fixing the mistakes he made when he relapsed. Call me silly, but I think it IS A MEDICAL ISSUE to talk to an anxious patient - DON'T WE MEDICATE FOR ANXIETY???? She said I sound like I want to be a social worker. Get a patient with unstable VS and she's in her glory. Get a patient who wants to talk she she sends them off.

Another FYI - when I was interviewed, the nurse administrator wanted someone who WOULD INTERACT with patients, I guess the preceptor didn't get the memo.

Not for nothing, although I love psych patients, I am done with psych nurses who don't interact with the patients. Yes. the pts can sometimes be dangerous and unpredictable, but if you're too scared then switch to another specialty! I have learned to keep myself safe AND enjoy a positive therapeutic relationship with even the most dangerous patients. You can't help them if you don't talk with them!

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I work a lot in psych.

I disagree that this is common nurses don't interact with patients. These nurses in my opinion, are just slack.

I always spend much of my time interacting, counselling & dealing with my patients (& their families' problems). Some nurses in psych seem to think they can get an easy shift by just doing notes and meds etc.

Remember, u don't have to be like this! Be pro-active, get out there and start talking to ur patients. Really listen to them, talk to their families, ask re their life, work, welfare, problems, past history, etc. Psych nursing can be very interesting and satisfying once u get that interaction and good communication happening.

It's your job, your license and your work life. You don't have to be a sheep and follow the others - ensure ur the best nurse u can be for ur patient.

I strongly believe that psych nursing has a huge "social work" component to it - the pt's social problems are the prime reason they become ill and the biggest barrier to getting well. The medical aspect to psych can be much lighter than any other kind of nursing but the therapeutic, communicative component is HUGE and is the difference in my opinion between a good or bad psych nurse. I find psych much tougher than other disciplines because of the emotional and psychological toll it can take on nurses, it can be frustrating to see pts relapse over and over, or languish in long term facilities, or constantly try to hurt themselves or others. The healing takes a long time and a lot of effort, with many relapses along the way.

As a psych nurse, I can honestly say, if you want to do this cuz you think it's easy, it's not, you need to find another speciality.

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May I ask what shift? I have worked both on a 30 bed inpatient adult pscyh unit as well as in the Psych ER....on all of the shifts. As a general I would say say this type of behavior tends be be the norm for night shift. We had two nurses and two techs on the night shift so you were responsible for 15 patients. Most were in bed and asleep when you started the shift and so you tended to only really interact if a patient was not doing well and/or unable to sleep and needing meds. Some times we would have one who's psychosis became exaserbated at night they became violent so of course then all 4 of us were out and dealing with that person. But other then that the techs would round the unit every 30 minor so and the nurses would jump in and do it occasionally just to get up and stretch.We occasionally would have a night shift admit.

As far as the other shifts--first of all the nurses had to go and bring the meds to the clients on the unit we didn't do a med window kind of thing. This required more interaction and allowed the nurses to see what their patients were doing on the unit. If they were isolating themselves or social with peers, etc. Some of the nurses were better about going out to interact then others as far as just rounding on their people or "hanging" out in the mileu with the patients. Some days for me it was hard when I had 10 patients on days to see all of them often if I had one or two that were taking a lot of my time with behaviors. If I had several admits, etc. This made it hard to write my notes I found and I'dbe asking the techs about the patient--which I hated to do but unfortunately the squeeky wheel gets the grease. Many of the units at the hospital were starting to make a policy for all the units medical as well as psych for the nurses to be required to round every hour if they weren't already out doing meds or a group or something with the patients. They need to see all of their patients every hour basically to do a quick assessment of safety, lethality, stability, etc. As even though the psych unit depends on good techs we can't as nurses truly have them doing "assessments" as they are not legally allowed to. These patients are there because they are not stable. If they were they would be discharged. So yes the techs are the eyes and ears of the unit and a good one is worth their weight in gold-- we as nurses still have to go and see the patients incase god forbid the techs don't see something or notice something that could indicate a patient escalating or becoming agitated or something. This is how we keep a unit safer is seeing things and squashing them before they get out of control.

So as far as this going on on your unit if it were me I might sit down and have a frank discussion with your manager. Let him/her know of your concerns. They have licensed nurses there for a reason and it's for more then just passing meds. Too much is going to be missed doing things like you are....which is a set of for something bad. Something dangerous like a NMS, EPS's or Serotonin syndrome may be missed. Or dangerous self-harming behaviors or violence could be not noticed until too late. We had a woman die in her sleep on a night shift and not be found for 8 hours as this was before rounds were required on nights. (before I was there)

So I would speak up and listen to your gut that is telling you this is not a safe situation......sounds to me like your gut is right.

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Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

Thanks for all the feedback from everyone! Tomorrow starts my second week, I've also only oriented to one unit out of 4, not including the psych ER which I will also orient to. Since I haven't seen much, as I've been there such a short time, I'm not making any judgments on how things are done. Once I've been there long enough to actually see what goes on, then I will have a better idea.

@MentalHealthRN.. I will be working 3-11, but the shift I have been on this past week is 7-3. One day I was there, the RN did rounds with the doctor, so they were able to see the patient then.

Like any area of nursing, I'm sure you get all different types. I have yet to meet more than a few, so I will see how things are after some time. I know we are known to have a pretty good program in the area, better than some of the others. So something must be going right.

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Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

I just wanted to share after my shift today. I was on a different unit, with different nurses. There was way more patient interaction. I asked about how much time is actually spent with the patients, vs being in the office. My preceptor today told me that there are those nurses who like to stay in the office, others do try to interact more. Although there are days with multiple D/C's that limit the time you actually have.

I had a great day today, with a great preceptor. I learned alot, as well as being given some direction on specific things she thought would be helpful for me to learn up front. She gave me some common meds to review, etc.

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OP ---I see on your profile you are in Buffalo, NY?? Is this ECMC you are at? I know they have even advertised here in Rochester needing nurses there.

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