Making the switch from hospital to psych. . .

[K8TLittleone]

Hello everyone! I am a relatively new nurse (graduated May '08) who until a few weeks ago was working in the Neuroscience unit of a large teaching hospital. I got great clinical experience on my high-acuity and fast paced unit. Prior to my nursing career, I was a corrections officer for 7 1/2 years. I made the switch for a few reasons: 1) my back wasn't handling the lifting and turning of large adult patients very well (I was injured while employed as a C/O), and 2) I wanted my awesome state benefits back (NY's retirement and medical are pretty damn good- I didn't realize how good until I got a job in the private sector). I now am in the middle of orientation in a state-run mental health hospital.

I am finding it very frustrating that many of the things that I routinely did as a hospital nurse is now "off limits" as a psych nurse- we don't even do a head-to-toe physical nursing assessment upon admission!! I'm told that those duties are the provence of the med clinic, and not my job. I see so many holes in the medical care of the patients, and feel strapped. A few of the nurses share my view that RNs should be able to do everything it is that we are trained and LICENCED to do, while some take the route that they don't want to have to bother with it. I thought as nurses we were supposed to take care of the WHOLE person, not just one facet! If someone has medical issues in addition to psych issues, they why aren't we addressing both on the unit instead of merely writing out a med clinic referral and passing it along to the med doctor?

Is it the same in other inpatient psych hospitals, or is NY just way behind the times?

Does anyone have any advice for a transitioning nurse like myself?

BTW- I am SO glad that I did hospital nursing right out of school instead of psych! I think it was really important that I refined my clinical skills and learned to deal with major medical emergencies before working in this kind of setting. I like working with this patient population, but again, I just feel that my practice is so limited!!!

[SweetLemon]

I am sorry that you are finding frustration in your new job, having privileges and then having then taken away can be really difficult.

Are your patients not being medically cleared before they are being placed on your unit??? Within the facility I work, all patients must be cleared by medical before they come to us and then we do assessments as issues arise. Pt. c/o abdominal pain we begin assessing them specifically for that. I know it probably seems like we could be missing a lot of stuff by not doing a full assessment Qshift but the majority of patients who come through our doors are not having the physical concerns you see in a med-surg setting. The ones that are presenting more medically complicated we do assessments and keep a close eye on. I have to say with your background in which you were required to do full assessment you will find yourself that much more equipt for whatever comes your way in psych.

One thing that makes me sad is how we loose a lot of our skills because we become so far removed from the typical med-surg cases. I would have to bet the majority of nurses that I currently work with are not able to correctly read an EKG strip.... while we rarely see cardiac patients its important to keep up on your skills for when the few and far between walk in your door.

[aloevera]

Circumstances warrant medical assessments and then they are seen by the MD consultant at our facility also.

Upon initial assessment if we see any major problems we send them to the medical hospital to be cleared before we admit them.

We are geared more toward psychiatric disorders but frequently see medical situations arise. Our clinical skills consists of doing EKG's, drawing blood, administering medications and dressing changes...and that's about it.....

For me, that is enough.....I enjoy psych more than I enjoyed working at the medical hospital....I don't want to do all that stuff anymore !!!!!

It would be very difficult to have medically unstable people on the unit with psychiatric patients.....Too much of a liability for the hospital...

[K8TLittleone]

Thank you both for your replies!

At our facility, if someone presents with some kind of obvious issue at admission we send them to the local hospital. And no, I wouldn't want acute medical issues on a psych unit either. We are told to do focus assessments as the need arises, but the RNs don't do EKGs or even blood draws- that's all done by med clinic. And honestly, what passes for a nurse's assessment is downright criminal. The RNs here seem more like overpaid secretaries and babysitters. And maybe I was spoiled at the hospital, but my attendings and residents actually listened to me when I had concerns about a patient. I tried talking to one patient's social worker today after we had a code with this particular patient. While I was sitting on observation with the patient for an hour after th code, the patient said some things and fixated on a few issues that I thought may be pertinent. While talking to the social worker, she looked at me like I had 6 heads, and basically ignored me. Funny thing is that later on in the day, the veracity and importance of the patient's statements were confirmed, but only after another incident and she told the same thing to the psychiatrist.

I'm sorry to vent like this, and I'm just hoping that things are going to get better. I really do like working with this patient population, but I also want to be treated as a professional with a unique skill set.

Any advice for me?

[aloevera]

I have had similar experiences with the therapist/social workers, also....like they do not have the time to listen....usually they do not....we are all over worked and understaffed....and it is only going to get worse, I fear....