Med/Psych

Double-Helix, BSN, RN · Feb 6, 2017

As a new graduate, your "focus" is learning how to be a competent, safe, effective nurse. Patients on medical units will have psychiatric co-morbidities, and patients on psychiatric units will develop medical co-morbidities. It is essential as any nurse, but particularly as a psychiatric nurse, that you develop strong knowledge and skills in assessment and recognition of the medical component. If your goal is ultimately to work in inpatient psych, you need to understand that medical issues can often be overlooked in these patients due to their psychiatric diagnoses and side effects of medications commonly used to treat them. As their nurse, it's your job to make sure you don't miss them. And in order to do that, you have to spend some time in the medical world.

I would expect a med/psych unit to house patients with underlying psychiatric illness who need acute care admission related to a medical concern. Both the medical and psychiatric needs will have to be balanced, but the medical need may be prioritized as the most imminent threat to health. It sounds like a good place for you to learn the basic skills you need to effectively specialize in psych nursing.

roser13, ASN, RN · Feb 6, 2017

What Double-Helix said. Can't tell you how often in my psych rotation, my CI would point out to us the current inpatients who had concurrent medical issues that were being virtually ignored in light of the psych admission. Basic medical supplies (Foleys, dressings, etc.) were scarce on the unit, if you could find any at all. The psych providers wouldn't touch the medical/surgical needs, and this was long before hospitalists existed.

In turn, from my Med/Surg years, so many of my fresh post-op patients would have benefited from dual treatment on a Med /Psych floor.

AliNajaCat · Feb 6, 2017

Some of you have heard my story of when I got called at home by my registry to go to the locked psych ward at the big city hospital to give a couple of units of blood. I wasn't doing anything else that afternoon, so, "Sure," says I, how hard can that be?

So I get there and sure enough, here's this woman pale as a sheet with a crit of about philodendron level, and I set to work getting her blood going. While I'm there, I ask how she got so anemic, anyway.

"Oh," came the answer, "She was having bloody bowel movements in the bed."

"Umm, did anybody call the surgery resident to check that?"

"Oh, no, she was just acting out."

Uh-HUH. "Call them right now!"

When I went in to work on the gen surg floor the next day, there she was. Still loony (I'm not a psych nurse, you know that) but at least getting properly worked up for a pretty significant lower GI bleed.

Cat365 · Feb 7, 2017

Some of you have heard my story of when I got called at home by my registry to go to the locked psych ward at the big city hospital to give a couple of units of blood. I wasn't doing anything else that afternoon, so, "Sure," says I, how hard can that be?
So I get there and sure enough, here's this woman pale as a sheet with a crit of about philodendron level, and I set to work getting her blood going. While I'm there, I ask how she got so anemic, anyway.
"Oh," came the answer, "She was having bloody bowel movements in the bed."
"Umm, did anybody call the surgery resident to check that?"
"Oh, no, she was just acting out."
Uh-HUH. "Call them right now!"
When I went in to work on the gen surg floor the next day, there she was. Still loony (I'm not a psych nurse, you know that) but at least getting properly worked up for a pretty significant lower GI bleed.

They really thought someone could "just act out" bloody stool? To the point that a transfusion was required?