New Grad, Possible Job in ER/Psych Intake

[ORTech2RN]

Hey all, I finally graduate in May. I interviewed within the hospital I currently work for a few days ago, and one of the jobs they asked if I was interested in was Psych Intake in our ER. I enjoyed Psych and the clinical rotation that went with it, but curious as to what the job is really like. Been told the basics, but would really appreciate if someone can tell me their experiences and the pros/cons to the position.

[ImThatGuy, BSN, RN]

Psychiatric intake in an emergency department. That sounds like the ideal entry-level job for me provided you got to work some emergent cases in the absence of psych patients.

I like the ED because of its diversity and application to everyday life; i.e, what do you do when X happens to someone ranging from ear ache to sucking chest wound (why I initially became an EMT), but the psychiatric thing is clinically new and interesting to me.

I'm actually envious of someone on this website for once, lol.

[mentalhealthRN]

Interesting that they would offer this to you. Were I live we have a psych ER in one hospital--a separate area of just psych staff--nurses, docs and techs and you have to have experience to be a nurse there. The other hospitals don't have a separate psych ER but use what we call a PAO--psych assignment officer. The position is generally staffed by an LCSW or sometimes an expereicned psych nurse. They do the evaluations for psych pts that come in and report their eval back to the psychiatrist who writes orders and decides if the pt needs admit or not. They work very independantly as far as the eval and need to be expereienced in psych evaluations. In knowing what to be looking for, how to recognize what decompensation looks like in the various mental health dx. They need to be able to do a lethality assessment. They require psych experience however and having actually worked in the psych ER myself (the first hospital I mentioned with the separate psych ER) and having to do the evals I can't imagine doing the job without prior psych experience. They actually decided to hire a new grad (while I was there) despite their usual requirement of experience as this nurse had a BS in Psych prior to nursing school. They thought she could do it. It was a nightmare. She really struggled and they asked her to move to one of the inpatient units for at least a year and told her she could come back after some experience under her belt. She just was like a fish out of water and missed a lot. The docs really had a hard time with her as it made their job harder. She would see a pt for the initial eval and report to the doc and the doc would ask her questions about the pt and she would have not thought to ask a lot. They would ask for her sense of what the pt needed and she would have no idea. The docs actually expect for the nurse to get all the needed info so that they didn't have to spend too much time with the pt. So that they can esentially have an idea of what to do with the pt and they go in and see them and maybe ask a few questions and let them know the plan--admit, discharge,etc. They depend on the psych skills of the nurse a lot, so for a new grad that would be hard. Just my two cents. Hate to see anyone thrown into a position where they are being thrown to the wolves. Good luck to you.

[PsychRN98, ASN]

Also having worked in many aspects of psych nursing for the past 12 yrs, including psych ER and intake, I would concur with mentalhealthRn completely. You really need to have experience in psych assessment before being able to do this job. There's so much liability in this position. I mean ultimately the docs decide who's admitted, but as was previously stated, they depend on the nurse's thorough assessment and judgement in helping them decide who to admit vs who to send home, who to send to outpt, etc. Sometimes the doc will literally look at your assessment, say "what do you think" or "where do you want them to go", talk to the pt for less than a minute, and send you orders for what you suggested. So its very important that you feel knowledgeable. Also you may have to deal with insurance companies, precerts, etc which can get hairy when you are also doing all the psych evals. Its a very interesting and at times exciting job, b/c you never know what's coming through the door. But you will also get those same feelings on the floor with psych and it would be wonderful if you could get even a little experience first. Best of luck to you starting out in psych:)