New Grad Psych Nurse Seeking Advice

mentalhealthRN · Jan 14, 2011

Well first off Congrats on the job!!!

Being that you will be the charge nurse on the shift it will be important for you to know what to do in case of any emergencies.........being safety/behavioral emergencies with a violent pt, medical emergencies, etc. As being the charge you will be looked to in being sure that things are handled well--that things run smoothly. That will mean knowing where things are, who you need to call, the numbers for those people, etc.

Besure you know how to get security to your floor--for non-emergencies, and for STAT emergencies....know if you call or over head page, etc.....how your system works. Know the contact numbers for the medical doc so incase there is a medical emergency you can get a medical doc there quickly. Know where things are for a code, for a restraint, etc. including the paperwork and find out what exactly needs to be filled out for paperwork for these things. There can be medical emergencies on a psych floor other then the obvious--code or a suicide attempt. Be sure to be familiar with things like NMS (Neuroleptic Malignant Syndrome) and its symptoms, Serotonin Syndrome, etc. as these are medical emergencies and will need to be addressed stat. Your facility may have policies and/or procedures for these things and you should probably read up on them and be familiar. As the charge you will want to be sure you are keeping an eye on the person responsible for rounding on the shift. Night shift I found they can become lazy and start skipping rounds.......this is how you end up with suicides and with deaths.....we had a woman dead for approx 8 hours before found by day shift as nights never realized she was not breathing. They were visualizing that "yes, the patient is there" but not actually assuring the patient was alive and safe. Rounds are not just to assure no one has escaped.....they allow the pt to be monitored to assure they are alive and safe and no iminent danger is observed. The area around them should be quickly scanned to assure nothing is noted in the environment that is a red flag for a safety risk--for example, some things I have seen or heard about--being found in rounding. A plastic knife the pt had snuck from the dining room was on the bedside table--and she was a cutter! A hole in the wall--the pt had punch the wall and was angry and quickly escalating but was laying on the bed facing the wall when the tech rounded so it could have been missed but the tech noticed the hole and when he asked about it the client sat up and his escalating anger and paranoia was quicly noticed and a nurse was notified and the pt medicated. So you can see a lot when rounding and sometimes prevent bad things from happening. So as the night charge you want to stay on top of the techs and be sure they are rounding and doing it right--this will make your job easier. Medicate as SOON as you see that a pt is escalating and your verbal is not working--with less staff at night you need to try to avoid a violent situation as much as possible. There will be pts awake. You always will have a few.....that can't sleep due to anxiety, or hallucinations or just plain anxiety. Just remember if they are having any psychosis symptoms--ativan will help them calm but will not treat the cause of the anxiety if its the voices making them anxious--they need an anti-psychotic too. I worked nights with some nurses who would have a pt come and say they were having voices and it was keeping them awake. The nurse would give the PRN Ativan and tell them to go back to their rooms.......common on night shift. Treat the symptom--the psychosis. That with better help the pt.

So hopefully this was helpful..........good luck to you. And remember, always stay calm.

Jules A, MSN · Jan 14, 2011

What you have described is almost identical to my first job as a new grad except I was also responsible for giving medications. 2 techs and me on the unit. The other nurses were very supportive and I was fortunate not to have any problems acclimating myself to the routine. Thankfully everything went smoothly and no major emergencies. If you really want to work in psych and have confidence in your abilities as a new nurse that is helpful. Good luck!

Mashira · Jan 14, 2011

MentalhealthRN, and Jules, bless you! Thank you so much for the help and support, it is very appreciated. MentalhealthRN, some of the situations you described I am very prepared for, others I am not so I'm definitely making a checklist of things to get well acquainted with. Again, thank you so much for allowing me to use yall as a resource!