New to in patient psychology unit-tips?

Abbyrose · Jun 15, 2017

I've been working nights on a psych unit for 5 years. For the most part, nights is much more laid back. Nightshift has limited staff, which can be dangerous when patients become aggressive and violent. Also, it can be challenging when acutely manic patients are awake all night with nothing to do and meds haven't taken effect yet. Sometimes they wake theirs peers while trying to entertain themselves by singing, running the halls etc. Also, many admissions tend to arrive on nights. Some general psych tips would be :

-use therapeutic communication (don't give advice, don't judge, don't minimize...I once had a coworker suggest to a patient that they use religion to cope. The patient was NOT religious and was triggered by the suggestion, and she began destroying the unit right before she squatted in front of the nursing station and pooped.

There's been many times when a patient is tearful and telling me about something terrible that made them feel suicidal. I try to not speak and just listen. Most people don't want advice or cliches, they just want someone to listen to them. I once had a new admission who was irritate and involuntarily committed. She was demanding to leave and said we were holding her hostage. We tried explaining things...Nope! We tried to ignore the behavior...Another fail. I cringed and crossed my fingers when I sat next to her and said " I understand why you want to leave and I would probably feel the same way. I sat quietly and just listened (and nodded) as she began yelling about the Dr, her sister, and everything else (if she would have appeared agitated that I was there or told me to leave, I would have) during her rant she began deescalting. after a while when she seemed to have gotten everything off her chest I asked what I could do to help her (aside from helping her escape). She thanked me for listening and said "you were the first person to actually listen to me. Thank you."

Don't engage in power struggles. I try to bend and give in to little things (extra snacks or leaving the tv on longer) when possible. I notice patients are more understanding when I have to say no or ask them to wait.

Have thick skin. They will point out your wide hips, the zit on your chin, your chipped nail polish etc. pretend you didn't hear it and redirect the conversation back to the topic. Don't get defensive or argue back. They're trying to get to you. Don't let it.

Good luck!

oceanblue52 · Jun 18, 2017

If you are working nights, it's really important to develop a good rapport with all of your staff, both nurses and techs. The on call doctors are not always receptive to being called (even though they are paid VERY well to be bothered). I have seen a few medical/behavioral emergencies in my time where the on call provider either didn't pick up the phone or flat out refused to order an IM or send a medically unstable client out. In these cases, your co-workers will be invaluable for keeping everyone safe and making tough decisions. I didn't work days very much, but these types of situations are much different during the day when you have administration, multiple providers, and extra allied health people to assist.

Every facility will have different rules, but in working nights I think it helps to give patients a little leeway sometimes too. If they can't sleep, or had a nightmare, or are asking for a snack, it is better to try and accommodate them while also setting limits. Denying a client ten minutes in the day room, or refusing them a small snack can easily eascalate a situation and result in a code. You might not have the staff to safely deal with this, so have a game plan for whoever you are working with to prevent splitting and to fill reasonable requests. It is possible to set limits and still avoid power struggles.

You'll probably deal mainly with audits, admissions, and making sure safety rounds are done. Night shifts are great, but they can wear you down...lots of good threads on this site that summarize tips better than I. Congrats on the new position!

Psycho-APRN · Jun 19, 2017

Learn the policy of who next to call if a patient needs a PRN or transferred and utilize it if you are left in the lurch by the one on call. I am the back up to the call person for the medical director. There are many lives that have been saved by a nurse who didn't go with what the on call doc said.

Develop a trusting work relationship with all of your colleagues. Trust can be the difference in an emergent situation going south quickly.

Try to not get involved in the day shift vs night shift squabbles. It is everywhere in nursing but seems worse in psych. It usually results in the patients suffering not the staff.