New to psychiatric nursing-Help

2002MissRN · Jan 14, 2006

i am a new grad who just started working in a hospital adult acute psych unit ... spend the majority of my time what feels like to me is "babysitting", and redirecting patients who don't get along.
however, on average our unit will have homeless people who don't exhibit s/s but seem to be there for a bed and 3 meals, moderate to profound mr patients, patients with behavioral and explosive disorders , many borderline patients, and a few bipolar and schizophrenic patients.
in my "new to psych" opinion, throwing together patients with such extreme histories leads to a very high acuity for the unit, and leaves me wondering how therapeutic this environment is for them.

hi, you voiced quite a few "thoughts" i experienced on my 1st time on a psych unit. it was a 32 bed adult unit who accepted what seemed like anything; i did feel like i was babysitting .

i work in what is now described as a "behavioral/mental health" facility. i work mostly with adolescents who exhibited more behavioral traits that true psychiatric s/s. our adult unit takes lots of homeless people as well as drug and alcohol detox patients. we get the occasional psych patient (adolescent experiencing 1st psychotic break and adults who are off their meds) in and you mostly definitely know the behavioral from the psych pt.

i don't know if there exists a true "psychiatric" hospital anymore:confused:, at least not based on research i have done and in talking with other health care professionals (mostly nurses and mds). it probably comes down to what is most cost efficient (you know the bottom line financially:twocents:) for the facility. grouping pts together is sure to keep the rooms filled.

i don't know of any great advice to pass along....i have worked in 3 hospitals and this seems to be the general population i have dealt with in all three places. i accept it as a challenge, you know - each new pt provides new experiences (may be similar story but different personality). sometimes when the true psychotic pt comes in, i think ok...this is why i chose this field and learn what i can and help/nurse to the best of my ability.

i hope you choose to stay in this field and look for the more challenging and rewarding experiences (may be few and far between, but they are there).

good luck with whatever area of :nurse:ing you choose to follow!!!!!

skrnypa · Jan 16, 2006

What you are describing sounds like an average acute care unit in a general hospital setting. Every unit I have worked in always struggled with creating a milieu that was therapeutic for eveyone's needs- the bottom lines were safety and keeping everyone as independent as possible (and focused on getting back out into the community). The art of nursing in those settings was figuring out to tailor the rules to meet the patient's needs.

Violence was one of the bigget problems in places I have worked. Just last week there was a story in my local newspaper that a woman was arrested at the hospital psychiatric unit for assaulting a staff member- this was never done when I worked there many years ago, but I have to say, I'm not convinced it is a bad idea (although I was surprised that the woman's name was given in the paper).

CharlieRN · Jan 17, 2006

Yes, yours is a pretty standard general psych unit. The only thing I find surprising is the "homeless" housing aspect. I find it remarkable that doing that, in the absence of psych sx is getting past the insurance watchdogs. In is generally preferable to not treat MR clients on a general psych ward but if no specialized facility exists in the area then that is where they will end up. Generally such pts are best served in a specialized nursing home level of care.

Thunderwolf, MSN, RN · Jan 17, 2006

Yes, yours is a pretty standard general psych unit. The only thing I find surprising is the "homeless" housing aspect. I find it remarkable that doing that, in the absence of psych sx is getting past the insurance watchdogs. In is generally preferable to not treat MR clients on a general psych ward but if no specialized facility exists in the area then that is where they will end up. Generally such pts are best served in a specialized nursing home level of care.

Good response.

And CharlieRN...I have missed you, my friend....where have you been?

Good to see you post.

StuPer · Jan 18, 2006

A little help here from my American colleagues MR?

As for the original post, yes I agree with other posters this sounds like a typical adult inpatient facility except for the homeless, unless they have a psychiatric diagnosis then we would not admit... no way (although how many homeless people do you know who wouldnt fit at least 1 DSM IV code).

I know this is probably dissapointing for you, and you were probably hoping for so much more. As has been pointed out providing a true theraputic milieu is a costly venture and as you have pointed out would be very hard with such a mix of diagnosis. Generally around the world that has meant psychiatric nurses struggling to do what they would like with the patients against what the organisation and manpower will allow.

It is a fact that mental health funding has been the lowest priority in healthcare spending around the world for at least the last 21yrs, it will take a massive boost in funding to get services anywhere near to the point where they can cope well with the demand.

Unfortunately this results in far too many facilities becoming 'a place of safety' for those clients that can't manage in the community, with staff simply 'babysitting' and managing the behaviours and psychosis as best they can.

regards StuPer

CharlieRN · Jan 19, 2006

Stuper; MR equals "mentally retarded".

Hi Wolfie, I have been busy.

Debinius;

Maybe it's just the psych unit I work in, or maybe it's because of the demographic area, but it just seems to me that I spend the majority of my time what feels like to me is "babysitting", and redirecting patients who don't get along.

I ment to add this in my first post but I ran out of time. I was online at work and the next shift came in so it was time to give report and get out.

In the area of psych, particularly, it is important to remember that the first duty of Nursing is to provide safety. It is not your job to provide a "cure". You are not there to "heal". Your job is to make the patients safe and secure so they can heal. At least you are to see to it that they are not harmed. The challenge is that a significant portion of your patients are toying with the notion of killing or harming themselves. The challenge is complicated by the need to provide as much dignity and responsiblity to them as is consistent with the need for safety. This is where you nursing judgment comes in. Does the patient need closer observation? Can he be given higher privledges? Is he ready for discharge? Many of these are officially doctors' decisions, but where do doctors get the information to make these decisions? They ask nurses.

So yes you are babysitting.

GooeyRN, ADN, BSN, CNA, LPN, RN · Jan 20, 2006

The psych hospital that I worked at had six different units. geriatric, dual-diagnosis,chronic, high-functioning, adolescent and children. I have worked all of the units. If the chronic unit is full, they get put on the geriatric unit and vice versa. (no adults on adolescent and childrens units tho.) If one unit is full, they "sleep" on a different unit and go to the appropriate unit for the program during the day. Gotta keep all of the beds full. :rolleyes: I would say 90% of the patients are pretty much just behavioral problems. Most are contracting for safety on admission so I don't know why they even get admitted. We get a lot of homeless in the winter. (northeast pa is very cold and snowy in the winter) All they have to do is call 911 complaining of suicidal ideation and they are taken to the ER. Then they know enough to not contract for safety while in the ER, so they get admitted. They then contract for safety once admitted so they get cafeteria priviliges. Sad, huh?

PsychNightOwl · Jan 24, 2006

As I entered the American Health system I wondered whether 'madness' would be the same here as in England. Whether the treatments and philosophies would differ, whether patients would come out with the same non-sensical conversation.... etc etc. Well, in case you are still wondering if your facility is unique... I give you a resounding no. I remember a time when we had 3 'John the Baptists', the Pope and the Queen of Sheba on the ward at the same time. Well... I haven't come across John the Baptist again since arriving across the Pond but believe me, mental illness is pretty much the same wherever you are. The only 'extra' problem I have now is that I speak with an English accent. Most are fine with it until you get the paranoid ones who seem to think I am a representative from the CIA, KGB etc.

Seriously, illness is pretty much the same everywhere.... it's just that some of the nurses have weird accents.

Recent quote...... "Ooooh you sound just like Harry Potter"

Cool huh?

danu3 · Jan 24, 2006

AI remember a time when we had 3 'John the Baptists', the Pope and the Queen of Sheba on the ward at the same time. Well... I haven't come across John the Baptist again since arriving across the Pond but believe me,

I forgot where I read it... somewhere at allnurses.com I think. Anyway, one psych nurse had two Moses (I think) in the same room. They were argueing and the nurse trying to de-esculate and ended up walking out of the room when both Moses decided to part the water in the paper cup to prove they are the real Moses