New to Specialty Needing Advise

[OrigamiRN]

Hi all!

I'm a new grad RN (ADN) who just got hired at a local Behavioral Health hospital. I've worked detox and rehab previously and I have no problem working psych; I love the field. But... the working conditions have changed. See, the psych unit didn't used to have ITA patients. In the month since we've started admitting ITA patients, things have gotten a bit nuts. The census is high as well as acute, and I haven't been able to work on my own unit due to poor staffing.... but really my problem comes down to how the unit itself is. It doesn't seem built for ITA patients -- visibility is poor, only MHT's are available in code situations, and many nights there is only one RN with 2 MHT's. It concerns me more that other RN's who have worked in acute psych are concerned about their well being -- that there's no plexiglass at the nurses station, that they feel isolated if something happened.

They complain about the physicians not Rx'ing enough medications (and often not an IM alternative) for some of the most volatile ITA's. People don't feel like there's enough support staff.

The way my schedule is set up, I'm having a hard time maintaining my 5-6 shifts in a row because the unit wears me down. I really love the unit I was hired onto, and felt so ready for that population. Floating once in a while would be okay, but this has become so regular, I'm scared I won't go back to my unit.

I'm too new to get in anywhere else and I'm really not sure what to do... Any thoughts, encouragements and advise are appreciated.

[puravidaLV]

i take it ITA means something along the lines of involuntary or something of that nature, not a term I am aware of. If it means involuntary than II get them all the time and its fun. Fun you say? yes, fun I say.

I first off work 12's no 8s hate 8's. Secondly my unit is controlled because I control it. I have two MHT's and sometimes a second nurse with some competency. My MHTs are personable, they are vigilant, and they appreciate I don't hide behind a desk all day long. I walk the halls I talk to the patients and I VALUE their insight. I look for signs, I ask questions "you look ******...you ******? you want something to de-**** you?". Humor is an amazing tool.

Have foresight. You have communication logs in your charts WELL USE THEM. You complain the doctors don't order? well it falls back on the nurses not reporting behaviors. PSYCH IS ABOUT KEEPING THEM MEDICATED, STABLE, AND HAPPY. People aren't in these facilities because they just ordered a pizza. There are two floors at my facility. The first floor is always going off...second floor (my floor)...calm. Is it that way all the time? no, yet I don't go to patients saying "we're going to have a good day", because that shows your not taking care of their needs as it is.

If your afraid of yellow packets than you need to get rid of that fear. i can do one in 10 minutes. I had one female test me hitting the walls, told her not to or I would put her in restraints, she hit the wall one last time, and I went right to restraints. Every pt saw it. Keep to your word.

and above all else if you don't feel safe in a situation than leave the situation before it becomes an escalation.

Don't think you're to new for anything. If psych isn't for you don't stay in it. It can be a dead end for nurses and as i see it there are already enough psych nurses who can't lift more than a coffee cup. I blew my back out working TICU, yet I have grown to love it and now furthering my education as a PMHNP.

[Jules A, MSN]

What is ITA? How many patients on your unit? In my experience 1RN and 2 techs isn't uncommon overnight staffing on units with 15-23 patients.

Like purvidaLV I think the sicker the better. :) I agree 100% with setting limits and sticking to your word it builds credibility with staff and patients alike. I'm a firm believer in PRN medication administration for the truly psychotic or manic who are unable to remain safe. In my opinion if you don't find these patients fascinating and instead are frightened you really should start looking for another job. These patients have very well honed instincts and will know you are nervous and could interpret that as any number of things. I'm not trying to be negative or judgmental, this is a tough field and not everyone is suited for it. I would guess there is enough disdain for psych that if you start interviewing and are just honest that you thought you would enjoy it but it is not your cup of tea there will be very few who judge that as a negative. Best wishes!