phone orders & prn meds in psych nursing?

GooeyRN, ADN, BSN, CNA, LPN, RN · Jul 30, 2009

Do psych nurses call docs for stat orders and do patients have ordered prn meds? What about lab work orders? During psych clinicals I saw the nurse pass meds and sit with clients during group activities; I feel like I saw only a small part of what psych nurses do. I'm interviewing for a psych position (not at a hospital) after working med-tele and wonder about the pace of psych nursing compared to what I'm used to.

Usually on admission, there are orders for PRN's. If by chance there are not orders, you call to get them if you need a prn. In psych, there is an enormous amount of paperwork. Then there are the scheduled med passes, prn's are given out like you wouldn't believe (by request, AND strongly encouraged when needed) and there is a lot of paperwork for PRN's, groups (and the paperwork that goes along with them!) , and then some psych places also require the patients to have co-morbitity (like the one I am currently working at) so you will have to do foley's, drsg changes, O2, etc. as well. You talk to each patient individually each shift at least one time, then sometimes you have to talk certain patients down if they are starting to go off. Lab work orders usually are written for on admission and as needed. (ex. lithium, depokote, tegretol levels, pt if needed, etc.) It will most likely feel more relaxed than med/tele. I worked psych before med/surg and am now back to psych. You are busy busy busy just like med/tele, but it is a different kind of busy. It isn't the "3 patients circling the drain, 2 climbing out of bed confused, and your admit is wating for you" kind of crazy. It is more of a "how can I keep these 2 patients separated before they kill each other, these two from trying to make out, this one from trying to cut themselves with the zipper on their pants, and get this one to stop screaming and making others anxious while getting all of the paperwork done" kind of crazy.

GraceNotes · Jul 30, 2009

That sounds pretty crazy! Thanks for your candid response. So do you like psych better?

GooeyRN, ADN, BSN, CNA, LPN, RN · Jul 30, 2009

I do prefer psych. :wink2:

GraceNotes · Nov 18, 2009

It's been a few months since I posted this question and I'm now working in psych. I do like it, the pace and the approach is different; busy, yes, but somehow there's time to think about patients, unlike med-surg. Regarding PRNs, some nurses don't give them on request, but talk the patient down or flat-out refuse them. Is this common practice? I thought PRNs were to be given as indicated by the doctor.

pandora44 · Nov 18, 2009

PRNs are given as indicated by the doctor. However, the RN must use his/her discretion about giving them. Often when a patient requests a PRN medication, what they are really seeking is the attention of the staff. These are usually patients with Axis II diagnoses who have a difficult time managing their emotions.

By talking a patient down or refusing them the PRN, the RN is putting limits on their behavior and encouraging them to learn better ways to cope with feelings. It is unrealistic for someone to take a medication every time they feel upset or anxious. Even pain does not always require a pharmaceutical fix. Learning when to give the PRN and when not to comes with practice.

Whispera, MSN, RN · Nov 19, 2009

I agree with Pandora. PRNs are to be given only if the nurse's assessment indicates they're needed (patient asking is part of that). By the way, when I was in nursing school, we were taught that PRN meant Per Registered Nurse, meaning as the nurse decides it is appropriate...

elkpark · Nov 19, 2009

PRNs are given as indicated by the doctor. However, the RN must use his/her discretion about giving them. Often when a patient requests a PRN medication, what they are really seeking is the attention of the staff. These are usually patients with Axis II diagnoses who have a difficult time managing their emotions.
By talking a patient down or refusing them the PRN, the RN is putting limits on their behavior and encouraging them to learn better ways to cope with feelings. It is unrealistic for someone to take a medication every time they feel upset or anxious. Even pain does not always require a pharmaceutical fix. Learning when to give the PRN and when not to comes with practice.

Also, some (many?) requests for prns in psych settings are just flat-out drug-seeking by clients who are accustomed to abusing the drugs "on the outside" (esp. benzos or opiates, although I've also run into people who get a "buzz" from benztropine mesylate -- go figure). The assessment skills and clinical judgment & expertise of the nurse are vitally important in psych settings.