Dragonfly.RN

Hi! I wanted to ask a few questions about behavioral health / psych nursing and the specialty forum doesn't appear to be so active. I am hoping this will be allowed here as I also would like some advice from other perspectives as well. Apologies for the length! I recently left a great hospital and position I was quite happy with (before covid) as it had just become too intense and too overwhelming. Patient loads were increasing from 6 to 7 and then 8, more and more was being added to our workload. On top of needing to move off night shift and move to day shift, which my manager couldn't accommodate, I just couldn't stay. I got a new job on days as an adult mental health RN at a small community hospital ( that seems to be on life support but is mass renovating and hiring). Their psych unit is new as of this past Jan. Has about 24 beds. They staff at 6:1 ratio and cap admissions to the number of RNs available. Right now cap is 12 because they average 2 RNs per shift now that I have comeon board. From my understanding, the hospital needs this unit to succeed. Needs it. This is my first psych job, though at my previous position I did rotate through detox/SA units, and assist with crisis holds in the ER. I've been a nurse for 5 years. So, in the begining the unit director and the charge RN for the unit, from my understanding, set up and amazing, working and flowing unit that averaged 16 patients and had staff. Then some sort of exodus happened. I don't know the story really. I was told the director was a massive witch and was incredibly wretched towards the staff. She could run a unit great and if she liked you all was good. Anyone else she'd berate right there on the floor in front of eveyone. She ended up getting fired. At some point in all this other staff left, including the Charge RN everyone loved. The interm director (all their unit managers are called directors) was the periop director and she did her best to my understanding. They ended up hiring a few more people, got a new director, but in the mean time the unit logistics fell to the way side. As far as I understand it, the new director is working on fixing it. Some of the problem I am learning is that the director never comes to the floor at all, and according to the current senior RN, the director claims that she is there to "run the program, not the unit". There no clinical manager and no unit charge. Current staff won't agree on anyone being charge and even so she'd have no ability to hold anyone accountable. There doesn't seem to be a lot of unity or responsibility and there is certainly very little accountability, especially when it comes to each shift pulling their own weight. Night shift actively refuses to do even the most basic tasks; they won't file papers in charts and will force admissions to hold till morning, they will not respond to referrals and pretend they didn't see them till morning shift change. They won't even clean trash or call EVS to do so. Day shift is left to cover slack and complaints to the director have gone seemingly unheard. Supposedly I'm told part of the issue is that much of night shift is agency/travelers/contract and should "eventually" get better. My primary concern is the care of the patients. It's a voluntarily unit. Prior to the director change, there was a psych MD and social worker, and therapist who held groups, on the floor almost daily. None of this exists now. The psych sees the patients through tele only, social work was out sourced so they see the patient through tele when required and all they do is coordinate discharge. Which... frankly is more like they jumble together a discharge. There is no therapist at all. Instead the techs and the nurses hold groups... these range from activity groups, to "non-therapy educational groups" (so I am told). It was explained to me as we are providing them education for things like.. coping skills. Not offering them therapy, and are to just guide a topic and let the patients talk among themselves. For me this just seems like a blurry line I am uncomfortable with and I am uncertain about the scope of practice concerning this. I am also getting mixed messages from the other RNs. Some of them will take the patients and speak with them 1:1 in the group room... others won't and advise not to. I work with the one who advocates it. I honestly am not sure how I feel on that. I have no issues talking with a patient, and I do with my medical patients, but these are people in acute psych crisis. So, I guess my question is... is this normal for psych? Is it okay to run groups and talk 1:1 with the patient about their crisis? I'm told it would build better rapport with my patients and that will "protect me" from them. I agree with building rapport and being someone that can trust and are comfortable talking with... I'm just really confused about where the lines are. Thanks.

Honestly.. I just write them down. I get report; do a round on the patients, assess and vitals, then take a few minutes to go over the chart and go over the meds. I make a quick jot of what meds I am giving and what prns they have. I use my own short hand, it honestly doesn't take me too long. I do another round on the patients, ask what I can bring them with their meds; a snack, water, prns. I've seen other nurses print out the MAR rather than write it down, and a couple others just write down how many meds are due.

That's too long of a drive. Seriously. I max out at 45 minutes and even some morning's that's too long. I don't mind it too much however, it does really help me unwind and decompress. 90 minutes? Nu huh. I mean, but that's up to you. You should drive the route for a few days and get a feel for it. Then consider... after a 12 hour shift, can you drive that? I had a coworker who lived 2 hours from our hospital. She actually rented an apartment that was local to the hospital with a couple other nurses who had to commute far. Prior to that, she'd just rent air B&B's, do her 3 days, then go home. The issue with this is... you're away from home for 3 days, not that anyone is going to see you or you will be able to do anything those three days because of the need for sleeping and the length of the commute. The other issue is you may not always get 3 shifts in a row. In every hospital I've worked, you put in your preferred schedule and then it get's balanced, which means the manger might move your days around.

You mean like, full on scrubs?! or just some scrub pants? I keep my old scrub pants and wear them, but with like... regular tshirts and such. Not with scrub tops. Scrub tops I use as shop rags or for really dirty chores, like someone else said, painting. I think the pants are fine.... but... get some real shirts.

My previous place of employment was similar; you could have 6 independent self cares while someone else has 5 completes and is drowning. Thankfully my particular unit was very team oriented and we helped each other out. Every night was pretty much a dumpster fire though. My current place uses the acuity, and while they try to keep you in the same "mod" (hallway), you might end up split but you're at least not going to be running from one end of the unit. If you do happen to have a patient down an opposite hall, that is typically an independent patient. Honestly it's a good system. It takes into account whether the patient is on certain drips, if they are confused, if they are incontinent, and various other aspects of the patient and patient care; pretty much everything, and of course you can use your judgement too if you feel they don't really fall in the parameters or guidelines for a certain score. You're still gonna end up with some chaotic nights, but it's nothing near as bad as my previous hospital.

Nothing is more annoying than a graduate RN who is "too good" to do patient care. I've seen graduate RNs (and senior RNs) spend 10 minutes looking for a PCA because they can't be bothered to put a patient on a bed pan, or clean up an incontinent patient. When I started my new position I would get nervous PCA's asking if I would help bathe my patients. Apparently a lot of other nurses are "too busy" (I'm sure some are). My current manager, if she hears a new grad or gets reports about a new grad (or any of her nurses) saying how "they became an RN to do RN stuff!" or in general complaining about having to do basic patient care; you're going to be spending your next shift being our "patient care coordinator". Which means you, the RN, get to help PCA's with baths, feeding, answering call lights, toileting... all the "fun stuff". PCA's are Patient Care Associates. Patient care (toileting, bathing, feeding, changing, etc.) is part of the RN role. It's not outside your scope. Your license is not suddenly jeopardized. You're not working as a PCA, you are working as an RN and providing patient care.

Just looking for some... feedback, opinions.. I don't know, maybe I just need to vent. I recently left my hospital job and I am currently working at a SAR/LTC facility. If the background is necessary; my facility was moving to a new one this fall. This summer was contract negotiations. In the they they added terms and guidelines on re-allocating nurses to different units at the new facility. Only nurses who had been there less than 12 months were subject to involuntary relocation to other units. My unit manager decided to include all "new" nurses on our unit, some of us who had been there 16 months. My name was pulled, I was to be moved to observation when we were at the new facility. I worked in MICU. I wasn't happy with this. I protested this to my unit manager and my union. Manager felt "it was fair", and union said nothing could be done until I was officially moved to that position at the new facility. I talked to SICU manager about transferring to her unit, she had a few openings available. My manager refused to sign off on the transfer, said it would be unfair and that my doing so would mean someone else on the unit would have to get moved to the Obvs unit. Union said there was nothing they could do. I made the choice to resign. A bit short sighted, I know this. I didn't bother having another position lined up for me. I quickly got a PT job at an SAR/LTC facility while I toss my resume out in wild abundance in hopes of getting into a new facility. It's a somewhat unique facility as the treat RNs like Charge Nurses. We run the desk, coordinate for the unit, coorespond with the MDs, monitor labs, do wound care, etc., and we are (supposedly) strictly on the SAR unit. The RNs work 12 hour shifts, and the unit is also staffed with 2 LPNs who are the cart/med nurses. LPNs work the classic 8's. When I interviewed with the DON I asked very specific questions about how nurses are pulled and to what units. I told her flat out I have no interest in working LTC. I just don't. It's not an area of interest and I find it utterly overwhelming (Kudo's to LTC nurses, you're amazing). I was told that when nurses are pulled, LPNs are pulled first, so an RN may have to take a cart. That's fine with me. No big deal. The DON told me in her time being there (3 years), she's only had to ask an RN to take an LTC cart twice. The only other time an RN might be on an LTC cart, if is they pick up an extra shift. I felt comfortable with this. I accepted a job with them. Red flags started my second week of orientation. Acting policy for pulling nurses to other nurses was; LPNs before RNs, Pick up shifts before scheduled shifts, then by seniority. Out of some crazy luck, my preceptor was pulled to LTC when a nurse called out. The LPN refused to go to the LTC card, threatened to walk off the job... and since she'd worked there like 10 years, they catered to her. We were only up on the LTC for about 2 hours before they were able to call in another nurse to come take the cart. I spoke to the DON about the situation, apologized to me, and I was assured it was a very unusual circumstance. Okay sure. I learned also that week that; the shift differential advertised for the position didn't exist, it was for LPNs only. And the "flexible scheduling" also didn't exist, the schedules were set. Okay.. fine. I've been on my own now for two weeks; last night I went in to the supervisor telling me I was being pulled to one of the LTC units. I was very confused, explained to her that. No. I wasn't, that I was told this wasn't a thing that would happen. I also expressed concern that, I wasn't oriented to any of the LTC units, that I don't know the patients on that unit. (In other news, last week they fired a nurse who was pulled to a LTC unit for giving the wrong meds to the wrong patient). When I asked why I was being pulled (it's my scheduled day, and there is always supposed to be an RN on the SAR unit) I was told that since Nurse LPN was the 3-11 nurse for SAR, she wasn't getting moved as she'd been there since 3pm (okay, np), but that since RN Nurse picked up a shift "and got here before you", he could be the RN for SAR and that I would be moved to the LTC unit. When I expressed that it was my scheduled shift, not a pick up I shouldn't be the one moved, I was pretty much told to suck it up, that she didn't know who made me empty promises, and that this is what rehab's do. Okay, I have been in a SAR setting before. Yes, they did, and it's why I asked those specific questions in my interview, and it's also the place where I learned how to draw lines in what I would and would not accept when it came to feeling like I was being bamboozled or taken advantage of. I said I need to speak to the DON. They put me in touch with the scheduler/HR woman. I tried to call her, she didn't answer. I sent her a text explaining the situation. She didn't respond. The supervisor again tried to get me to take the LTC unit cart "for just a couple hours" explaining that at 11 the 11-7 nurse would be in (assuming she wasn't going to call out), and said I would be "fine". But, 9pm is a major med pass for 30 patients who I have never met. Yes, the MAR has pictures but some of them are several years old. No, the patient's aren't always wearing bracelets, and while there are names on doors I know lots of patients wander into other rooms. I am just uncomfortable with the idea of taking the cart. I just have an overall bad feeling about the whole situation. After stepping aside and speaking to my husband, just to get perspective, I decided to not accept the assignment, and to go home. As I am walking out, the supervisor starts complaining loudly on how now she has to be supervisor and take a cart because "someone is being a baby and throwing a tantrum." I get it, she's upset. No amount of apologies is going to make her any happier. Halfway home (30 minute drive); the HR/Scheduler text me to tell that my actions are considered job abandonment, that I can't just walk out because I am being pulled to another unit, that she doesn't know who I spoke to about these claims I am making but RNs get pulled to LTC all the time, and that because I had arrived after than the other RN is why I was moved; despite again... what seems like against their own practices of moving or pulling nurses. I explained to her how I felt on the situation, and her only reply to me was that I needed to suck it up for 3 hours, and do my job or she would no longer be able to continue my employment with them. I replied and told her I am sorry, I cannot accept that assignment, I will not be in tonight, to let me know if I should go to work Tuesday, and that I would be speaking to the DON. She hasn't replied. So, I guess... AITA? Was there some other or better way I could have handled this? Or is this just one of those be glad you jumped ship before anything else happened type things. On the other hand, loss of this job is not a hardship for me, I am not in desperate need to this position and I made that clear to them, as I am still interviewing for hospital positions (and actually awaiting an offer from one) which is why I was only PT to begin with. It's just really... I don't know, defeating.. a really crappy feeling that's lingered with me since last night and it sucks. Sorry this was way longer than I thought.