betterliving

sorry, but what is BAL? basic....?

Any requirements do need to be supported by administration, and understood by administration, otherwise the education needed to maintain basic legalities and safety falls on the charge nurse. This is an exhausting proposition in many ways: sometimes the charge nurse is the everything (ie. only) nurse on a smaller unit, and the "teaching" involved is time and labor intensive. There's also the stress involved in what seems to de-evolve into arguments. Example, I was recently given report on a "drunk old woman" that involved NO labs, not even an etoh level. My question about the level of intoxication (blood alcohol), was met with irritation and ER doc complaints about the demanding nurse, along with a tangential "the pulse ox is OK". The psychiatrist whom I notified advocated the path of least resistance, basically to let the ER doc take responsibility for declaring medical clearance and accept the lab-less patient. Certainly one way to reduce stress. Anyway, one of many examples, where you just have to hope, it seems, that the patient will be OK on the non-medical psych unit and that on the issue of accountability, the RN will be able to place the budren of responsibility where it really is. Of course, I have taken to being very thorough in my documentation (on the nurse-to-nurse report sheet), jotting down what I ask about and the responses given. I consider this part of the admission paperwork if patient arrives to unit. I don't seek to make trouble for the fallible organization I'm employed by, but clearly, there is a need to protect one's professionalism and livelihood, along with patient safety. I am a very experienced and capable psych nurse, have never been nor will ever be a critical care RN, and last worked on med-surg about 15 years ago. I make no bones about my strengths and non-strengths and refuse to be unreasonably exploited (just reasonably so? ;-) The guidelines and awareness shared by other posters on this thread are appreciated.

What do psych nurses consider the words "medically cleared" mean if that is a requirement prior to admission/transfer to an in-patient psych (in this case gero-psych) unit? We are currently in the "if the doctor says so" phase and wonder if that's where we'll end up. We don't accept patients with IV's onto the unit but much else is OK. Opinions are welcome as are guidelines used effectively in general hospitals with psych units in same building. Anyone with any experience in ERs would be especially helpful. Thanks!