Joandarco

I think you will probably be okay if you are just doing it for a couple months and you will learn alot. The basic rules of nursing always apply, giving emergency meds when needed, talking to Pts and assessing problems, documenting your assessments. Just always ask your peers or charge nurse if you have to make a judgement call, get some feedback. It takes a while to learn a specialty like psych, but you can manage and learn at the same time.

Although we are off the subject, I have to agree with Mr Ian. You are are a relatively inexperienced nurse and need an environment more conducive to being mentored by experienced nurses. It sounds like a dysfunctional environment at best, with a lot of Nurse-to-Nurse hostility, (see Kathleen Bartholomew's writings). I have been in jobs in the past with bad managers (clueless, self serving, covering their butt), and had to leave. I want to thank all of you who have given me feedback on my issue of the rules about food and contraband. I feel confident that your feedback and other resources I have found will succeed in a lightening up on these rules, for our particular unit and population. I will be presenting my findings to the practice committee in early Feb. This has been my first experience with an online nursing discussion, and I like it! Thanks again. Any more comments from others are still very welcome.

You said you have elderly patients. Do you have 85 - 90 year olds? I would say about a third of our patients at any time are in this category and are getting ECT treatments, which means a stay of 2-3 weeks. I don't think this group benefits from the severe restrictions, nor do the ethnic patients, the Somalis, Cambodians, etc. who don't even speak English.

You did great. You recognized that the patient wasn't in an any acute distress, despite her demands. A lot of psych patients want drama and attention, pulling you away from the patients that really need your attention. Point out the objective data, with reassurance. "hey, your BP and heart rate are great now, you're really coming along, you're doing much better!" That kind of thing.

Thanks for your input. No, there weren't any severe consequences, no one OD'd or died. The patients that were involved were pretty quickly released, since they were obviously not invested in treatment. Actually, the mix of ages, disorders and ethnic groups makes for a very interesting milieu, and we do a good job of preventing conflicts between patients. But the number of psych beds in this area has been shrinking for years. I do remember the old days when this hospital had 5 separate psych units: One just for elderly patients, one for Drug and Alcohol, an adolescent unit... those days are gone at least for now.

To Whispera: Making exceptions does make things difficult. Of course it is the drug seeking patient who complains most about this. But given our diverse population, I feel we should have a more open policy, as we did in the not so distant past. We have not had any incidents with plastic bottles, and metal and glass are not permitted. In the past, patients could keep a small supply of soda in their cubicle in the nurses station and we would dole it out, especially since it was not cold, into a paper cup with ice. Currently even that is not permitted.

I work on a 19 bed unit at a large hospital. There is another psych ward on the same floor with 20 beds. Both are locked, adult, inpatient units. Our patient population varies in age and disorders. For example, we may have an 18 y.o acting out Borderline, a 40 y.o. male with depression and alcohol addiction, and an 85 y.o. male with severe depression. We usually have several older adults with depession and catatonia who are receiving ECT treatments. I work part time on the evening (3 -11) shift. We always check any thing that visitors or family members bring in for the patient. Visiting hours are only for 2 hours a day, 1 in the afternoon and 1 in the evening, and the visits take place in a dayroom with a staff supervising. Of course, metal and glass objects cannot be kept in the pateints rooms, or belts, long straps, or scarves, etc. But until a few months ago visitors could bring in food or drinks such as soda. An incident occurred where a patient had a visitor smuggle in some cocaine, hidden in some food, although the details of that have never been shared with me.This patient shared the drug with a couple other patients, tox screens were done, the police as well as risk management were involved. I wasn't there when it happened, but, as bad as it was, I cannot think of another such incident in the past 20 years. Anyway, management immediately instituted new rules: no food could be brought in for patients, not even a Pepsi in an unopened 20 oz. bottle. The patients could no longer keep a few dollars on the unit to purchase a soda from the machine, nor could they order a pizza or any food for delivery. At the time we were told that this was a temporary necessity and would be revisited, but it wasn't, until I brought it up right before the holidays. A young visitor wanted to bring in some homeade Christmas cookies for her Grandma, but was told no, no exceptions. I was also concerned because we get quite a few older patients from other countries, such as Somalia, Cambodia, Nigeria, etc. and in the past, their families would bring in home cooked, familiar food for them. A lot of them will not eat our American food. As an experienced psych nurse, I feel we should be able to use judgement on what is brought in and consumed by our patients. Of course we should pay extra attention to the patients with addiction issues, but these are the minority, not the majority of our population. Since I brought it up, management has asked me to research best practices in this area, but I haven't found anything in a lit review. The other hospitals in our area don't restrict food, just caffeine. Please give me your feedback. Thanks!