greenbeanio

VegGal, Can't speak for all inpatient settings but in the 3 that I have worked in, "med passes, initial assessments, ongoing assessments, monitoring clients and documentation" just about sums it up, in addition to admissions, discharges, and going back and forth with the doctors reminding them of what the patients need etc. And of course de-escalation and calming patients down and behavioral codes on occasion. And I like to do a lot of patient ed whenever possible. Occasionally I can squeeze in a group but its hard, time wise. No IVs, caths etc, - at least, not under normal circumstances. (I remember just one patient with an IV, and one that I had to help straight cath - although if a med sure nurse hadn't happened to be a float that day, I would have asked for a med surg nurse to come help out). Some wound dressings, though. And sometimes baths and incontinence care. As for a reasonable patient load - hah! That depends on just how superficial your patient care is expected to be. And on acuity. On my unit 6 patients is routine and although we are technically able to go up to 8, we never do - the charge nurse takes the extra patients. So much depends on acuity though - recently one of our teams had only 4 patients on it and it was way more work than my team with 6.

I got a blank page when I opened it?

Yup! Better still, they are supposed to be updated every shift, section by section. Makes for a lot of documentation busywork and nobody cares what they say. :/

I'm just starting out in home health psych - transitioning from inpatient psych. Hoping you get more responses since I'm still in training and had some of the same questions and concerns as you do. My agency seems to have mostly patients with schizophrenia/schizoaffective D/O, Bipolar, some depression/anxiety D/O with borderline PD. As to the safety issue, I've been told that if something doesn't feel right, leave immediately, get to your car and call.

OMG. "Is it for real?"! How traumatic for you!

As a last resort, if you have a laptop, take it over to the kid and start using Google Translate. You will get some funny looks from him because the translations can be pretty hilarious and awkward, but at least he will get the gist of what you're trying to say and vice versa. Also, he will see that at least you're trying. Google Translate will also sometimes say the phrase for you.

Whispera, you have helped so many for so long. Thank you. I am much less experienced than you but feel free to PM me.

Do yourself a favor and get this book and read through it cover to cover: Inpatient Psychiatric Nursing: Clinical Strategies & Practical Interventions: 9780826109712: Medicine & Health Science Books @ Amazon.com It is the best "training" you could get in inpatient psych that is in a book. The rest of the training will be on the job, learning through experience. And the best way to get that right now is to look for a job as a mental health counselor or psych tech (different names, same thing) at your local hospital. Because nursing school takes a lot of time and you could be getting invaluable experience in the meantime.

So much depends on the individual patient, and what their body can handle. Some of them can have enough antipsychotics to slay a horse and still be walking around quite calmly. Some of them need it to stay in control. And then again, some are med-seekers and totally dependent on popping pills. What you do depends on who you have. Here's how I would proceed: 1) Like Jules A said, ask the patient to give the previous meds a chance to start working, and offer support/distraction in the meantime. 2) If it's a patient well known to the unit, check with the other nurses who have been there longer to see if they know this patient's pattern. 3) Like Elkpark said, check with the doctor who wrote the orders, if they are available. 4) If that MD is not available, check with the on-call doctor. 5) If there is some reason you can't reach the on-call doctor, then like ThymeRN said, check with pharmacy. 6) If all else fails, check with the Nursing Supervisor. 7) If nothing else works, and you have checked with everyone available, you can give the medication as ordered. After all, it is ordered and the attending doc is the one responsible for being aware of the patients meds including PRNs and it is up to them to write in clear parameters. OR If you have a strong gut instinct about it and your nursing judgment says not to give it, then don't give it and start preparing for a code. (Which may not happen but its good for the unit to have a heads up.) 8) Document everything, including everyone consulted and rationale for your decision to medicate or not medicate.

As someone said, hindsight is 20-20. So in the situation I would probably have said "This is completely inappropriate, and frankly pathetic and ridiculous. What exactly are you hoping to get out of this?" Then I would have reported it to the supervisor and to security. But given the fact that I am not in the situation, I can afford to have 20-20 foresight and so I would call the police and file charges. Because I refuse to be sexually harassed by anyone, anywhere, at any time. And the fact that he did it to one of your coworkers as well shows that he is a habitual offender and deserves to get the message loud and clear. Where's Lorena Bobbitt when you need her?

Like this stuff: https://en.wikipedia.org/wiki/Psychiatric_and_mental_health_nursing#Therapeutic_relationship_aspects_of_psychiatric_nursing

That's what I've been hearing recently. That it's unrealistic for patients on acute inpatient units to expect a one-to-one check in with staff each shift, or individual patient education. That these days its all done in groups. And the depression/anxiety/SI/HI/AH/VH/paranoia assessments that we are required to chart on can be done briefly at the med room window. That inpatient psych nurses cannot realistically do the interventions listed in the literature and the textbooks, and that at this point, on account of increased patient numbers, acuity, and liability (leading to increased documentation requirements), all we can hope to complete in a shift is passing meds, brief assessments, charting and de-escalation/crisis response as needed. That building trust and establishing therapeutic relationships and providing patient-centered individualized care is no longer possible except on the fly, maybe squeezed in as a luxury only after the essentials (the "tasks", the charting) are completed. And that all the therapeutic work of healing has to happen in groups, "in the milieu" and outpatient, after discharge. Not one on one with nurses any more. Is this true? Is this a nationwide trend? Is this how we all have to work these days? Or do any of you work in places where you can still have meaningful contact with your patients?

OMG! Where is this wonderful unit you speak of? Sounds great!

Here's one I think is very good - very practical and geared towards real life inpatient psych. Its called... Wait for it... Inpatient Psyhiatric Nursing! By Linda Damon et al. If you get only one book for inpatient psych, this should be it! Inpatient Psychiatric Nursing: Clinical Strategies & Practical Interventions: 9780826109712: Medicine & Health Science Books @ Amazon.com

We use a behavior plan, refer all questions and concerns to their contact person who sets a time to meet with the pt for a finite length of time that is not extended. And encourage the pt to write down all of their concerns so that they can be addressed within the time allotted.