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.

So here's a curious fact. The post by cheezwizz90, RN has disappeared. So have all the posts that quoted him. If you google part of what he said, it shows up in the search. But when you click on the links you can't see either the original post or the posts quoting him. What's going on? I can understand why he might want to delete his post, but what happened to all the others? "What if I have a patient who self-identifies as an elephant? Sh…

Love it! What was the group about? And I MUST know how you stopped a fight with your funky socks!

Oh, now I get it. I had posted this in the Psych Nursing forum so I assumed you were on a psych unit.

Thank you for posing this question - I think we need to consider everything we do in this light and not keep doing things "because that's what we do". (My comment is off-topic, I know, but I just had to respond to this. :) )

No utopias anywhere in nursing but I think the Western Mass workplace culture is better than a lot of other places. There seems to be more of an expectation of healthy communication, and dysfunctionality not being the accepted norm.

Do you know what # you are on the wait-list? I know somebody who was notified the day before the program started that they were in. So don't lose hope! Also, if it turns out that you don't get in, you might want to go ahead and do their 1-year LPN program because then you automatically get into the 2nd year of the RN program. So at the end of 2 years you have an RN, just like the rest of them who weren't waitlisted. And you would actually get a much more intensive clinical education via the LPN program. Just putting this out there so that you have something positive to work on while you're waiting to hear about the waitlist.

Thanks, Jules. What do you think of the use of anticonvulsants in mild alcohol detox in a patient with no hx and low risk of seizures or DTs? You know, the patients who have no objective symptoms and whose only detox symptoms are "really bad anxiety, I'm jumping out of skin, I NEED some Ativan right now"?

OP: When you have a long-term heavy drinker, does she do anything to prevent seizures, even if it's not a benzo? Because I think that would be important. One of our docs sometimes used scheduled Depakote for seizure protection instead of putting someone on an Ativan CIWA. And this link is to an article that includes using Tegretol for alcohol detox. http://www.jfponline.com/index.php?id=22143&tx_ttnews[tt_news]=178826

The post by not.done.yet brought back terrible memories of nursing school where I had instructors who were impatient with my slow speed and with my tendency to be thorough and do it by the book, and yet they would never just come right out and tell me not to bother trying to do it the way we were taught to. I am so grateful to some older nurses who shared with me the stories of when they were new and they had been told they weren't cut out for nursing but here they were, 30 years later, still going strong! It is true that new nurses who are more introspective, analytical and more aware of possible poor outcomes as well as those who are more empathetic to their patients are both slower and more cautious/anxious. Some of the bubbly 19-year-olds I went to school with were so blissfully unaware of what could go wrong, of course they were full of confidence! Just hang in there - find a job that's bearable and stay in it at least 18 months and you will find you are feeling much better once you hit the 1 year mark. And once you have been there 18 months you can safely start looking around without looking like a job hopper. You just have to keep the anxiety in check.

It's not necessarily always a power trip. I work in psych and sometimes there is a good reason to delay a PRN. Sometimes orders are written so that patients can take all their PRNs really quickly in an unspecified amount of time - such as "tid" = 3 times in 24 hours but technically speaking they can take it 3 times in 3 hours because it does not say "every 8 hours". And some patients will take all their PRNs in a couple hours and then fall apart for the rest of the day or on the next shift. So sometimes it can be in their own best interest to try and save the PRN for later. But as the nurse, I never leave it up to the aide to explain that to the patient. I explain it myself, and I offer to help them reduce there anxiety in some other way. Or if I have already explained that to the patient I let the aide know that and ask if they would be willing to help them through distraction or deep breathing or some other relaxation technique. You can't just never get back to the patient. I'm sorry you were put in that position. And if you ever are again, like others have said, ask the nurse "What would you like me to tell the patient?" or better still, "Could you please let him know that?" or get the patient over to the nurse so he can ask her himself.