JenTNRN

Our hospital forced everyone to switch from 8's to 12's with exception of a few people who medically cannot work 8's last march in hopes to improve staffing by only having to schedule 2 shifts versus 3. Well, it has resulted in more burnout, less staff, and higher turnover. Psych is very difficult for me to do 12 hours. I am too mentally drained. I didn't use to feel like this when I did 8 hour shifts. I am actually going back to Med-Surg! I hate to be negative, but it didn't work out in my hospital. Also, our dayshift 8 hour nurses inconsistently had a 3-11 nurse coming in, so I would have to pick up patients at 3!

My Psych hospital has a inpatient 5-7 day detox unit. Etoh detox protocols we use are Ativan 2mg or Librium 50mg every hour for Ciwa scales >10. Using the Ciwa, we assess every four hours under 10. If initial assessment is 10 or greater, then assess 1 hour after medication thereafter until you get it under a 10. CIWA assessment assesses for the following s/s and you score them accordingly.I would grab a CIWA and read over it. Is the pt nauseaus, dry heaving, vomiting, mild-severe tremors present, level of orientation, mild-severe anxiety, HA or head fullness, mild to severe agitation present, sweaty palms or drenching sweats, is the pt hearing, seeing, or feeling things not there. This can be as mild as lights hurting their eyes, numbness or pins needles in fingers, sounds seeming too loud. Or the A/V/T hallucinations can be as severe as hearing/seeing things not there or feeling bugs crawling on them. If they are having severe A/V/T hallucinations and do not normally have them, then they are most likely heading for deliurium. The assessment is subjective and objective. I use VS as a tool, but if they have hypertension or cardiac hx, it makes it difficult to tell, but most people detoxing from ETOH, will have elevated BP and HR. Also, we give vitamins. Every pt detoxing from ETOH gets an initial Thiamine 100 mg IM, then thiamine 100mg po, pyrioxidine 100mg po, and a MVT daily for 7 days. A lot of pts detoxing from ETOH will not have any s/s until 24-48 hours after last drink. I always ask how much they drink daily and for how long and when last drink was. The ones I generally worry about are the ones that drink 12-24 beers or generous amt of liquor daily for long period of months or years, or that amount 4 days or more a week. Opiate addicts detoxing are not a medical emergency, but they are uncomfortable. They will have severe cravings, stomach cramps, leg cramps, diarrhea, increased anxiety and agitation, dilated pupils, piloerection, and mood lability and verbal aggression. Also, if you have someone that's been on benzos for awhile are at risk for seizures and it is dangerous to be cut off all at once on their benzos. We usually titrate them down for 5-7 days and monitor for withdrawals like increased anxiety, agitation, elevated BP. The hallmark with them is tachycardia. Hope this helps! Good luck!

In my 2 years of Psych, I have only been hit once. I worked my whole pregnancy in Psych, but I never worked the acute units while I was pregnant. At our hospital we have acute male and female units, Child & Adolescent unit, an A & D unit, and a sub acute thought disorder unit. If the hospital you are going to has acute units, I would stay off of them. Talk with the staff on the units because a lot of psych patients histories and behaviors are well known by the staff (Revolving door) because they often discharge and return again and again, so staff should know the safest patients to put you with!