Domestika

Just my two cents, a good thing to get in the habit of is not referring to your patients as a diagnosis (ie. "bipolars" and "schizophrenics"). I know it's just semantics but I think sometimes it can shape the way you view people, and it's probably hurtful for patients who overhear themselves or others being referred to in this way. It's a habit I had to get out of right quick.

In my experience the nurse is mostly there to set things up once the patient comes in and disconnect things once the procedure is done. The procedure is so quick, there's really not time to do much else. The anesthetist should be handling most everything else and the physician is doing the actual procedure. I've seen an experienced nurse get people in and out in basically 15 minutes. The majority of that time is the anesthetic doing its thing and then making sure the patient is stable before performing the actual procedure.

I know at least here in Canada that sort of thing is determined by the union you belong to. They would stipulate what previous education will add to your wage, if anything. Without a union involved...I have no idea. It's probably up for negotiation with your employer.

I should mention that I'm in Canada, so things are organized a bit differently than in the U.S. Three months is a pretty lengthy stay on this acute unit. She would have been gone a week or two ago but her discharge plans were changed at the last moment because someone she previously had a conflict with was discharged (from another acute unit) into the same rehab house as she was meant to go to. So things have been delayed a bit while they try to find another set up for her. And I should mention that her psychiatrist says that she presented to the unit with the most severe schizophrenia he has ever seen, so her stay was always going to be a lengthy one. But there does seem to be a real lack of "in between" services. The acute unit is for stabilization and discharge is sometimes difficult to set up. Some people are discharged back into the community with no supports other than "here are some phone numbers and your prescription. Remember to fill it." Some people go to supported living facilities or into extended care. There is one patient on the unit who has been there for more than a year because they haven't been able to find an appropriate facility for her (that will take her). She is geriatric, quite mentally ill even when "stable", has severe COPD and needs help with her personal care (staying clean, etc.) Oh, and she has been aggressive in the past. So she takes up an acute bed. Not a perfect system. Thankfully the unit does have an OT during the week who holds the community meeting, supervises crafts and does genuinely interact with the patients and does things like teach them the guitar or piano. They also get some gym time every few days. But they don't go out of their way to involve people in these activities. It's written on a board on the unit and sometimes there's an announcement that the activity is beginning, but the people who are a bit more isolative or shy simply don't attend any activities whatsoever. And as a result, they have next to no interaction. It's disheartening to see nurses say "Oh, so and so is the same. Still guarded and superficial, didn't talk to me, remains flat, isolated" etc. Because you know that the nurse probably went up to them, asked how they were, didn't get a response and that's their whole "assessment". That's all the interaction the nurse will probably have with that patient on her 12 hour shift. I think it takes more work than that. Actual work. I'll look into your suggestion of finding some materials I can provide them with, even just Health Canada printouts on their particular illness and coping strategies or something. I'm just a student right now so I'm still learning all the skills myself. I don't always know what to suggest or even how to respond to their questions and concerns. But I'm doing my very best to offer my ear to anyone who wants to speak into it and I make it a point to constantly be on the floor, walking around, making myself available if anyone wants to engage. I'm only one person and I'm just a student, but I figure maybe I can still make a difference. There might not be formal therapy, but just having someone to vent to and talk to can help relieve some of the stress of being on the unit and coping with illness.

The unit I'm on does community meetings once a day. Though, to be fair, it's the OT who leads the meeting. And there's no assessment or charting done on the patients via the meeting; it's just a space for the patients to vent or voice concerns. It sounds like your administration is simply trying to get blood from a stone. You sound like you're run off your feet as it is. Something has to suffer when you are given 50 tasks, all important, and you are only one body. Maybe you can look at combining some of your other tasks to cut down on the amount of time required (I have no specific ideas here) or delegating paperwork somewhere? Is it also mandated that your psych tech holds group? Because if it is a requirement for YOU but not for THEM, then that's an easy fix: you hold group, they do some of your tasks. Good luck!

Thanks for all your great insight! MentalhealthRN: I definitely understand what you're explaining about people needing to be stabilized before they will benefit from psychotherapy. And there are many people on the unit who I don't believe would benefit at all from psychotherapy in their current state. However, there are patients on the unit who have reached a level of stability that I think is conducive to talk therapy (ie. the 21 year old woman who has been on the unit for three months stabilizing her schizophrenia medication and is now moderately reality-based). She can carry on a conversation and mostly understand what you are saying, but there is no teaching going on. She is still only assessed for signs of efficacy of her meds. There are also patients who come to the unit after a suicide attempt, or in advance of a possible suicide attempt, who I think could really benefit from some therapy. They are more or less mentally competent. They can carry on a "normal" conversation and have insight into their issues. Yet they are treated in the same way as the severely psychotic: assess for med efficacy; adjust as needed. Someone else also mentioned the cost involved in providing "out patient" services to inpatients. And I think this is a big part of it. When I asked my clinical instructor why there was no therapy side of things on the unit she said that "people are here just to be stabilized. Once they get back into the community they can contact counseling services". I think it's disasterous to provide treatment just to the point where the person isn't going to kill themself or others, send them back out to the community and expect them to locate and attend counseling for a problem most of them don't believe exists. Granted, some of them have "case managers" who try to help them connect with services, but the severely mentally ill often have no insight into their illness and simply go back into the community, decompensate and then come back to the unit for another med stabilization. Round and round we go. Although I have no experience, I have a hunch that some of these revolving door patients would be back on the unit less frequently if they were learning some coping skills while they were here. It's kinda frustrating to watch! It's definitely given me a better idea, as a student, of what I want out of my future work. I want to not only stabilize peoples' mental health with medications when needed, but also impart information, support and skills that will help them grow as people and develop more insight into the role they can take in their own mental health.

Come on, acute psych nurses. I know you're out there. :)

I've only had four shifts on the psych unit (I'm a psych nursing student) but yes, I've been afraid of a patient. I had an otherwise friendly 19 year old male suffering from schizophrenia storm across a room while we were having a normal, friendly conversation and begin yelling about 3" from my face. I'm scared of him! It's the unpredictability of it that makes it so scary, I think. I'm learning that it's important to be relaxed but also keep your wits about you and keep mentally alert, watching people for changes in body language. I think that's why I'm so mentally exhausted at the end of each shift. I'm such a newbie that I haven't figured out how to be alert without being on edge! I will say, though, that I'm lucky enough to work on a unit who has security quite readily available. They are not stationed in the unit, but they show up pretty darn quick when you call them. Not that that will actually stop you from being punched in the face if someone decides out of no where that they're going to do that. But interactions we have with potentially aggressive or threatening patients are almost always accompanied by security.

Hi everyone, I'm new to posting, but I've been reading for quite some time now. I'm a psychiatric nursing student and I've just started my second psych clinical, this time on an acute psych unit in a hospital. I'm on the unit for a 12 hour shift two days a week (a weekend day and a weekday). Is it normal for an acute psych unit not to partake in any kind of psychotherapy with the patients? On this unit there are no individual therapy sessions, no group therapy sessions, the psychiatrists come on once a day and sit with their patients for 10 or 15 minutes to assess if the medication is improving their symptoms...and that's about it. The nurses on the floor have brief one to one chats with the 4 or 5 patients on their "team" to assess their mental status, but they don't go out of their way to interact with the patients beyond that. As a student, I didn't know what to expect when I started on the unit. But I did expect that there would be some support for their emotional needs, not just medication for their psychiatric symptoms. This is not a poorly-funded unit. Nurses have, at most, 5 patients on their team. They have security available at a second's notice. The unit has a big activity room with huge leather recliners, a big tv, a Wii system, expensive exercise machines, etc. So it's not like therapy goes by the wayside because of budgetary issues. Is this the norm?