DAL2010

I've had well known politicians, athlete and news anchor (comes with working for a high-quality system in a big city.) 1) Psych: Athlete: super well known, 90 day stay for substance detox/rehab. No special treatment. 2) IMCU: 1 major news anchor, very kind, jovial even, no special treatment per se, but did receive some extra ice cream & Lorna Doone cookies from staff, like we would give to all our super-kind patients! 3) IMCU: 2 high-ranking, well-known politicians (at different times). Received special accommodations in that in both cases their arrivals to us were planned, so we moved patients out of the nicest, biggest, recently remodeled rooms so the politicians could have them, unit management re-arranged nurse/tech schedules to hand-pick the staff caring for them, hospital staffed additional security at entrances and near elevators/stairs, local restaurants catered food in (don't know who paid for that) and our hospital-system highest leaders stopped by to tour the unit and speak to staff and take photos and give us small gifts and acted like they did that all the time (note: those were the only 2 times in my career I saw the hospital system level leaders. We didn't know who they were until they told us). One of the politicians family members repeatedly tried to get us to give information about tests/diagnoses etc, when the patient had not given us permission for this. The family member was quite snotty, but the pt was kind. Both patients were kind and not difficult to care for.

Um...which rock do you live under? Not every city even has both male and female OBGYNs, not every insurance provider has both genders in their network, etc. Lots of reasons that patientd may not be able to choose their providers. Also, I really feel like you're trying hard to create issues where there are few to be had.

I've worked medical and psych. In medical, sometimes male colleagues had to request female staff to assist male patients to the bathroom or with cathing because some male pts were uncomfortable with male staff handling their genitals. In psych, every pt gets a full-body skin check on admission and we always let patients know both male and female staff are available and let them choose. I've been doing this for years and have yet to have a male patient request male staff or deny female staff perform the skin check.

I'm sorry some people here are giving you flak. I for one, heed your warnings seriously, as does my entire hospital system (large system in central Texas). I get very frustrated with other nurses (like some on this thread) minimizing the risks and gravity of this situation. Every time a healthcare professional downplays the situation, that opens up the general public to say, "see, its not so bad." Then they gather and march and break stay-in-place orders and then guess what? They spread the virus and more people die, even some of the ones who felt 'it wasn't so bad.' And while I absolutely see that nurses in different types of units or different geographic locations experience this virus differently, those differences should not negate the severity of the situation. This is not the flu, its not Ebola, its not the common cold and nurses need to recognize and advocate for the health of our general public in the US, which means high numbers of people with the conditions OP describes, even high numbers of nurses. I get so angry with nurses blowing this off and not taking it seriously.

I'm sorry you're going through this. My hospital system (central Texas) has put practices into place for staff to request re-assignment to non-Covid units r/t personal or family risks (if the staff member is or lives with a family member who is high risk - like your daughter): fill out a personal risk form with our Pandemic Command Center and they will work hard to re-assign you according to your capabilities. If that can't happen (for example, you work ICU and all of our ICUs have Covid patients right now), then you can immediately qualify for FMLA (if your private PCP won't do the paperwork, one of our system MDs will), and this time off will not take from your PTO bank and will not have negative consequences down the road. This applies to full-time, part-time & PRN staff. I feel very lucky to be in a hospital system like this. I work very closely with 1 nurse (in her 70s with DM) who has taken up this offer for the past few weeks with no return yet in sight, as our city expects our peak in 2-3 weeks. My very small unit also has 1 nurse out Covid + and 1 nurse out Covid suspected right now. We are not allowed to do extra shifts right now per our hospital system to promote our own rest and well-being - we have internal and external agency nurses & techs to cover shortages. Typically, overtime is easily available, so this is a Covid related change.

I used to work with a nurse on Child/Adol Psych who always seemed busy. My shift started at 1845, so I assessed all my patients (10-12 pts per shift, ages 6-17 years old), gave meds, monitored snack and hygiene time, spoke with parents and CPS, received new admits, etc. We did paper charting: each assessment is 5 pages, plus a narrative note on each patient. We also reconciled our paper MARs every night. I was always finished with my work and ready to report off at 0645. I had time for a leisurely lunch and to converse casually with my co workers overnight. My colleague, on the other hand, started her shift at 2300 (after the kids were sleeping). She had no assessments, no med passes, no phone calls with families, very rare admissions. Her tasks were to count meds with me (about 4 minutes each night), reconcile MARs for her patients (6-8 pts because she refused full loads, and sleeping) and to document their sleep hours (which were calculated and given to her by our tech. This lady was constantly frazzled, super busy in the nurses' station, and never ready to report off in the morning because her documentation wasn't done. We gave report one at a time and no one could leave until everyone was done. We frequently wouldn't clock out until after 8 am. It was ridiculous.

1 RN to 8 pts; 1 Tech to 16 pts. Acute detox, all substances.

I remember a while back we were told to not say PTSD but to say PTSS (replacing Disorder with Syndrome). The goal was to improve patient participation in care with the thinking that no one wants a Disorder, but hey, a Syndrome, not so bad, anyone could have one of those! Yeah. Didn't last long because the terms don't matter.

I have never been assaulted in Psych (5 1/2 years in). When I worked medical (med-surg, Cardiac/Neuro ICU/IMCU), I was hit, kicked, scratched, bitten and groped.

I think a lot of people have felt this way before. This is how I approached my shift when I worked medical: Get assignmentLabel report short for each pt (or one sheet, segmented off for each pt)Quickly glance at lab results, timed labs due, timed meds coming up soonReceive report from offgoing nurse. If bedside reporting, check wounds/lines/drains/critical drips with offgoing nurse. Let pt know you are meeting all of your patients for the day and you will circle back around in the next half hour or so.Jot down each pt's meds in 2 columns: scheduled and PRN (when last given or next available)Jot down tasks due for day: line/dressing changes, drain maintenance, tests/procedures for each ptCircle back to each pt as promised, taking fresh water with you. Check wounds/lines/drains/drips if not done with offgoing nurse. Take vitals (or review if taken by tech). Give am meds as appropriate and update pt to day's plan and when PRNs are available. Chart in the room while doing your assessment, or, 2nd best option: place your computer just outside the room door, and chart as soon as you exit. Please do not leave charting for later 'until all your pts are good.' I've seen that go south when pts crash/code and the charting is not current with the most recent assessment. Especially if the primary nurse is off the unit, and no one knows what's going on or how the pt presented before the code.Prioritize your tasks and complete in order of importance to pt need (which may not align with pt want). I know Karen wanted her Lorna Doone cookies 3 minutes ago, but Jim is having difficulty breathing and chest pain because his Pleur X needs emptied.Cluster care for each pt. It's okay to instruct pts to think of anything they might need from you and ask you all at once, or write it down for you to address on your hourly rounds. That way you aren't bringing meds one trip, then another trip for juice, then another trip for a blanket, then another trip for ice chips, etc.Delegate. If you have techs, let them do their work, and ask/remind them to do their work when necessary. Coordinate with them ahead of time to plan things like wound care if you need them to help hold a patient on their side to get to a coccyx or something.Let your peers/charge know when you will be unavailable for a period of time. "Hey, Pt SoSo has a tube and tons of meds, I'll be in room 402 for a while. Can you watch my call lights for me?" or "I have to start blood in 410. I'll be in there until about 1030."Recognize that things happen: pt conditions change, you have discharges/admissions/transfers, you assist a peer in a difficult situation, etc. It's okay. Take care of the emergent need, then refer back to your report sheet and pick up where you left off.Try out different report sheets to find one that works best for you as you gain confidence and practice in your workflow.

As a Psych nurse, our standard is that if we believe a patient to be concealing items that are unsafe, we address it with the patient first, then if necessary, we call the doctor to report our concerns, then conduct a skin assessment if doctor orders it. We also require a doctor's order to search patient rooms for contraband. In your scenario, after the patient denied contraband or seemed insulted, I would have spoken with that patient's primary nurse, who should have spoken with the patient. If primary nurse did not address the situation, I would have taken it to the charge nurse. If neither nurse addressed the situation, I would have contacted the supervisor, who could speak with the patient and/or call the doctor for search orders. (Even though you are a nurse yourself, your actions were limited because you were working as a Tech at this time.) I actually find it difficult to believe that accidentally & casually waving a pen could impart a great enough pressure to pop styrofoam through a shirt - sorry, but I find your explanation a little light. While I can't say this was fireable, I would say it should have definitely led to education for you on appropriate interactions with patients and appropriate elevation of concerns.

I disagree with canoehead. I have a strong background in Cardiac/Neuro ICU/IMC and have worked the past number of years in a free-standing Psych hospital, in Admissions. A big part of my job is screening patients for medical clearance (in addition to Psych need and appropriateness). We will not accept a pt with systolic above 159. We also have parameters for EKG, HR, Electrolytes, BAL, WBC, Platelets, BG, CIWA, CINA, 3rd trimester pregnancy, Med levels (eg Lithium, Depakote) and Acetaminophen. We also require all patients to be fully ambulatory on their own and able to toilet & feed themselves. Canoehead seems to speak from an ER perspective, and sometimes when I'm screening, I get pushback when I instruct ER staff to replace K of 3.2 or give insulin for elevated BG, to facilitate patient transfer to my facility. It's all in the interest of patient safety - as a psych hospital, we are not equipped with the supplies to handle a CVA or MI or to stop bleeds (no IV supplies or IV meds in the building). I advocate for patients to be in the safest environment for them: they can receive Psych or TelePsych in the ER or medical hospital, but they don't really receive emergency or life-saving medical treatment here. If that means transfer to my facility is delayed, so be it.

Background is Cardiac/Neuro IMC/CCU. Have been exclusively Psych for a few years. Psych Nursing experiences can vary greatly based upon patient population. My facility has distinct units: Detox, Mood Disorder, Gen Psych, Psych ICU. Detox can be medically complicated. Mood Disorder patients can be mentally exhausting (esp. Borderline DO patients), Gen Psych includes all aspects of Psychosis - nonviolent, PICU includes Psychosis/Behavioral with violence and nudity. Working the Mood Disorder Unit requires offering great time and emotional support, not physically demanding whereas PICU is very much physical (as in stopping patients from hurting themselves or others regularly). I'm currently in Admissions, so I am the first point of contact for new admits - I frequently end shifts emotionally fatigued, especially when speaking with trauma victims and suicidal patients. Their histories and experiences are sometimes heartbreaking. I'm sometimes threatened with physical assault. I am thankful I work at a facility that actively teaches and practices safety for patients and staff - we are very good at de-escalation and working together and have very few injuries to staff or patients. Similarities to bedside nursing are time management and prioritizing patient needs vs patient wants. In general, I've found that Psych Nurses treat each with more compassionately and with more respect than other areas of nursing I've worked. It's a "we're all in this together" mentality. Important skills/traits for a successful Psych nurse include: compassion, kindness, a genuine want to help people, listening & speaking without judgment, practicing with rational detachment.

Former Home Health. Enjoyed the work. Could not live on the pay. Paid per visit: $30 regular, $45 admission/recert. Recerts are every 3 months. Medicare/Medicaid require 60 minute visits. Private insurance 45 minutes. So, while a company may say $40-50 per hour, I never saw anywhere near that because travel time is your own (some companies pay mileage - mine paid less than the Federal Government allowed, so I filed my miles at tax time). The amount of work taken home can be a lot - requiring paperwork before leaving in the morning and after getting home at night. I was required to use my personal cell phone - which meant patients/families had my phone number (I've heard some companies give out company phones). I had a 20 patients a week, with most having weekly visits, occasionally two for wound care. That was less money than I'd made as brand-new grad on Med Surg. I went back to hospital nursing to make more money and have my time off really be time off. Numbers could vary a lot based on geography and agency size. I was with a small agency and lived in the Midwest at the time.

I have worked as a Travel Nurse in Cardiac, IMC, ICU and Psych. Yes, there are horror stories (and people love to share them!) that Travel Nurses get the most challenging assignments. This was not my personal experience, but I saw it happen with other travelers. It depends on you. I went into each new site confident in my nursing skills and abilities, but humble in the fact that I did not know everything about that site/unit. I asked appropriate questions (like where to find supplies), then proved myself as a nurse with my work quality. I never felt I was given difficult patients on purpose. I did work with 2 different travelers who were cocky and frequently told permanent staff things like, "that's not we did it at such-n-such last job," and they just had "better than you" attitudes all around. Those two people did seem to get harder patient loads. It's important to realize though that Travelers are needed to fill staffing shortages for many reasons, including: unit/facility is poorly managed, patient acuity is generally very high/overwhelming, etc, so the units needing Travelers may be generally perceived as more difficult over all than well-run units. The permanent staff generally appreciated Travelers, because our presence took some of the load off them, especially if they'd been pulling a lot of overtime to cover shortages and were getting worn out.