Our psych E.D. is a locked unit inside the medical E.D. It holds seven patients, but sometimes the census tops seven and we have patients lining the halls in the medical E.D. On night shift we have one nurse and two techs; day shift has two nurses and one tech. We also have a security guard in the psych E.D. 24/7. Patients are medically cleared on paper only. Really. After they enter the psych E.D. blood and urine samples are collected, and CT scans and X-rays are done. Then, they have to return to the medical E.D. if labs or imaging tests are abnormal. Some of our E.D. physicians frequently downplay the ailments of psych patients. We have to make multiple requests for BP meds, insulin, or Librium, and too often those requests are denied. It can get frustrating. Some patients have limited insight and don't want to be held involuntarily, and they will put up a fight. We also have to do insurance authorizations, which is sedentary and very time-consuming. Another time-consuming task is reviewing charts and accepting patients from other hospitals that don't have a psych E.D.