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I'd also recommend looking into Collaborative Problem Solving, which is a newer model developed by Ross Greene. It teaches you to see children as lacking the skills to do well and teaching them these skills vs. taking an authoritative approach to interventions. I've been working in child and adolescent psych for 6 years and love it! As long as you can take care of yourself, know your triggers, and separate from the sadness that comes along with the population, it's a truly rewarding job! Many kids have the resiliency to do well, the system just needs to work in their favor to assist them (which is unfortunately the difficult part). Good luck to you!

I was in the same mindset as you when I graduated nursing school a little over a year ago. I applied for a PRN position at an urgent care center and got it. While it's not med-surg and I'm not sure it would be enough experience to land me a job there, it has given me extra experience. I'm IV trained and have both my ACLS and PALS certs through the urgent care center. I say do whatever you can to add skills to your resume and if for some reason you'd want to leave, you have other skills under your belt to help land another job.

A co-worker of mine who was hurt (kicking multiple times in the stomach and had to go to the ED) by an aggressive 17 years old patient on our C&A unit was discouraged from pressing charges and told by our HR department that she could "lose her license" for pressing charges if the parents then chose to sue her. Is this true? I know ED nurses press charges all the time if they're injured. CYOA IMO. Our organization isn't going to foot the bill if she has medical issues down the line. They are also saying her getting hurt is her own fault because "you should never be in front of a patient". When obviously during a restraint attempt the patient was all over the place and was able to kick her when she couldn't get out of the way. We use CPI (no floor restraints) which is ineffective in most situations (especially with children). Just wondering others thoughts on this.

NurseKris is your unit a child and adolescent unit? I can only use data from these units due to the specialty and them usually requiring more staff.

Those of you that work on C&A inpatient acute psych units, what is your current staffing matrix (specific numbers per census)/HPPD and/or staffing guidelines? I've presented some literature to our management re: appropriate levels, but they'd also like to know what other units are doing.

Thanks for the feedback! I'll be less nit-picky next time :) Ativan was a bad example as narcs are way different than Tylenol. I've just heard horror stories of nurses getting fired for giving a med in any way other than ordered.

If an order is written for Tylenol 650 mg po PRN headache/fever can the Tylenol be given for pain/menstrual cramps (outside of the order parameters) with "nursing judgment"? I'm a newer nurse (a year) and tried to get a Tylenol order changed so we could give it for pain, but the on coming nurse said we can just give it using our nursing judgment. I know if the situation was say Ativan 2 mg po PRN for seizures we then couldn't give the Ativan for anxiety even though we know this is an indication for it.

Every facility is different, but mine requires a bachelors in a human service related field (psychology, social work, etc). A nearby facility only requires current coursework in one of these disciplines. Definitely use your interest in psych nursing to market yourself in an interview. It's always nice to have passionate techs working!

I agree with Orca and elkpark. I'm a charge nurse on a 16 bed child/adolescent unit. We always have 2 RNs on - one to pass meds and the other is charge. With only 16 kids - some shifts are beyond crazy with admissions, discharges, medical issues, restraints/seclusions, family concerns, etc. I can't imagine being the only nurse responsible for everything plus having more kids. Child/adolescent is a HUGE liability if something goes wrong and it's definitely a specialty that requires good training and orientation. Good luck to you! Keep us posted!

Joint Commission recognizes ANY time you tell a patient they can't leave a room or physically prevent them to do so as a seclusion. I work C&A and we got dinged when they asked a kid if he was allowed to come out of his room and he said no. We're not allowed to use time outs at all anymore.

I thought about talking to him but he could easily deny it to me and it would go no where. If it were a different nurse I might think it was done innocently, but this nurse is notorious for cutting corners and not doing his job. He sees psych nursing as "easy" and is often found hiding when an issue is going on on the unit, doesn't take care of medical issues (they're always left for me on evening shift), and makes a million excuses. He knows better than to sign my initials. The staff that performed the check wasn't a nurse - him and I were the only nurses on that shift. While I understand he might have seen the blank and ASSUMED it was done so he wanted to make sure it was documented, this does not ok him forging my initials. He could have simply left the document for us to sign the next evening as we often do when we catch things that are forgotten. My clinical managers response to this all was that we "can't go back in time" and that if people didn't forget to do things, this wouldn't happen. In other words, she's not going to do anything about it. The milieu has been crazy lately and EVERYONE forgets things now and then. I commend the staff member for remembering she forgot to document and going back to do so as many staff would blow it off. I feel as though my manager isn't taking this seriously. I like her, but she was forced into being our manager after our last one passed away suddenly and she isn't keen on confrontation with staff.

That's exactly what I did. I didn't want to point fingers without knowing for sure and figured it would be best for her to investigate who it was that signed it. There are only 4 staff that worked that shift (we're a 16 bed unit) so it's pretty clear that someone else used my initials.

I'm a charge nurse on a psychiatric unit where patients on suicide watch need to have a body/room search done each shift. One of the staff forgot to document that she completed this the other night. When she went to initial for doing the checks the next day, she found that my initials were there as if I did the checks. It's CLEARLY not my signature and looks identical to another nurse's handwriting that worked that evening. I'm so angry that he would falsify my initials at all, especially when I didn't even perform the check. I sent an email to my clinical manager and am waiting to hear back. What should my manager do about this? I'm not looking for him to be in trouble and don't want to come off that way to my manager but I definitely want to make sure it's handled correctly. Who knows what else he's been falsifying on the floor as he's the charge nurse on another shift.

Amen. I really wish people (upper management/the admissions department/ERs) knew what goes on on a daily basis on a psych unit. There are not numerous nurses waiting to take admissions. There are 1-2 nurses who are responsible for med passes, verifying orders, talking with the physicians, discharges, etc. on top of having a patient assignment, managing the milieu, leading groups, doing q15 safety checks on patients, talking to families, de-escalating and talking with patients who are in a current crisis... The list goes on and on. On top of that an admission takes time and extra staff to perform skin checks and body searches. It's unrealistic and unsafe to have admissions back to back without the extra staff to do so. We briefly had an "admissions nurse" in house that was a lifesaver when the floor was acute, but management felt this was a waste of money so it was done away with. Bottom line - every floor/unit poses their own challenges and as nurses we need to work together instead of pointing fingers at one another.

IMO and experience, you have to be fairly laid back and not upset easily by things. Especially working in C&A, you'll be called every name in the book and children have a way finding flaws and pointing them out. You just have to be very aware of your triggers and sensitivities and monitor when you're reaching your limit. Also, I think working C&A definitely isn't for everyone. Will they allow you to shadow for a day? Would you be working 8 hour or 12 hour shifts? Night shift on my unit is fairly quiet. Evening shift gets all of the kids to bed (with the occasional straggler child who doesn't want to go to bed or teen who is having suicidal thoughts) and the majority of the night is spent doing small tasks around the unit and doing admissions (this is our heaviest admission time). Day shift is filled with groups, school, and sessions with the psychiatrists. One nurse goes to treatment team and updates everyone on the kids status from the previous shifts and offers insight into their treatment. I work 4 8 hour shifts a week and that's plenty for me. Some days are easy and rewarding... Others you're so physically and emotionally exhausted you need a weeks vacation. It's all in what you can handle personally.

What kind of groups do "techs" run on your units? I work evening shift on a C&A unit. Over the years are programming has become more lax and the evenings have a lot of free time. Seasoned staff and administration want the kids to have more structure. I was a tech for 4 yrs on the unit before graduating nursing school and now being the charge nurse on evenings. I used to run "therapeutic" groups with the kids all the time (and still do when i have free time) e.g psychoeducation, education on coping skills, anger management, goal-setting, etc. One of our newer "techs" ( we call them behavioral health specialists) stated that she "doesn't get paid enough" to do therapeutic groups and that we simply need therapists on evening shift. Their job description does state that they are to lead groups. The only groups they're currently responsible for on evenings are goals groups where they review goals and coping skills. This lasts approx 10 mins. Am I expecting too much to want them to lead groups again? It seems like the motivation and work ethic of staff has decreased significantly with turn over. I'm head of our unit council on the unit and my boss has given me a lot of decision making and leadership roles on the unit. I don't want to run to her whining about staff, but how can I make people do their job (Other than wanting to slack off and talk/flirt all night)? Or am I asking too much?

I did the same and despite people telling me to get Med Surg experience, I went right into psych. I had been working on the same floor with my previous bachelors and knew that's where I wanted to be. I couldn't see making myself miserable for a year doing something I didn't really enjoy by going into Med Surg. You can always relearn skills (starting IVs, catheters, etc) - and psych requires a lot of critical thinking and fast actions so you'll never lose those! I say follow your heart as well. If you know you're going to stay in psych - go for it!

We're allowed to ask our admissions department for 15 minutes to get things settled and finish up whatever we need to quickly. If we're swamped we usually let them know the situation and tell them they can bring the admission to the floor but to let them know they may have to wait a little until someone can do the admission. This doesn't happen frequently. It also helps that admissions staff also help out on the floors sometimes so they know how crazy it can get.

What state are you in? I guess I should be grateful as it sounds many other places are staffed a lot worse than we are. But working with kids (and their families) I want to provide the best care possible and not have to worry about liability issues (e.g. Teens having sex on the unit, fights, etc.). It seems whenever something happens it comes back on us, but we're doing the best we can with what we've got. Constantly having to tell kids we can't help them at that moment because there's a million other things going on isn't acceptable to me. I am grateful that we always have 2 nurses though. Between admissions, discharges, medication, orders, and talking with doctors and families, doing that alone would drive anyone crazy themselves.

I work on a 16 bed child/adolescent (ages 4-18) unit and we ALWAYS have 2 nurses no matter what the census. Where they short us is not giving us adequate support staff (ours are Behavioral Health Specialists and all have a bachelors degree in mental health). The most we can have is 3 and thats when we're at a full census. We run groups and as many know children require much more time/attention and a higher liability than adults. What's frustrating for us is our grid is the same as our adult floors and its definitely the bare minimum for all of the responsibilities we have in a shift. Does anyone else work C&A and have more staff than their adult floors?

Yes, we have two goals groups and a wrap up group at the end of the day, RT activities and therapy groups until 4 pm, and 2 hours of school with IU teachers M-F. Unfortunately we don't have a gym or a lot of options for the kids to get their energy out safely, which is one of the things we'd like to look into. Our staffing grid has been cut significantly in the past 5 years. It used to be doable to have nursing staff lead groups throughout the day but most of our time is now spent doing paperwork and more or less babysitting and redirecting the kids. We're looking for some sort of structure for the unit and motivation for the kids to want to participate in treatment/follow directions without being punitive and causing more acting out behaviors.

I've worked on an inpatient child/adolescent unit since getting my bachelors in psych 5 years ago. I've recently graduated from nursing school and have transitioned to a nurse on the unit. I'm really trying to be a leader on the unit as our management is pretty poor. Approximately 3 years ago we moved away from a point sheet/level system in hopes of transitioning to CPS (collaborative problem solving). The hospital put a lot of money and time into this effort but without adequate leadership, the change failed and we're now left with no programming. The kids pretty much do as they please and we (the staff) feel powerless and like the unit is out of control when the acuity increases. Management gave me the go ahead to meet with staff and discuss changes that need to be made on the unit, including programming. Does anyone have any experience/suggestions for models that work? Or know of places to get information? I've done some pretty extensive journal searches but only come up with articles on seclusion/restraint, why level systems don't work, and implementing CPS.