ruhzdyn

Hey "Red". I understand your dilemma. I used to work on an observation unit aka crisis unit. Although I'm an RN-BC, my notes at the very least consisted of the following. Mood- (stated mood), Affect- (Euthymic?), Speech- Regular Rate/Tone/Volume (pressured, latent, etc) Thought Process- (delusional, paranoid, thought blocking, etc.) Gait- (steady?) client denies SI/HI/HALLUCINATIONS. (If hallucinations are present, I usually will state "command type" "paranoid type" "persecutory type). Client denies pain at this time. (if pain is present, location, blunt/sharp, intensity, factors making it worse or better). Interventions provided include- therapeutic communication, medication administration, promotion of therapeutic goals, with observation at 15 minute intervals for safety (tailor as needed). Post intervention assessment included client now calm and states feeling in control of mood. Of course this is very basic. Off the top of my head, my notes would look like that in general. Hope it helps!

Congradulations on your new position "wish me luck". I work for the State of Nevada with an inpatient psychiatric hospital and have been with them for the past year or so. Prior to that, I worked for another organization affiliated with the state for about a year. They provided outpatient services. I enjoy my job. The pay is rather low but I do like that they still retain a pension. Like any government job, they tend to be reactive rather than proactive about patient care. That can make change difficult. With young new minds, sometimes new ideas aren't welcomed. Regardless of whether we are psych nurses or not, we do still care for other co-morbidities. For example, many meds can technically prolong QT waves. We have to have the intuition to know when to further assess clients who may have history of heart problems as a result. Many antipsychotics can lead to metabolic syndrome as well. Knowing to look out for signs of significant weight gain or insulin resistance is therefore also important. Still other meds can lower the seizure thresholds. Many clients, especially those with history of seizure disorders thus have to be carefully watched. Teaching in med-surg like conditions will become part of your basic nursing interventions as a result. In other words, that idea of "they don't lose their bodies" may not be completely accurate. Regardless, I hope you enjoy psych as much as I have. It's been a rewarding experience and I have gained so much from it. I hope you do too.

Interesting post. I recently changed position at my organization. Previously, I too was on an acute observation unit. Because I work at the state, many of my clients were uninsured or out of days with their insurance policy for private hospitalization. When I first started there, it took me a while before I had established my reputation with the technicians. Initially, I too would often be pressured to ask for an IM medication. Like you, I've always felt that they must be warranted not because I'm upset at the client or some sort of justice act. Our specialty is under its own code of ethics where we do no harm. Clients are frequently on a legal hold in which their rights are suspended because they are a danger to themselves, others, or can't care for themselves. In those cases, we are held to a high standard in which we are obligated to look out after their interests. In those cases, no matter how bad of a partner they may be in this relationship, we must look after them and make difficult decisions on their behalf. Our duty as a nurse is that of a benevolent role. We must not ever forget that we have to make these decisions in the best interest of the client. It’s a lot easier if there is a denial of rights for medication. Without that denial of rights however, we must not medicate unless they are escalating. Even in cases like that, if I can perhaps get them early with a dissolvable (i.e. zydis, M-tab, etc), I can still meet my objective. Keep your head up and do the greater good. You sound like you’ve already made the right decisions.

Psych is a great specialty. No two days are alike. Everyone's illness seems to manifest a little bit differently with each individual having their own unique story. I like that I'm always on my toes in the specialty too. It can be a little hectic as well as depressing. In the medical hospital setting, we frequently have to push people through until they are able to be discharged due to the fixed reimbursements based on diagnosis from hospitals. In psych, we really get to know the patient because we want to be sure they are better before being discharged. In a medical hospital, their sentinal events tend to happen in hospital while in mental health, they tend to occur just after discharge(i.e. suicide). Furthermore, when digging into nursing theory, you'll find that many of our nursing theorists were heavily influenced by their own experiences with psychiatric clients. A lot of the theoretical basis for their work was built around the foundations of developing relationships with clients that are not always receptive. The deep roots that psych has in the nursing profession is huge. It's a great specialty. As you mentioned, the starting pay is not as high. I assure you though that there are plenty of oppurtunities for your income to grow within the specialty. Whether you will eventually end up as an educator for future mental health nurses, a practitioner, or in management, you will love the influences that mental health nursing will give you. Remember, before you can start anticipating fruits, give the seed a chance to grow and flourish first.