are all psych facilities like this?

[celle507]

Hi,

I am a relatively new nurse (5 months med/surg experience) and didn't particularly like med/surg so I decided to try psych nursing since I've always had an interest in psych anyway.

However, the unit that I was placed (adolescent) is very, very short-staffed (which is one of the reasons they put me on there). During the interview, they told me that there would always be two nurses working there but there is hardly any nurses here so usually, only one nurse is on with 4 mental health associates. I've only been orienting for a week, but every day, there is an issue of staffing (who will be on tonight?, who can we get? who do we need to float from other units to work?) and there is no consistent staff for the kids since it's usually staff from other units who are floated to our unit.

I am a new nurse so I DON'T want to be put in the position where I am responsible for the entire floor, esp. in the event of emergencies (3 restraints last night!). The nurse manager promised me that I would not have to work on my own and they would always float another nurse over. However, I am not sure this is the best place to start off my psych career ... the place seems very disorganized, very short-staffed, the kids do not seem to have many activities, and the staff who do work there seem to let the kids run wild.

Now, are all psych places like this or is this perhaps due to the fact that it is run by a for-profit company?? Should I look for another psych job elsewhere or stay in this place but maybe on another unit? This unit has had a mass exodus of nurses, and MHA's in the past few months and they are trying to regroup and restaff so I feel bad for leaving but at the same time, I feel like I can't work under these conditions... any advice? I also hate to leave another job so quickly...

I am thinking maybe transferring to an adult unit since *maybe* the adults will be easier to work with than these adolescents ... is that true? I also feel like I haven't developed a good rapport with adolescents... sheesh, I couldn't even connect with adolescents when I was one, nevermind now that I am ten years older than them! :)

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I used to work in a psych hospital. Mostly on the adolescent unit, some childrens, and some adult. Your staffing sounds good compared to where I worked. On nights, one nurse covered BOTH the adol and child units. (14 pts on each unit. The unit was connected by a set of double doors, and the nurses station)And there was one tech to share between both units. It didn't matter if there were pts on suicide precautions or not. After a suicide occured on the unit, obviously staffing changed for the better. (but I already left) I personally find the adults easier to care for than the adolescents. But that is me. Good luck with whatever you decide.

[nurse43cat]

well first of all welcome to adolescent psych nursing.. I worked the unit for over 3 years......it was tough let me tell ya......... didnt have an ounce of experience except thru raising my own children...setting limits , appropiate behavior, time outs, choices=consequences for behavior etc etc. But anyways to make the answer short... I never ever had the consistent staff necessary majority of time.... I was out there helping the one tech I had on a 16 bed unit to make sure the children and adolescents were safe...Because come right down to it if something happens to one of those children...it wont be management answering to TDH it will be you as a nurse unless you have adequate documentation that you consistently asked for assistance from them.....believe me it is your butt none the less..........do whatever your gut feel is right .....if you feel that you are not experienced enough to handle the milieu of adolescents/children......get out asap ....Get the basic knowledge from general psych because adolescent and children psychology is totally different than adult psych... so thats my input and experience... I eventually got out of it......I was realizing my license is too important to me to lose over management inability to recognize patient safety as an issue as well as them worrying bout the mighty buck...

Best of luck from an old psych nurse

Cathy

[TxPsychRn]

I would wonder why there was a mass exodus of nurses as you stated , probably due to the conditions you talk of , what is the nurse to pt ratio on your unit , I would definately get acquainted with your hospitals staffing model (don't be afraid to ask for a copy) , and demand that it be met if you are working that shift . Working adolescents is a whole different ball game , lol . it has it's own poblems and rewards . I believe that overall , working with adults is easier and if you feel out of place with the kiddos then you should ask for a transfer .

[Nursebaby23]

I have been an LPN for 3 years, and just recieved my RN. I have always wanted to persue psych nursing, but in my area most mental health facilities will only hire RNs. I will be starting at a state psychiatric hospital soon working with adolescents. I am very excited, but I just don't know what to expect. I'm thinking that this particular unit is very hard to staff, seeing that this position was the only position available. Wish me luck!!!:uhoh21:

[CharlieRN]

I've been a psych nurse probably as long as you have been alive and I second the motion. If you feel more than a little uncomfortable, get some experience with adults before you deal with kids. By and large kids are more physically dangerous than adults. They also have greater potential for hitting your emotional weak spots. Adults are hardwired to have emotional weakness toward children. Further, almost everyone has some emotional baggage from childhood. You can be sure your clients will find your weaknesses and exploit them.

If you feel the problem is inadequate staffing, consider this; adolescent units do not need as heavy an RN presence as, say, an adult detox unit would. Generally kids are physically well. Two RN's are generally enough for a medium size unit that has no "special problem" clients. One to do meds and treatments, one to be in charge and manage the unit. But this is assuming there is an abundance of well trained, sane, responsible adult nursing assistents, and that nurses are not expected to run therapy groups etc. The adult to kid ratio should be about 1 to 3, past 1 to 5 is risky, 1 to 6 is the limit of safe. Remembwer safety is the name of the game. It is job one. It is more important than getting the meds passed, or any other task accomplished. That is why the nurse incharge should not also be trying to get the meds out. Managing the milieu is a full time job. As a new nurse, it should not be your slot. You should be the med nurse, at least at first.

[Meerkat]

*THREE* in restraints in one night?!! OMG, our administrators would KILL us!