Psych floor in hospital vs Free-standing Facility

[Guest321574]

Hello all,

I'm wondering if there are any major (or subtle) differences in the working environment between a psych floor in an acute care hospital versus a free-standing facility. Differences in pt diagnoses/co-morbidities, etc.? Or scheduling policies?

Any general thoughts on whether working on one is preferable to the other?

Thanks in advance for your thoughts

[Orca, ADN, ASN, RN]

I have worked in both. As I see it, advantages and disadvantages of both:

Hospital unit

Advantages - Easy access to medical care when needed, or when emergencies occur. Specialists and consultants don't gripe about coming, usually making rounds there anyway. Colleagues on other units can advise you on medical matters if need be. Patients you get have generally been carefully screened medically.

Disadvantages - Sometimes get dumps from other units and ER of people who are just management problems. Had one rushed to me so fast the staff on the unit didn't get x-rays of the shoulder he shattered when he "bumped into a wall" (their description). Some stigma among hospital staff who neither understand nor appreciate what psychiatric nurses do.

Freestanding

Advantages - Don't accept people needing extensive medical care. Focus is on psychiatric treatment only. People who work there have chosen psychiatry and are committed to it, from the physicians to the nurses.

Disadvantages - Intake people often aren't nurses, and they sometimes don't ask the right questions regarding medical issues when accepting patients from hospitals sight unseen. I had a patient who was on four liters of continuous O2, which immediately told me that depression wasn't his primary issue. He died 20 minutes into my shift. He came from a hospital 100 miles away and he was admitted based upon a verbal description that carefully omitted important facts about his medical condition.

Geropsych units get a lot of dumps from nursing homes (people the staff just want a vacation from). A good many are just exhibiting symptoms of Alzheimer's, which a hospital stay isn't going to fix.

[Whispera, MSN, RN]

I've worked in both types of psych facilities. Pay was about $8 per hour less in the free-standing psych facility than in the general hospital, but what happened during the work day didn't vary much between facilities.

Some psych facilities take the sickest of the sick psych patients. Some don't. Some take patients with extreme med/surg problems and others don't. Some take prisoners from local jails and some don't. It all depends on where you work.