Psych nurses don't know medical?

allnurses Guide · Sep 10, 2020

The secret to this is to talk to the docs before these situations happen. Let them know that you are smart and capable at assessing patients. To be fair to the Doctor's I have seen many nurses over the past 20 who only saw horses when they were assessing hoof beats. You are gonna have to go looking for that zebra every so often. Onece the Dr's know that you know your staff they will trust you more.

Hppy

Orca, ADN, ASN, RN · Sep 10, 2020

There is definitely a stigma. I went straight from nursing school into a position on a hospital adult/chemical dependency unit. Some consulting physicians took their time returning our calls, because it was "only" the psych unit calling, and we couldn't possibly know when it was appropriate to call a medical doctor. I also ran into an issue finding employment when I worked for a free-standing psychiatric hospital that was closed by the parent company. I drew unemployment compensation for three months at a time when hospitals were running full page ads in the newspaper looking for RNs. I couldn't buy an interview.

futurepsychrn, ADN · Sep 10, 2020

15 hours ago, hppygr8ful said:

The secret to this is to talk to the docs before these situations happen. Let them know that you are smart and capable at assessing patients. To be fair to the Doctor's I have seen many nurses over the past 20 who only saw horses when they were assessing hoof beats. You are gonna have to go looking for that zebra every so often. Onece the Dr's know that you know your staff they will trust you more.

I now work in a state psych facility and I know and have dealt with all of the on call docs except the one that was on the other day. The others pay attention when I call, this one not so much! However, when I finally got him to come and check the pt he realized I was right . Then he ordered labs, I&O's, fluids etc., and kept calling back to see if they were done ( can you say worried?), he even called the night supervisor to find out why they weren't done yet ( too late, I'd already talked to her!). He even asked for my full name because apparently he didn't like my attitude when he treated me as though I didn't know what I was talking about. I gave it to him and asked if he needed it spelled. The other hospital had an on call Dr but it took an act of Congress to get them to come to the Psych unit. In that facility, I called the medical director of the hospital to get orders. I know how to get around them and do what's best for my patient, but it's just really frustrating to have to take all the extra steps

futurepsychrn, ADN · Sep 10, 2020

Orca, I tend to go back and forth between Psych and medical when I get burned out on Psych. It helps me refresh my skills.

futurepsychrn, ADN · Sep 14, 2020

Update..... back to work after 4 days off, pt was sent to ER after I left that day because the labs came back with an electrolyte imbalance. Well geesh, I tried to tell you something was off! Maybe next time you'll listen instead of letting your ego get in the way.

KJoRN81, RN · Sep 15, 2020

There is definitely a stigma. I work a chaotic mixture of both: medicine psych! Gives me a run for my $ every day LOL.

Orca, ADN, ASN, RN · Sep 16, 2020

On ‎9‎/‎8‎/‎2020 at 5:13 AM, futurepsychrn said:

Why oh why is it that Drs think if you are a Psych RN you don't know anything about medical? I'm so tired of calling the MD, because a patient is going south medically, and being brushed off, because apparently Psych nurses can't recognize a medical issue.

I had a patient on my unit who was fading in and out of consciousness. For some reason, a cardiologist who we normally didn't work with took an interest in his case while he was in ER, and he said that he would cover his medical issues. I called the cardiologist and left messages several times. I finally called the psychiatrist, who ordered a chem panel. It showed a blood ammonia level that was off the scale. The cardiologist finally called. The LPN answered the phone. She said, "This is Dr. X. He says to stop calling him unless the patient is lying dead in the floor." I had her hand me the phone. I told him, "Your patient has a blood ammonia level that isn't compatible with life. Unless you give me some orders right now, you may not have to wait long for him to die." I got my orders.

Not long after my unit opened, we received a patient from ER that had attempted suicide by driving his car into a utility pole. He came to the unit in a wheelchair. He was dressed in a gown and covered with a blanket. He told me that his ankles really hurt. I lifted up the blanket, and both ankles were severely swelled and bruised. I called ER to see if they had ordered x-rays on him, because there was nothing about the ankles in the ER report. The ER physician's attitude was "How dare you question my judgment." I called the psychiatrist, who ordered bilateral ankle x-rays. We sent him to surgery the next morning to repair two shattered ankles. What I believe happened was that as soon as the patient said that it was a suicide attempt, the ER physical stopped his physical assessment and ordered him admitted to us. Even a layperson would have seen that there was a major problem with his ankles.

Stillcrazyafteralltheseyears · Oct 30, 2020

I had the same problem with a medical director I worked with. As u said 9 out of 10 times I was right. I came to believe that the director didn't want the affected patients medically sent out because of cost. But I didn't go away and kept reporting and documenting the patients decline. I don't care if Dr.s yell at me and try to make me out as a idiot. That doesn't scare me. After awhile their was mutual respect between the two of us. He knew I cared for the patients and I feel he started to care a little more because of my actions. You never know who u affect by your caring and diligence. You are doing your job, and I bet the nurses you work with appreciate that they r working with someone that's keeping the patients safe. Your a good nurse! Take care and follow your instincts.

verene, MSN · Oct 31, 2020

Had a patient come in for acute exacerbation of chronic schizophrenia. On assessment seemed there was a delirium component. Long story short - yes the patient had chronic schizophrenia they also had stage 4 hepatocellular cancer and were looking at a life expectancy measured in months not years. No one had bothered to do any sort of physical assessment.

I also had a patient sent back from ED with a note of "This is psychosis - please don't send her back - Dr. X" .... I'd knew this patient... it wasn't psychosis. Her O2 sats were in the low 80s... hypoxia anyone? She also couldn't stand/walk (which she'd been able to do when sent out that morning). She had a LOTS of comorbid cardiac and pulmonary issues. Got her transferred to a different ED - that ED doc was great: "Oh boy.. Ms. Y has a lot going on with her doesn't she! I'm not sending her back to you tonight - she's looking at at least 3 days in ICU. I can't believe an ED sent her back to you! - she's really sick and crumping fast! I'm glad you guys sent her over to us -- we'll take good care of her and let you know how she's doing - how long are you able to hold a bed assuming we can get her stabilized?"

Even now as psych NP the amount of medical I see is a LOT. I NEVER assume patients have had a good medical rule out prior to arriving at our hospital (free standing psych). I've found: grave's disease x2, severe aortic stenosis, vascular dementia, cancer (x2), epilepsy, gallstones, inguinal hernia... and that's just in the past few months! Thank God I have a good in-house medical team to work with!

Orca, ADN, ASN, RN · Nov 2, 2020

The only patient that I have ever had die in my care should never have been admitted to us. I was working in a stand-alone psychiatric facility, morning charge nurse on the geropsych unit. It was my first day back after my days off. The patient in question was sent to us from a hospital 100 miles away after hospital staff convinced our intake person that he was suicidal. When I made my morning rounds after report, an oxygen concentrator set to four liters of O2 told me that depression wasn't his primary issue. He appeared to be sleeping, so I did not assess his orientation during first rounds. I could at least tell that he was breathing. It was an agency CNA and me on a ten-bed unit. I went into the med room to set up my morning meds, maybe 20 minutes into the shift. The CNA knocked on the med room door. "I don't think this guy is breathing." Sure enough, he wasn't, and we ran a full code - thanks to the hospital not sending his DNR order along with him. When the paramedics arrived, we were performing CPR. They contacted a physician at one of the local hospitals and had him to declare death.

I found out later that he had told staff at the hospital that he came from, "I don't want to live like this", due to a litany of medical issues. In their infinite wisdom, they interpreted this as suicidal ideation and called our intake line. I also told our intake people that if they were going to agree to admission for a patient who they had not personally seen, they needed to first ask whether there was anything running into or out of him before accepting. We were not equipped to handle IVs or tube feedings, nor should we have ever gotten anyone who needed that much oxygen to survive.