Psych patients on medical floors

[rn undisclosed name]

I will start off by saying I don't like dealing with psych patients. If I like it I would work in psych. It's just not my cup of tea. In my experience psych nurses don't like dealing with medical issues.

So, my question is how to deal with these patients. Depending on how bad the patient is I don't think it is proper to tell them the psychiatrist has to come and evaluate them. The psychiatrists don't appreciate that but I don't think it is my place to say anything because that can just agitate them more if they know a psychiatrist is going to see them. If the psychiatrist determines they should be admitted for psyiatric evaluation I think they should tell the patient and not leave it to the other staff. I am wondering how others deal with this situation.

[carolmaccas66, BSN, RN]

In Oz, all patients admitted must be seen & assessed by a psych doctor, irregardless if they come onto a mental health unit, or through the ED/ER. An intern can schedule a patient, but a psych patient must be seen by a psychitrist within 48 hours of admittance.

As a nurse on a med unit, you should not have to care for psych patients. And most of them, except the scheduled ones, are just normal people with acopia and social disorder problems. You should be advocating with ur NUM and the psych doctors to have these patients moved to a mental health unit where they can be cared for by experienced psych nurses.

But, of course, in the real world, psych units run out of beds and med units take the overflow for everything. I suppose I've gotten used to caring for patients with all sorts of conditions, and anything and everything as an agency nurse, so I don't think twice about it. See if you can contact a psych liaison nurse to help you next time, but ur NUM should really be trying to get these patient's psych beds, or at least give you med nurses some psych training.

Let us know how u get on anyway!

[Flo., BSN, RN]

I also don't like psych patients on my surgical floor. We are not staffed or equipped to properly care for them. If I think that they need immediate psych intervention I don't tell them either, I just have the MD or NP come and evaluate. The only exception being a suicidal pt. We put them on 1-1 care and I explain that I am concerned for their safety and a psychiatrist will be coming to evaluate them.

[SnowboardLovinRN]

Just be glad you have psych MDs at your hospital! At my hospital we don't... I don't think any hospital besides county in our city does. It is horrible because they so badly need that care. I don't like taking care of them either, but they are there for medical attention... the management of psych issues may have landed them where they are but it is not necessarily the primary issue.

Having each patient evaluated sounds amazing!

[blondy2061h, MSN, RN]

I did clinicals in nursing school on a psychiatric medsurg unit. It was a unit for people with both active medical issues that would likely otherwise land them in the hospital and active psych issues. It was a weird mesh of psych unit and medsurg unit in that it had regular patient rooms with o2 set ups, beds, and vital sign machines, but also had psych unit aspects like group therapy rooms. Often times the medical issues were directly related to the psych issue. I remember a manic depressive patient who tried to poison himself and went into multi-system organ failure. I remember a few anorexics on tube feeds or TPN. I remember a man with schizophrenia who, despite having a warm home, spent a cold night outside and had to have several toes and fingers amputated. There were also patients who just happened to have major psychiatric issues and medical issues, though the two might be unrelated, one always influenced the other.

It was an awesome learning experience, but I could never do that full time. Those nurses have my utmost respect as some of the hardest working in the hospital. It was full of challenges. Paranoid schizophrenics with central lines? Oxygen tubing on a suicidal patient?

Occasionally they got regular psych overflow, but never medsurg overflow. It was such a unique, and need unit that it was nearly always full. I should clarify also that stable psych patients who were well controlled on meds went to regular medsurg units. THis unit was for patients who definitely needed acute psych care as well.

[That Guy, BSN, RN, EMT-B]

Our hospital opened up a new off campus Geri Psych Unit. Problem is they have to be medically stable to go there and they are usually closed so I dont see the point of having it when we never send our psych people there.

[Mrs. SnowStormRN, RN]

Are you dealing with psych patients because they have a medical issue? If I have a psych patient and they have a medical problem (maybe a drop in blood sugar, or increase BS) I have to deal with it (which I personally dont mind), but if the person has to be sent to a hospital because we are not equipped for that particular medical problem, than a non-psych nurse would have to care for them. Otherwise, psych patients may have high BP, Diabetes, HIV, MI, stroke, they might break a bone, may need a particular surgery, or any other type of medical disorder/procedure that requires care outside of their psychiatric disorder. What I am asking is, is it a medical patient that has a psych disorder? Or are they moving psych patients to your floor because psych is overfilled (big difference)?

[Do-over, ASN, RN]

Only medically stable "psych" patients go to the psych unit - they are not equipped to deal with the acute medical issues, or treat DT's, etc. At least at my place.

I can't think of an environment where a nurse will not have to take care of patients with psych diagnoses. Patients with mental illnesses have babies, develop cancer, CHF, diabetes, etc, etc, etc.

[rn undisclosed name]

We take care of the medical problems which I have no problem doing. Once they are medically stable we wait for beds in psych and it still takes forever to transfer them to psych d/t a multitude of issues (not wanting to take report, sometimes there is no bed, stating no bed is available when in fact a bed is available, etc). This is the first place I've worked at where we have inpatient psych and I believe that is part of the problem.

These patients are difficult because you can not reason with them and they argue with staff. I have set limits though I probably do not do as good of a job as psych nurses.

I had a pt d/t a domestic situation and was put in the situation of trying to get in touch with his wife to find out her version of the story before the pt could either go to psych or be discharged. He was there for chest pain and bloody stool. Refusing further workup. If we are not doing anything medically then dealing with the psych aspect is difficult. The pt was not on a police hold and if they are not being admitted to psych for further workup I should be able to release them AMA. This eats up a lot of my time and don't feel I should have to do investigative work to determine if the pt would cause any harm to his wife. I feel that is the job of the police since they investigated the domestic situation. The psychiatrist wrote the order for this to be done in order to determine the pt disposition. In the meantime I am not able to perform my nursing responsibilities to my other patients. I contacted social work for assistance and they tell me when psych is involved they don't get involved until psych signs off. When the pt was in the ER it took 7 police and security to hold this guy down and he was placed in leather restraints and sedated.

[decembergrad2011, BSN, RN]

If you have the attitude that they are wasting your time and a pain in the butt, what kind of attitude do you expect from them?

You're going to encounter psych patients in any area where you work, just as psych patients come to in-patient units with a host of medical co-morbidities. It doesn't sound like you are being asked to lead group therapy or perform psychiatric intakes. What exactly is your problem here?

And if you think that it's not a part of your job to find out the details of a possibly abusive encounter...just wow. What happened to being an advocate?

[Fiona59]

Our Psych unit won't take a patient with an open wound or requiring IV treatment. So, suicide failures wind up on general surgery. If we are lucky we can get security to stay with them. Our staffing isn't changed to enable us to spend more time with them, we have our usual case load. We can get the Dr down for a consult but Psychatrists are a very different breed. It's like they are doing us a huge favour by gracing our unit with their presence.

Geri Psych is a joke. Some LTC's will resist sending their patients out to be assessed because they loose funding while the elder is away. They have to be healthy. So acute care becomes the dumping ground of families who just can't cope anymore.

Mental health issues shouldn't be so taboo and honestly the Psych Units have to pick up the pace and deal with medical issues. Refusing to take a patient because they are on qid antibiotics on a patient who is non-suicidal hardly wins them friends on surgical floors. And before you jump on me there was no way this patient was going to pull the IV, sit in a closet and bleed to death.

[Mandychelle79, ASN, RN]

You dislike psych patients on your medical floor and I dislike medically unstable patients being transferred to my floor because they have a history of pysch issues. We do many medical things on our floor that we do not get reimbursed for because they are on a psych unit. Psych patients on a medical unit, both aspects get reimbursed, no medical care gets reimbursed for on a psych unit. We have done wound vacs and blood transufusions because the medical floor did not want them because they had a pysch history. I'm sorry but if someone is being transferred from the psych unit to hospice care ( unless they were in hospice prior to coming and were there for a med adjustment) I do not think they were really medically stable enough to be on the psych floor to begin with.