Psych tips, please

[mammac5]

I offered to fill in for a shift in the psych eval unit at the hospital where I work. As you may know from previous posts, I'm all about adult chronic disease management and have NOT worked psych before.

I want to be a team player and be helpful, which means I also don't want to be a pain in the patoot to others on the unit. Tips appreciated.

[zenman]

Well if you're on an adult unit it's probably still all about adult chronic disease management. Just be yourself and be real.

[ddunnrn]

As a psych nurse for 25 years, I can say the most important thing is SAFETY, SAFETY, SAFETY!!!---yours, your co-workers', and the patients'.

The first thing I learned in psych was "never let the patient get between you and the door". Always be aware of your escape route and where patients are at all times relative to you. Don't leave dangerous objects sitting about, and always lock or close doors that are meant to be locked or closed.

Don't cut corners on suicide checks, body searches, or any other such security procedures, because the universe will find a way to make you regret you did.

Do not engage in or support others in "staff-splitting"--apply rules and privileges equally to everyone, as far as their treatment allows. If you enter a situation where another staff person, even one "below" you in the hierarchy, has made a decision concerning a patient issue do not countermand them unless their decision is grossly inappropriate.

Otherwise enjoy yourself, be yourself, and take the opportunity to experience as much as you can. If you plan to work there a lot, you might ask the staff who the "regular" patients are, and get to know them.

PS: Remember--in most states, unless a patient has a court order to force meds or other treatment forms, they have all the same rights anyone else has: to refuse meds, and to leave any time they want, unless they are involuntarily committed. Your mileage may very depending on what state you're in.

[mammac5]

Related Question: Are you supervised by the psychiatrists or physicians who manage adult primary care?

[ddunnrn]

re: the questions posed about who supervises you. It's probably just a pet peeve of mine, but chances are very minimal that any nurse is "supervised" by a physician of any sort, unless they work in an office setting. Physicians are rarely in the RN's hierarchy of command, which is one reason a doctor can't generally write up a nurse for "insubordination". The nurse was never "subordinate" in the first place, so can't commit insubordination. The nurse can be disciplined for "failure to follow a physician's proper order" but it is definitely not the same thing, and usually only applies to implementing orders in a chart, not capricious MD commands like "get me this chart" or "get out of my chair". I have been fortunate enough to work in some psych environments where parts of the inter-disciplinary team, including MD's, NP's, MSW's, and RN's, were all treated as equals.

This is part of the politics of nursing that really needs to be addressed more fully in nursing school.

PS: my statement applies to my experience in the US--I have no knowledge about other countries' practices.