Psyche RN's being required to do wound care - help!

homehealth43130 · Sep 12, 2005

The latest at my agency, run by a medical nurse with little respect for psychiatry is that psyche nurses must be able to do both, and vice versa with the medical nurses! This is crazy. some of the wounds are 45min and of course there's no training except to go out with a med nurse the day before! What can I do besides leave?

We currently do not offer Psych nursing, but have in the past and we also expected our Psych nurses to be able to do med/surg visits if they were light. We did give them orientation to routine visits. This is also expected from our Maternal Child nurses.

elkpark · Sep 12, 2005

I've been a psych nurse for 20 years (psych CNS for 11), and don't think it's unreasonable to expect home health psych nurses to also do med-surg interventions while you're in a home -- you're licensed as an RN, right? So you're accountable for the same basic skills and knowledge as every other RN. The fact that you've chosen to develop some expertise in psych nursing doesn't change that. What sense would it make to have two nurses visiting the same patient?

I would be much more concerned about your "and vice versa" comment -- having med-surg nurses doing psych visits! Now, that is a bad idea ...

renerian, BSN, RN · Sep 12, 2005

The mental health nurses I know have been doing it since 95.

renerian

NurseyBaby'05, BSN, RN · Sep 12, 2005

I've been a psych nurse for 20 years (psych CNS for 11), and don't think it's unreasonable to expect home health psych nurses to also do med-surg interventions while you're in a home -- you're licensed as an RN, right? So you're accountable for the same basic skills and knowledge as every other RN. The fact that you've chosen to develop some expertise in psych nursing doesn't change that. What sense would it make to have two nurses visiting the same patient?
I would be much more concerned about your "and vice versa" comment -- having med-surg nurses doing psych visits! Now, that is a bad idea ...

:yeahthat: We med-surg nurses have psych patients all the time.

homesrus · Sep 13, 2005

:yeahthat: We med-surg nurses have psych patients all the time.

Our psych nurse does simple med surg assessment skills during her visit No phlebotomy because she works part time for us and doesn't have the opportunity to keep that skill sharp. Our med surg, maternal child or ET nurses do not ever do psych visits that have been specifically ordered by the doctor as such.

Swanee · Sep 14, 2005

I've been a psych nurse for 20 years (psych CNS for 11), and don't think it's unreasonable to expect home health psych nurses to also do med-surg interventions while you're in a home -- you're licensed as an RN, right? So you're accountable for the same basic skills and knowledge as every other RN. The fact that you've chosen to develop some expertise in psych nursing doesn't change that. What sense would it make to have two nurses visiting the same patient?
I would be much more concerned about your "and vice versa" comment -- having med-surg nurses doing psych visits! Now, that is a bad idea ...

Now think about that statement. I'm not saying that I shouldn't be responsible to do basic med surge nursing skills. I'm talking about tunneling wounds! My point is, just as a med surge nurse is not trained to assess a patient, with a long hx of suicidal gestures (never knowing which time may be the real thing), I may miss a medical patients baseline vs some subtle sign that they may be taking a turn for the worse. Do any of us want family members being taken care of by a nurse thats practicing out of their discipline? I have recently learned that many agencies are letting their psyche programs go as the funding is poor and medicare is where the profit is. When the psyche patients are let go, those nurses will have to do wound care. I'm not even 45 and history is already repeating.

I've decided to finish my APRN in psyche. Funny how a situation can make a choice so easy. Once again, the mentally ill are disregarded.

Thanks for the feedback.

Swanee · Sep 14, 2005

Our psych nurse does simple med surg assessment skills during her visit No phlebotomy because she works part time for us and doesn't have the opportunity to keep that skill sharp. Our med surg, maternal child or ET nurses do not ever do psych visits that have been specifically ordered by the doctor as such.

I actually had phlebotomy training in the ED and it provides time to assess a patient while you're doing it! I agree that the orders should be followed because the patients rarely find out that they have a psyche nurse doing a dressing change. One medical patient I see called the office to see why they sent a psyche nurse to give him an injection. Both psyche and medical nurses usually collaborate on patients with both issues. That's what staff meetings and case conferences are for. Each has a perspective that the other does not. The scary thing about this is nurses fought hard to have the different disciplines due to the unique expertise and those that are minimizing these skills are the nurses and others that are running these agencies. Hmm.

Swanee · Sep 14, 2005

The mental health nurses I know have been doing it since 95.
renerian

What are they doing, basic med surge or complicated wound care? My agency has a certified wound care nurse who is excellent. Would you like a surgeon prescribing an antidepressent for you? When a patient presents with a psyche issue to their GP, they get a referral to see a psychiatrist. Why are disciplines of nursing treated as trivial?

Swanee · Sep 14, 2005

We currently do not offer Psych nursing, but have in the past and we also expected our Psych nurses to be able to do med/surg visits if they were light. We did give them orientation to routine visits. This is also expected from our Maternal Child nurses.

This is reasonable and expected. Psyche patients are living longer and have many chronic illnesses, mostly from life of smoking among other things. Training is important. Inservices are rare now and few get a break to go to a conference any more. Education is key. Thanks. I'm going back to school....again!

homesrus · Sep 14, 2005

This is reasonable and expected. Psyche patients are living longer and have many chronic illnesses, mostly from life of smoking among other things. Training is important. Inservices are rare now and few get a break to go to a conference any more. Education is key. Thanks. I'm going back to school....again!

Actually, I really value our psych nurse and the work she does. She does not go on routine med-surg visits and probably for the type of wound that you are talking about it would be ideal for another nurse to manage the wound care. your skills are very much needed in home care . Our small agency can hardly keep up with the referrals for psych. we have one part time nurse for psych and she has two full days seeing just referrals for some type of homebound mentally ill patients. depression or such. When she goes on vacation we scramble to find another qualified RN to make those visits. There is no one else in our agency that has those skills.

elkpark · Sep 14, 2005

When a patient presents with a psyche issue to their GP, they get a referral to see a psychiatrist. Why are disciplines of nursing treated as trivial?

Umm, actually, the majority of people with psych dxs are being treated by their family practice/internal medicine docs, not a psychiatrist. My internal medicine PCP will cheerfully admit that fully half his practice nowadays consists of Rxing antidepressants for people ... When I was doing psych consultation/liaison at a big teaching hospital a few years ago, part of what our team did was to train family practice and internal medicine residents how to manage "garden variety" psychiatric dxs in their patients (and when they needed to make a referral). Insurance companies expect PCPs to manage less severe psychiatric problems themselves, without referring to a specialist, same as any other type of medical problem. I'm not saying I think that's a good thing, or that I am in favor of this, but it's the reality of the healthcare "marketplace" these days. I doubt that your agency can get reimbursed for having two different RNs making visits to the same patient.