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

[Swanee]

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?

[Swanee]

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.

There's got to be a balance some where! We have the same problem. No psyche nurse will sign on now that it's known that wound care is part of the package. The assistant director is the only one that insists on keeping it this way. There is value in every discipline and that's why we need them. After my declaring I wasn't going to do the 45 min tunneling wound, my boss called today to ask for my expertise on a medical pt with worsening psyche symptoms. I'm getting mixed messages. No matter what, I need to take a class next semester. If I survived pathophysiology, everything except pharmacology will be cake! Nice chatting with you!

[Swanee]

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.

I worked with 77 yo nurse who was seeing her GP for psyche. She had been demented for three yrs. Utilities were maxed, life insurance was gone because it lapsed. He said she was a little confused but was taking her meds and appeared to be OK. She urinated on towels at home and by the time her family got to her, the house had to be professionally cleaned. Her savings was gone and she thought she was in a time wharp! The GP said he just didn't know?! I'm thinking that's negligence. Her meds hadn't been filled in six months and the pills were fused in her mediset. She's now with a 24 hr sitter.

The agencies will pay for the visits if you have the nurses rotate between psyche and med. There's no such thing as quick training. They should make a referral.

[elkpark]

There's no such thing as quick training. They should make a referral.

I agree with you completely, but that doesn't mean it's going to happen ...