Psychiatric Home Health Care

[nashRNxz3]

Are any of you in the field and what do you think of it? i interviewed for a job after several years of doing inpatient psych and also ACT. I have several concerns after the interview. Most patients are being treated by their general practitioner for one, rather than by a psychiatrist. Also it seems you are a "one man show"...the only person seeing this client in the field. With visits being only twice per week there is little time to assess how someone is responding to medication. I was told that I would assess and then make suggestions to a general practitioner rather than a psychiatrist as to what medications I felt the client should be on. While I have long years in the field and very good assessment and psych med knowledge, I am a basic Rn , not a P.A. or nurse practitioner. My feeling is, particularly with older patients that med changes should happen in a long term care facility or hospital where a patient can be monitored closely for cross med reactions, hypotension, fall risk, altered mental status, etc..... I wonder too why these clients are not tied into their county mental health services. I am concerned about liability, practicing beyond my scope of practice, and safety for the patient. With being on Assertive Community Treatment teams, at least you have other team members to assess and bounce things off from. Being a lone psych nurse on a home health care team, I wonder how much good input and support one gets. So if you are in this nursing niche or have an opinion on this whole thing, I would love to hear from you.

[Smitty08]

Hi Nash RN! I think you have correctly identified some of the concerns of a home care psych. RN. I used to do that. Another factor is the very short length of stays in inpt. settings now, so that clients return home without the benefit of a long stay and a fully stabilized mental status. I would say your experience will serve you well in the home care area, in fact, I think it's essential as you are often "on your own" and the prescribers are not always able or willing to work closely with you. That said, you can certainly fill a need and if you like autonomy, you have plenty of that! Good luck!

[caliotter3]

I also agree with your observations although I have no experience in this field. Based upon my home health experience, I do not think you should expect a lot of cooperation in general. It seems to me that many in hh care do not devote a lot of effort to the process. There is a limit to the amount of advocacy you can do as an individual with all the time required and frustrations you are most likely to encounter. Good luck with your venture.