Psychiatric Medication Nurse

[fawnsternurse]

Hello I have another question and this forum seems the best place to ask these questions.

How many of you have worked in Facility's that may assign you the medication room job and then also place you on safety checks. (Every 15 minutes)

I am currently in a facility on a unit with the most violent Psychiatric patients.

There is bare bone staffing. And they are also utilizing Licensed Mental health Counselors. Which is not a bad thing , I am just sharing to give a visual.

There is one Charge nurse ( recently a new Nurse and only a few months experience and a week experience as a charge nurse) One Medication Nurse ( me who is Agency) and 2 LMHC for Patients with a history of violence.

I find myself the Medication nurse daily because I am agency and not trained for charge.Although I do have 18+ years of experience in this realm. 27 years experience as an RN.

However as a Medication Nurse it is my responsibility to make certain that the medications are set up and passed safely.

This is the first facility I have ever worked in that does not have a psych tech(s) to do safety checks, and they have the RN's and LMCH's to do checks.

Well, pray tell how do I safely pass medications, PRN's etc and also be responsible to do State Mandated Every 15 minute checks?

The facility Administration refuses to have more staff even though it is the most violent, acute unit.

I have never worked in any Psychiatric Facility that expects the RN's to do these checks and still maintain a safe med pass as well as be available for high unit acuity and escalating patients.

Recently we have had a rush of all violent men. Myself an Agency Nurse on Medications(I have loads of experience but have not been oriented to all the policy's of the hospital as well as paperwork) A new RN charge nurse and two young, female LMCH's. We had 3 admissions last night. A high unit acuity with physical and verbal altercations between the patients.

In the middle of me attempting to pull medications, or return medications because of refusals and document, the LMCH wanted me to do checks. I said No, because I needed to finish what I was doing.

I can honestly say I have no down time in this job, have not taken any regular type breaks(How can I with unit acuity being this high and bare bones minimum staff)

I am on the unit in Milieu as often as I can safely be. But I am also in a back room with an Omni Cell and computer so I can pull medications, document and do my BIRP notes.

I feel pulled in many different directions here. My feeling also is if a patient escalates the Charge RN should give the checks to the LMCH's ( who cannot pull meds) and have me pull emergency medications.(Also last evening I had a diabetic patient with a very high blood sugar.... but oh wait... Stop everything , I have to do safety checks! )

I have NEVER worked anywhere that is not the expectation.

If I am wrong about this please feel fee to share.

I am humbling asking what other peoples experiences are in this and thoughts?

[fawnsternurse]

P.S. I have forgotten to mention that this facility has been in the news for not only the level of violence but successfully completed suicides.

[Davey Do]

fawnsternurse-

You seem to have a Firm Grip on Reality, Good Experience, and know The Story.

If we allow ourselves to be put in Sticky Situations, we have to deal with the Ramifications thereof.

The Very Best to you!

[fawnsternurse]

Hello Davey,

Thank you for the feedback.

I am a Travel Contract Nurse, so yes, I do not always know what I am getting myself into before I start.

They would like me to re sign but I am pensive especially after last night.

[Whispera, MSN, RN]

What are the LMHCs doing during their shift? Are they out with the patients? If so, they could much more easily do the safety checks on most since they're out there anyway. I think if they're with the patients (and that's my experience), they should be responsible for the checks (this is also my experience in three different facilities) all the time.

Seems it's time for a change. Maybe they're doing it this way because that's the way they've always done and and they've forgotten there's another way?

[Meriwhen, ASN, BSN, MSN, RN]

I find myself the Medication nurse daily because I am agency and not trained for charge.Although I do have 18+ years of experience in this realm. 27 years experience as an RN.

Facilities usually not let an agency nurse act as Charge. It doesn't matter if you have all the experience in the world behind you or you've been visiting that site forever and a day--the Charge role has to be their own employee. They may grab any employee they can and make them Charge and let you know that you will need to "help" this person (i.e., pretty much run the show for them), but don't expect to be officially designated as Charge.

To be honest, working both meds AND rounds for the whole shift sounds like trouble. I've done meds and rounds, but we're talking covering a break or doing them for scheduled period of time that is NOT during a med pass, not doing q15s for the entire shift. You can't stop a med pass to go do rounds, and if you have to hunt patients down for meds, that means your med pass will take forever if you have to drop everything every 15 minutes to find EVERYONE. And what if it's the middle of a code?

What you describe would put me off of working there. I would reconsider not returning after your assignment is completed.

Best of luck whatever you decide.

[Mandychelle79, ASN, RN]

I am usually charge but on our unit EVERYONE during the shift is assigned safety check times. When making out the assignment sheet I take into consideration what times the med pass is for the 3-11 shift there is a small one around 5 and our large one that starts at 830 till about 10. So if I am assigning the medication nurse checks either 4 pm, 6 pm, or 7 pm are usually the times assigned. If a PRN is needed during those times, I get it for the patient. If something hits the fan we all work together and usually the MT's grab the book and say i got them.

[Psychcns]

I have worked places where everyone does checks. I cant remember if this included the med nurse. The problem is getting someone to cover your meds, ie prns calls from pharmacy, if you are doing checks. I think the charge has to step in. Maybe ask your preceptor how to handle this.

[SheriffLauren]

On my unit the med RN on 3-11 counts at three and then passes the 4pm/5pm meds and then there is a gap until 7-9pm when the heavy med pass takes place. They take dinner break from 9-10pm. We never schedule the med RN for any duties other than med pass, we work with very acute and violent patients and frequently have situation when emergency IM medications must be administered and have found its safer to have one person controlling the medications for that shift. I think assigning anythign else is seriously risking a med error.

It sounds like the hospital admins have their heads up their asses, I would quit and look for a new job.

[fawnsternurse]

Thank you everyone for the feedback. I have come to find out that this is not only a new unit and a work in progress but it is also steering away from the medical model to a more Social work model.

However, with that said the bottom line is that when someone is assigned to medications that should be their only responsibility especially when working with high acuity violent patients.They don't seem to "get that". This is not so much about me not being willing to help out but more about overall unit safety. The charge nurse keeps telling me " we work together as a team" Which means that when I am doing rounds they may very well pass a med. or two... That makes me feel very uneasy as this is not always communicated to me in a timely fashion. Oye Vey! I just want this contract job to end with my license intact.

[blackribbon]

I am a contingent psych nurse. On that floor we have a minimum of 2 RN and 3 if the census is greater than 22, one dedicated med nurse (an LPN) from 7am-10:30pm (after that, meds are passed by the RNs), and one to two mental health techs (two during the days, one from 11pm to 7am) Ours are not usually highly violent though we do deal with a lot of psychotic patients. I thought we were bare bones....how would you handle 1:1 patients with that kind of staffing...especially if it involves two patients acting inappropriately with each other such as violent or acting out sexually? The techs do our rounding and the RNs cover their assigned patients during the tech's breaks. There are the days were we work short for whatever reason, but this is the expected and normal minimums. I have served as med nurse but again, that was my only responsibility during the med nurse hours of 7am-10:30pm.

[Psychcns]

Is there a safety checks policy? Are you violating it if you give a med when on checks? Does the policy have a procedure for handing off checks? Is the patient expected to wait for you to hand off checks to get a prn med. as everyone is saying having a person do meds and safety checks is a set up for problems.