Psychiatric Nursing Advice

Davey Do · Sep 22, 2011

Welcome to AN.com!

If you go to the top under "Specilaty" and click on "Nursing Specialties", you can scroll down to "Psychiatric Nursing". There's a whole area devoted to the to Psych Nursing. I think you can find anything you're looking for there.

Dave

carolmaccas66, BSN, RN · Sep 22, 2011

This is difficult to answer, as psych nursing covers many areas, ie: substance abuse, PTSD, depression, abuse, anorexics, bariatrics, to name only a few!

How you approach a psych patient depends on the patient and their condition.I get handover, then I go thru all my patients' charts and notes, to check meds have been given, see if doctor has changed med orders, what doctors/other nurses/allied health have written re the patient, etc. Then I quickly r/v any bloods/labs, but the shift coordinator usually does that b4 handover.

I usually have a ratio of 1:6 or 1:7 patients. I initially go round and say to all of them, I will just spend a few minutes chatting re their concerns/needs in general before I do anything else. If patients are new, I need to be cautious - some don't want to talk, some are defensive, some are highly manipulative (anorexic patients are generally like this), some can be downright hostile. I also do obs/VS, BSLs, dressings etc early before it gets busy later on. Also check if patients are going for ECT, if they have been fasting, etc. I get my notes & documentation done early too. Get as much as you can done EARLY cos time runs away from you. I always use a cheat sheet & scribe everything on it for handover & so I don't forget. There is lots of charting, like alcohol withdrawal, food charts, mood charts, mini mentals, etc.

You have to do hourly or half-hourly checks as well, depending upon what category your patient is in - you just have to sight them & that they are well generally, and this is documented on an ongoing flow sheet. Sometimes u have to chase them all over the place, as by law, we must actually sight them, or we can scribe: unable to locate after searching (there's a key code we use). When I come on, visitors are usually there & they have many questions, which u have to be careful answering so u don't breach confidentiality. Then dinner comes along, with anorexics (and bariatric patients) sometimes you have to supervise what they are eating - it ALL gets documented. Then there are the ones with NGs, they need their litmus test done, nutritional supplement hung & pump started. Then there are the ones who pull everything out, refuse to eat, then u must call their doctor. If we catch them throwing up in the toilet, call the doctor & get a sitter to stay with them (this is protocol in many places).

After dinner, I usually spend time (if possible) with each patient and I say I can only sit with you for maybe 20 minutes, then it gives them a time frame to work with. I get my pills/injections done early at 4, 6 & usually 8-9 pm. Patients usually come to you asking for medication anyway.

Then I finish any charting not done, extra charting, helping others with meds, deal with any issues, speak to doctors, liaise with shift coord if necessary. It can be hard cos if u have any suicidal patients/patients with multiple issues and medical conditions, it takes up a lot of ur time. Many psych pts think ur their personal nurse, but you have to be firm at times with some of them.

With admissions, we always used to sit in with the psychiatrist when he interviews the patient - some places don't do that. Try to take time & do a thorough admission, so you cover all your bases.

Then we do pills to get people settled for the night. BSLs need to be done too, and anything ur behind with, do it now. Then the night staff start at 9.15pm & we do handover.

This is by no means a normal day & I've probably forgotten stuff. Most days are pretty much chaotic, patients' emotions are high when they have something happen, u have to then spend more time with some patients than others. It's all about balancing & time management - but isn't everything!

It's interesting work, but I warn you: do not go into psych nursing unless ur prepared to hear some very horrendous & horrific stories of abuse, PTSD. You will get patients who are totally messed up, and when u work in locked wards, be prepared to defend yourself as these patients can be violent, with Hx pedophilia, murderers, women and child abusers. I refuse to work in locked wards now as I've already been half-strangled & punched in the head. That was enough for me.

But in the main, I enjoy it & get a feeling of satisfaction helping people. And you are ALWAYS learning about the human psyche, no doubt about that!

I hope u take up psych nursing, it's tons of work - I'm currently doing my Graduate Diploma in Psych - but it's well worth it.

Good luck.

amacdon · Sep 27, 2011

Thank you so much for replying! Your answer is very helpful and detailed! I'm not exactly sure of what some of your abbreviations for words are though, but I'm sure I'll figure it out!

carolmaccas66, BSN, RN · Sep 27, 2011

Thank you so much for replying! Your answer is very helpful and detailed! I'm not exactly sure of what some of your abbreviations for words are though, but I'm sure I'll figure it out!

You're welcome.