Acute Psych Unit

  1. So, I work on an acute psych unit. I reeeeally need to vent lol; not because the unit is too challenging or the patients are hard to deal with. It's because the techs are hard to deal with sometimes!! They seem to think IM injections are used as some kind of punishment.


    NO, I am NOT telling the doctor the patient needs an IM just because YOU feel the patient deserves one.

    NO, I am NOT telling the doctor the patient is highly agitated and needs an IM because YOU don't like his everyday bad attitude. If he's not threatening, assaultive, or physically hostile, then just let him have a bad attitude. That's just who he is.

    NO, I am NOT telling the doctor the patient requires an emergency stat IM just because you feel "we need to lay down the law here and show that fights are not acceptable." He may have been the aggressor, and started a physical altercation with another patient, but he's utilizing the quiet room to decrease stimulation and he is in control of his behavior now. Plus he was offered a PRN.

    NO, I am NOT telling the doctor the patient needs an emergency IM because you think oral PRNs are not "strong enough."


    Neither do the techs chart nor give medication at my facility. It's like they don't understand that emergency stat IMs are a last resort because stat IMs are given so often on my unit when warranted.

    ***This is only a vent for what I go through on my unit. This is not intended to deface techs in general or insult anyone.***
    Last edit by Angeljho on Jan 22, '13
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    About Angeljho, MSN, RN, NP

    Joined: Oct '09; Posts: 393; Likes: 1,204


  3. by   Meriwhen
    Fair enough: we've all had those days and those techs. Though strangely enough, I find the punitive "IM them all!" attitude isn't just a tech thing--I also see it quite a bit in other nurses.

    One thing to keep in mind though...usually the techs are with the patients far more than we the nurses are; because of that, they sometimes have a better finger on the patient's pulse. So while I'm not saying that the "IM them!" attitude should always fly, it may very well be possible that the tech is seeing something in the patient that's worth a double-check on your part. Maybe you're right, maybe the tech's right...never hurts to check twice either way.

    Hang in there!
  4. by   Psychtrish39
    I am an experienced psych nurse and I have lead an acute care team. You are the team lead and it is your nursing judgement and the physician's order who decides who is IMed. While I have always taken into account what a MHT has shared with me that punitive lets teach them not to fight does not belong on a adult psych unit that doesnt even fly in corrections anymore at least in the state where I live in.
    I am a big believer in an injection as only a last resort, talking and oral PRNs work better. I only have went to the IM when a patient couldn't calm and were actively trying to hurt a peer, a staff member or me or another nurse. Follow your gut and your unit protocols and if you are in fact a new nurse I can't tell just guessing by your name you will have to show your coworkers you are in control of the floor.
    Its your critical thinking skills is why you are team lead and your license is why you get to call the shots literately.
    Hang in there and the fact you don't go right to the injections will allow trust and a relationship to develop between you and your patients. Good luck sounds like you are a born psych nurse...
  5. by   chevyv
    Oh love the coworker! I had an LPN stand over a pt and yelled at me "I want them put in four points right now!" I was standing there along with Security wondering who exactly needed to be put into restraints...the pt sitting on the bed calm and cool as a cucumber or the freaked out nurse looking wild-eyed at me!

    Needless to say it didn't go well and the nurse refuses to work with me. I actually am relieved.

    I read an article recently where a psychiatrist and a rn had their licenses sanctioned because they put someone in restraints as punishment. I too, see similar things happen, like the IM's, taking away privileges, etc for nothing more than personalilty differences. Mostly, that some staff don't like some pts

    I understand and second your vent!
    Last edit by chevyv on Jan 24, '13 : Reason: sp error
  6. by   ruhzdyn
    Interesting post. I recently changed position at my organization. Previously, I too was on an acute observation unit. Because I work at the state, many of my clients were uninsured or out of days with their insurance policy for private hospitalization. When I first started there, it took me a while before I had established my reputation with the technicians. Initially, I too would often be pressured to ask for an IM medication. Like you, I've always felt that they must be warranted not because I'm upset at the client or some sort of justice act. Our specialty is under its own code of ethics where we do no harm. Clients are frequently on a legal hold in which their rights are suspended because they are a danger to themselves, others, or can't care for themselves. In those cases, we are held to a high standard in which we are obligated to look out after their interests. In those cases, no matter how bad of a partner they may be in this relationship, we must look after them and make difficult decisions on their behalf.
    Our duty as a nurse is that of a benevolent role. We must not ever forget that we have to make these decisions in the best interest of the client. It’s a lot easier if there is a denial of rights for medication. Without that denial of rights however, we must not medicate unless they are escalating. Even in cases like that, if I can perhaps get them early with a dissolvable (i.e. zydis, M-tab, etc), I can still meet my objective.
    Keep your head up and do the greater good. You sound like you’ve already made the right decisions.
  7. by   MedChica
    Some techs don't really understand.
    Our aides are like that. They just want us to medicate them all...LOL 'Give them some ativan...something!" You just have to explain things to them.
    That's how it is. I've had to explain to one of our aides that we - nurses - don't just do 'whatever the doctor' tells us. In her defense, she was a new aide and new to nursing.

    We're a 'no restraint' facility. We don't do '4 pts', so meds really are a last resort. We give IMs sparingly and we'll give them prns, i.e., ativan, clonipin, etc... before then.
    I've been a nurse for 7 mths and I've administered an emergency IM twice.
    They were refusing all meds, unmanageable, were a clear and present danger to self/staff/other residents and had that 'homicidal look' in their eyes before anyone thinks of it.

    Some nurses don't understand, either. When I did clinicals in med surg? The RN (on 1x1) kept the pt snowed...purposely. He was an alcoholic and in the throes of DTs.
    To me, it didn't take all of that but that's how some nurses are, i.e., letting their personal issues get in the way of their nurse/pt relationship, etc....
    This nurse doesn't want to be assigned 'that' pt because they're a child molester and was giving he charge hell about it.
    This nurse doesn't want 'this' pt because they're an alcoholic and she has an issue with drinking.

    I still care for them. It's kind of ridiculous. I saw a lot of that during my clinicals, though.
    A few of my residents have allegedly done horrid things in their youth. One of my residents was in some sort of mood a few months back where he was going on and on about having sexually abused some child and wanting the electric chair/to burn in hell for it. He was also simulating masturbation.
    I told him to that such an act was ok in his room but it was highly inappropriate to do that sort of thing among the other residents... and to have respect for them. Then, he was talking about 'the little girl' again.
    Couldn't be redirected so I sent him to his room.
    I don't treat him any differently for it.