Thanks Bobbi Jo and Mary Jo!...I have a few more more ?'s

[mia]

Dear Bobbi Jo and Patty Jo,

Thank you so much for your responses! I have to tell you that since I posted last, I took a job as a psych tech. Unfortunatly, I am even more confused and concerned now. I have discoverd that I really enjoy working with the patients. I feel there is such a need in this patient population for good nurses to act as patient advocates. In addition, I especially enjoy the large education component associated with psych nursing that I learned about in school and even experienced in my academic clinical rotation. However, I have to tell you that I am not seeing this in the facility I work at. I don' t know if Im just in a really bad hospital (there is some strong evidence that this is the case) or if this is just the way it is everywhere. I am not trying to be judgemental or offensive, Im just stating what I am seeing at this hospital. The nurses rarely ,if ever, come out from behind the nurses station. They totally depend on the techs (or I should I say "tech"..... sometimes 1:17 patients) to interact with the patients (which is very difficult to do effectively when your trying to do checks every 15 minutes,serve meals, take vitals and fill out your own bit of paperwork on each patient). They then use the information provided by the techs to give report. I do not know what the nurses are doing, but they look very, very busy with paper work. Is there really that much paper work associated with psych nursing that the nurses do not interact with the patients (except when they give meds...from behind the nurses station)? If so, then maybe I don't want to do psych nursing. Or is it possible that to interact with the patients the way I would like requires certification or higher education? Can you advise me? Am I just at a bad hospital? If not, then can you tell me what the expected duties of a psych nurse are? I really appreciate the time you have taken to answer my questions!

Mia:)

[Bjo]

Mia,

Unfortunately a lot of times the nurse is overloaded with paperwork. I can tell you that I have the most wonderful techs working for me! I depend on them constantly. But this isn't just present in psych nursing. Every aspect of nursing has been effected by managed care. There have been so many cutbacks everywhere that the majority of the responsibility falls on the nurse. This also is precepitated by the regulations set up by state and federal agendy. Thus the reason for all the paperwork. I don't know where you work but I would hesitate to say it is a bad hospital unless I had more information. You should be able to tell by your observations and interactions if the patients are receiving the therapy and care they are entitled to. I would strongly recommend that you advocate (but not too loudly) for the increased interaction with the patients by the nurses. Or you can just do this on your own. There will be munerous opportunities for you to make a difference in someones life and those little contributions should give you personal satisfaction, if nothing else. Sadly, I cannot tell you that the nurses aren't expected to devote 90% to paperwork and 10% to direct patient care.

Bobbi Jo

[pattyjo, MSN, RN]

Hi Mia: All the new regulations for gov. agencies, managed care etc etc etc have certainly increased the level of paperwork, and yes, unfortunately, it is the RN's responsibility to do a large amount of it. One of the frustrations nurses in *any* facility are feeling has to do with the sense that paperwork has taken priority over patient care. Now, in my hospital, I can't say the split is 90/10 as Bobbie Jo has described. Remember though, each place is different, depending on staffing practices, acuity of the patients and so on. We have no techs at all on our unit; the hospital where I worked previously used them alot. Our census now cannot go above 18, at another job I had, we thought it was slow if we had 40! You can see where this would cause big differences in staffing patterns.

Nurses on my current unit are actively involved with patient care. We each have an assignment, and are responsible sometime during the day to sit down on a 1:1 basis with each of our patients. Additionally, we have groups 3 times a day across day and evening shifts, and these are most often educational: meds, relapse prevention, specific illness and so on. This is a short term facility, so we don't often have the kind of ongoing group therapy you see on TV! My previous job was more long term, and as such, we could plan our groups to last over several sessions. Again, all hospitals are different.

As far as other duties: same as any other unit, with pre-discharge planning and teaching, meds, managing symptoms, sometimes working with families, and so on.

I think certification in any specialty demonstrates a commitment to excellence in that area in addition to a certain professional pride. You may still perform the duties you speak of without certification though. Some advanced practice nurses set up private practice and see their own patients. Those regs are set up by state board of nursing and probably vary quite a bit.

Mia, if you have any other questions, just ask. Good luck to you as you continue.

Patty