Question to all nurses who work in Psych

Around my area, nearly all the hospitals are just meds, assessments, and busy work. I wouldn’t have time to run a group; I barely have time to talk to my patients. I have 10 or more patients asking for PRNs and acting out all day. Plus, several discharges and admits. Lots of documentation and treatment plans. Some places do IVs, but it’s not common. Those are just the facilities with medical units.

18 hours ago, TCASII said:

Around my area, nearly all the hospitals are just meds, assessments, and busy work. I wouldn’t have time to run a group; I barely have time to talk to my patients .....

Thank you TCASII. I appreciate the info.

What is a reasonable patient load per nurse on a psych unit ?

VegGal,
Can't speak for all inpatient settings but in the 3 that I have worked in, "med passes, initial assessments, ongoing assessments, monitoring clients and documentation" just about sums it up, in addition to admissions, discharges, and going back and forth with the doctors reminding them of what the patients need etc. And of course de-escalation and calming patients down and behavioral codes on occasion. And I like to do a lot of patient ed whenever possible. Occasionally I can squeeze in a group but its hard, time wise.

No IVs, caths etc, - at least, not under normal circumstances. (I remember just one patient with an IV, and one that I had to help straight cath - although if a med sure nurse hadn't happened to be a float that day, I would have asked for a med surg nurse to come help out). Some wound dressings, though. And sometimes baths and incontinence care.

As for a reasonable patient load - hah! That depends on just how superficial your patient care is expected to be. And on acuity. On my unit 6 patients is routine and although we are technically able to go up to 8, we never do - the charge nurse takes the extra patients. So much depends on acuity though - recently one of our teams had only 4 patients on it and it was way more work than my team with 6.

On 8/10/2019 at 2:57 AM, TCASII said:

Around my area, nearly all the hospitals are just meds, assessments, and busy work. I wouldn’t have time to run a group; I barely have time to talk to my patients. I have 10 or more patients asking for PRNs and acting out all day. Plus, several discharges and admits. Lots of documentation and treatment plans. Some places do IVs, but it’s not common. Those are just the facilities with medical units.

This is much of my experience as well. Sometimes minor wound care, lice/scabies treatment, or the like. It's not uncommon to have 14-16 patients, 1-2 admits, 1-2 discharges, med passes, PRNs, intake and discharge assessments, transcribing orders, communicating with insurance and pharmacy, collaborating with treatment team, deescalating patients, and occasionally minor medical like wound care, removing stitches, lice tx, etc --- the day goes by really fast. On a slow day I do like to spend time with patients and work with them one on one or in small groups. Only facilities with med-psych units have IV and catheters - none of the places I float to have this.

As for number of patients - I work sub-acute so up to 16 per nurse is normal - depending on the acuity of those patients this can be very reasonable, or absolutely overwhelming. Higher acuity facilities seem to have 4-6 per RN.

Thank you Greenbeanio and Verene. Your responses were very helpful. Although I'm really interested in mental health nursing, I've decided not to accept that job that I was offered because the hourly rate offered was very low. I had to weigh the benefits vs the possibility of getting hurt and also all the things I'd have to deal with, and I just couldn't see how I could justify taking a position that paid about $10 less per hour when compared to other RN positions in the area. Just didn't make any sense and I have no idea why their wages are so low ?

I will generally be the only nurse on the floor with 18-20 patients.

The number of patients is contingent on the workload. Where I currently work, 10 patients if often too many. The amount of charting and treatment plan work is very high. If all the patients are calm and not needy, then 10 is ok. I would do a much better job if I has 6 total, however. I've had 18 on a locked emergency unit and managed to survive, but I also had 4 great techs that handled a lot of the commotion. I also wasn't expected to document half as much as I do now. Not to mention, my techs at my current job are largely uninvolved with assisting the RNs.

The unit I work on does not allow patients to be admitted who are in need of IV or O2 therapy. Too much danger regarding tubes which can be used as a ligature.

I work in inpatient acute psych. We occasionally will have patients with IV's, but it's typically only the sickest catatonic patients receiving fluids or an ativan challenge. For the most part, we do not accept patient's with IV's or with feeding tubes. We will very occasionally accept patients who self-cath but it's extremely rare.

Typically, on a true behavioral health facility, they should be medically cleared, meaning no tubes or invasive lines because of suicide risk and they don't typically have the staffing for it. In the past, I have reviewed medical paperwork to see if a patient is appropriate for admittance or if they need more medical care. Nurses can pass medications as well as collaborate with other team members about the care. We do rounds with the doctor so they know the status of the patient and what interventions are needed. Psych units are pretty busy because of different behaviors, so don't think you'll be bored, but to cherish the moments that are "quiet". The most important part is patient and staff safety. That itself, is enough to keep you busy and your nursing assessment abilities working! ?