Question to all nurses who work in Psych

Specialties Psychiatric

Published

Specializes in LTC Management, Community Nursing, HHC.

I recently applied for a psych position at a small facility where they treat people ranging from adolescents to the elderly, both inpatient and outpatient. and I was informed that apart from the adolescent and adult treatment programs, they also have an adult co-occurring program, adult intensive program and older adult program. They also have several outpatient programs.

I've worked with mental health clients in an adult day healthcare center, along with the elderly (non-mental health), so we were limited as to the type of clients we were allowed to have in the previous work setting (i.e. all on meds / very high functioning).

My question now is in a psych facility with inpatient and outpatient clients, what would the role of the RN be, if they don't have groups and sessions to lead? I was told that this facility does not do groups at all, and in my previous experience with mental health clients, we also did groups with them (RNs and LPNs did those). I'm basically asking about RN responsibilities apart from med passes, initial assessments, ongoing assessments, monitoring clients and documentation. Are IVs and tube feeds and caths done in these settings?

Just a little confused about the role of the RN here and would like to know more before I have an interview. I've had one conversation with someone from HR and that's where I got the above info. I did ask if I could request not to work with adolescents, and she said yes, but that the RN would have to cover pretty much any unit at times when they were short. I'd be okay with that at rare times, just don't see myself working with adolescents in any setting on a regular basis as I have absolutely no experience with kids / teens.

I really liked working with my mental heath clients in the community setting, and am hoping I'll like this setting as well. I do know it will be very different though. Thank you for any info anyone may be able to give me.

1
Up Vote Up Vote ×

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.

5
Up Vote Up Vote ×
Specializes in LTC Management, Community Nursing, HHC.
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 ?

1
Up Vote Up Vote ×
Specializes in mental health.

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.

2
Up Vote Up Vote ×
Specializes in mental health / psychiatic nursing.
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.

1
Up Vote Up Vote ×
Specializes in LTC Management, Community Nursing, HHC.

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 ?

1
Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).
On 8/10/2019 at 9:40 PM, VegGal said:

Thank you TCASII. I appreciate the info.

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

I have 14 to 20 adolescents on a mixed gender unit with 2 floor staff and a medication nurse

Up Vote Up Vote ×
Specializes in Psychiatry, Forensics, Addictions.

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

Up Vote Up Vote ×

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.

Up Vote Up Vote ×

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.

Up Vote Up Vote ×
Specializes in Psychiatry.

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.

Up Vote Up Vote ×
Specializes in Behavioral Health.

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! ?

Up Vote Up Vote ×
+ Add a Comment