Question re: ED and mental health

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 31, 2011

Remember your hierarchy of needs. Physical health before emotional. I've never seen an ER that gave real emergency psych care. They focus on the physical problems and refer the stable psych patients & transfer crisis stuff. I've been frustrated many times because we just couldn't take the time psych patients deserved. Broken bodies are easier to see and fix than broken spirits, but both experience incredible pain. I hope you have good luck in finding the combination you want, because it's truly needed. Also, there's financial pressure against psych patients.

twinkerrs · Jan 31, 2011

My DON worked in a psych ER before transferring to our facility. So it is possible to combine the two. I dont know about in a regular ER though. Most of the certifications in mental health can only be added after a minimum of 2000 hours working in mental health.

Whispera, MSN, RN · Jan 31, 2011

Sometimes hospitals have nurses who specialize in psych who are called to the ED if a psych patient comes in. I did that for awhile.

My city also has a Sex Offense Services program. Volunteers go to the ED to help women who have been raped. They don't have to be medical professionals. They go as emotional support as the women go through what they go through in the ED. Maybe your city has such a program. I think that would be good experience for you, to see if you truly like working with sexual trauma victims.

LoveMyBugs, BSN, CNA, RN · Jan 31, 2011

My city also has a Sex Offense Services program. Volunteers go to the ED to help women who have been raped. They don't have to be medical professionals. They go as emotional support as the women go through what they go through in the ED. Maybe your city has such a program. I think that would be good experience for you, to see if you truly like working with sexual trauma victims.

My county also has this program it is run through the county DA's office, we had 2 weeks of training then you are oncall 2 shifts a month.

mentalhealthRN · Jan 31, 2011

I am in Rochester NY and worked at Strong Memorial Hospital which is a large university hospital and I worked in the CPEP (Comprehensive Psychiatric Emergency Program)there-- Psych ER-- we saw all the psych patients who either came in or were brought in via MHA (Mental Hygiene Arrest). Some were just triaged directly up in the main ER and some needed to be seen and cleared through medicine then came up--any known or suspected OD/Ingestion, injuries/wounds, and older patients, like over 65. The adult and child and trauma bay were on the first floor and the psych ER on second, directly over the medical ER. With 6 exam rooms and 4 rooms for extended obs beds-- (up to 72 hours then d/c or admit, similar to medical obs beds) The hospital then has several different inpatient psych units--child, adolescent, adult/psych ICU, MICA, a geri-psych unit and a medical psych unit. The CPEP is staffed 24/7 with nurses and psychiatrists and till midnight 7 days a week with psych social workers. So you can work Psych ER--strictly, you just have to find a hospital that has one. Oh and we got the ETOH/drug pts too once out of the critical range of levels where they no longer need fluids/Tele/bananna bags, etc.

They require you to have like a year or two experience before they will hire you to the CPEP though. So I suggest if you are interested in Psych start with inpatient psych for a year or two and then you could start to apply to psych ERs---where you can find them. I loved it there--exciting and its nice to care for all ages 4--104 years old! The nurses are very involved and actually do the evaluations as well as meds, restraints, etc. Very much a part of a team who evaluates the pt to determine if they need to be admitted or not. Good luck to you!

mentalhealthRN · Jan 31, 2011

Oh and the sexual assult nurse thing--here in NY we have something called SANE certification. Sexual Assult Nurse Examiner. My friend actually runs the program at one of the local hospitals--started it there as they didn't have it. I can get you more info from her if you are seriously interested. You can work in psych and once trained do on call hours for the SANE nurse for the medical ER. Then you go in just if they get an assult in.

nickos · Jan 31, 2011

Hi there,
I am a nursing student in a BSN program with one year left. My goal is to work in the ED. But, I also have found I love mental health nursing. From what I gather, someone who enjoys the mental health/illness population is much-needed in the ED setting. I'd like to combine the two by gaining extra training or certificates in mental health. I also would be interested in working with sexual trauma victims. Being that I am still a student, I wondered if there is anything I can do to beef up my resume in addition to regular certs (ACLS and the trauma courses) in order to gain an interview. Thanks for any advice you have to give!

Hello OP :) I am currently employed as a mental health tech in a smallish ER in Oregon. While we don't have nurses that specialize in psych, our staff nurses sort of take turns working the "psych side" of the ER. Certainly an ER setting isn't ideal for long-term treatment of psych pts, but we do what we can to stabilize and care for pts while we determine what our goal is (whether it be placement in our inpatient psych unit, placement elsewhere in the state, outpt treatment/referrals, medication administration for control in a crisis situation, etc. I can't speak for other ERs, but our "psych" nurses do not hold special certifications (beyond whatever is required of them to work in our ER in general). However, we do have an inpatient psychiatric unit where I work that employs both nurses and CNAs. From my understanding, the CNAs do not necessarily need special certification (there is definitely training involved, but not a special degree or certificate based outside of the place of employment), but I do not know about the nurses.

As far as sexual trauma victims in our ER, I am not aware of a program (volunteer-based or otherwise) where I work that provides individuals for the victim to speak to/be consoled by. We do have a number of ER nurses that have also voluntarily gone through SANE (sexual assault nursing education, I believe) certification to be certified to participate in SA exams and evidence collection and documentation.

I hope this helps!

Klohmann330 · Jan 31, 2011

OHSUstudent,

I don't know if you are willing to relocate, but the Hennepin County Medical Center (known as HCMC) in Minneapolis, has a really good E.D. which has its own special unit for "psych emergency's", basically, if someone is brought into by ambulance-(or walk ins, drive ups) for injuries obtained while under the influence of substances, or due to delusions, or suicide attempts etc, they are processed through the emergency psych dept, it's the complete package of mental health and trauma. You would have to look up more information online, but I did part of my mental health nursing clinical through the HCMC EPD(emergency psych dept.) and it was pretty intense, very challenging taking care of the medical needs, while ducking because the pt is trying to knocking your head off. never a dull moment....but it's worth a look if you are willing to relocate, and I'm sure there are other programs in the hospitals in your area that are similar. I guess my point is, is that you don't have to give up on either area of nursing because you can do both at the same time!

hope this helps!

NurseBlogger, BSN, RN · Jan 31, 2011

Our ER has a sexual assault nurse expert program which falls into forensics nursing. There is no shortage of psych in a larger ER. I agree though, less psych and more psych crisis management and referral. I never saw myself being an ER nurse and took a 13 week contract as a travel nurse. Fell in love with it. We hire a lot of new grads with a 6 month orientation program. Look for a good orientation program with a solid hospital (preferably with Magnet status).

Good luck!

Popwhizbangz, LPN · Feb 1, 2011

I don't know about any Certifications, but Psych experience is definitely helpful in any ER, first because there is definite immediate safety risk, to pt (ODs, cutting, etc.) and others, esp in ER where pt may have drugs, weapons, etc. Second, if you know how to manage psych patients better, you avoid ugly restraints etc. I can't tell you how many patients I've had who were perfectly manageable with us, but a few hours previously or subsequently got violent, restrained, chemically restrained, the whole deal at an ER. Psych skills make work safer and more pleasant, wherever you work, because psych issues are everywhere. Everywhere.

MassED, BSN, RN · Feb 2, 2011

Hi there,
I am a nursing student in a BSN program with one year left. My goal is to work in the ED. But, I also have found I love mental health nursing. From what I gather, someone who enjoys the mental health/illness population is much-needed in the ED setting. I'd like to combine the two by gaining extra training or certificates in mental health. I also would be interested in working with sexual trauma victims. Being that I am still a student, I wondered if there is anything I can do to beef up my resume in addition to regular certs (ACLS and the trauma courses) in order to gain an interview. Thanks for any advice you have to give!

if you're interested in it, go for it. We always could use someone who likes psych and wants to do SANE. Neither of which are up my alley, but hey, we all have our niches.