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our facility is expanding and we have nurses coming in with little to no psych back round. I am one of the few seasoned-15+ yrs. experiece plus a certification-psych nurses,a House Manager and very involved in their orientation. I'm concerned about a tendency I see toward not getting out of the nurses station and out in the milieu. So far all the new nurses have had at least a few years med-surg experience,so shouldn't they know about getting out into the population and doing MSE's,casual chit chat,getting a feel for the climate of the milieu? It's as if they expect to sit in a chair in the nurses station and have the techs hand them charts. One of them even went so far the other night as to get up in my face about transport arrangements while I was trying to get an escalating manicy pt. to take her meds and get her out of the general population before one of the psychotic pt.s assualted her for being so invasive. It was as if this new nurse had paid no attention to what was happening outside the nurses station.

Frankly I'm shocked by the behavior. This is not my first time out of the chute orienting new nurses and I really enjoy helping people learn,but this is, for lack of a better term,an attitute I've not seen before. From reading the med-surg threads I don't get the impression it consists of sitting,and I don't remember doing much sitting when I worked med-surg,though it has been several years.

Am I missing something? Has there been an attitude change out there in regard to what psych nurses do? how will any of these nurses work charge on a unit and keep their pt.s and staff safe?

The education team is going to meet to try and address the situation. I'd be grateful for any input.

Thanks!

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I don't think all general nurses just hide in the office. I have worked with quite a few. Some I think are fearful of entering the milieu, some percieve psych as being "easy". I have worked with one in our psych intensive care area who was totally oblivious of her colleague being threatened by a patient until the alarm bells went off! Some have started off in psych fairly ignorant but with time and education and enthusiasm from the trained staff have improved significantly. It seems that here in Aus that there are less nurses opting to take on psych training and that we are just going to have to use general nurses to keep our patients safe.

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Sounds like a basic orientation failure. I think I would have them function as mental health workers( or whattever your institution calls psych nursing assistents) for awhile until they can demonstrate that they know how to function in a psych environment. Their role, as nurses, will be to supervise such an environment so they need to be comfortable in it. You could explain it that way.

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Thanks for the input!! In the past we have had great success with the majority of the med-surg nurses who have come to us,I say this some what tounge in cheek since thats how we all started :-) I appreciate you perspective and suggestions,esp. the positive role modeling from our established staff and giving the new hires the milieu time. I'm seriously considering taking them with me or one of the other House Managers for a shift or two. I'm hearing a perception that the supervisors "don't help us enough." We'd tried to give the new hires more time on the unit,so had changed some of what we do. I think maybe they need to see the whole "house" running ie-what is happening on the other inpt. units,what our RTC is doing,what the access center is doing or if there is no access clinition what the House Manager is doing as far as inquiry/intake calls,back up to the other units,passing meds for the RTC if there is no lic. that shift. As I write I think we may have left out the "big picture" piece we used to give our new hires. I wonder too if seeing the whole house at once will help them see just how valuable they are as a part of the big team,not just the unit team.

Thanks again,please keep the input coming. I am very interested in what size of facility/setting you are in and what your perspecitves are on the good,bad and ugly-hahah- of learning psych nursing:-)

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I'm a night supervisor at an approx 110 bed free standing Psych Hospital. We have five inpatient units, one for children, one for adolescents, one adult duel dx subabuse/psych, one general adult psych, and one high risk adult psych "Adult Intensive Unit".. We also have a large( for us) partial hospitalization substance abuse program, some of which patients stay on grounds in independent housing. We have 2 children's residential houses with a total pop of 15 and two adolescent residential programs totaling 24 beds.

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wow,CharlieRN,compaired to your facility we are a unit. We went thru some bad years,managed care took a hard toll, and even worse internal management was very nearly our undoing.

The parent company was ready to close us. A management company has taken charge and we are beginning to pick back up,fast! our census had doubled in the last month and we are really struggling to have enough functional licensed help. To the few of us who have been there since the place first opened it is like "the old days" with 2-3 admissions per 8 hour shift, at least. The hardest part right now seems to be getting the newer RN's to embrace the increased activity and stop sitting and complaining. We "old dogs" thought this was down right fun to be busy,have the new pt.s come in,and *gasp* be assured of having a job!

It seems so much has been lost.

There is a core group of us trying to help our new staff adjust well and feel confident in their postions. We work hard to model the attitude we want to see replace the apathy and negativity.

Thanks for the reply and suggestions. What do you do for an orientation schedule? Has anyone else seen a facility recover? or do they?

thanks

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Are these new psych RNs overwhelmed? I sometimes have 2-3 admits in a shift and it's very taxing being the only RN as each admission takes approx 2 hours to complete from start to finish. Are these nurses apathetic or in need of support and that is why they are asking the house managers for assist and unable to get out on the floor? Chaos is not fun for anyone, esp an orientee.

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I work in a state hospital - 4 adult admission units, 1 intensive tx/forensic unit, 3 adolescent units, 3 adult extended rehab units, 3 nhu, 1 adult CD & 1 adol CD unit. 300 beds approx.

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thanks for the reply lovinghands...overwhelmed is very possible & you are right about chaos.We,the House Managers-have been taking turns working the units as the new RN's back up,letting them charge the unit with us on the meds or running program with the techs. We are letting them function as freely as they want,not stepping in unless they ask or it looks like things are getting too far out of hand,then we try helping them go thru critical thinking to get to what they need to do. I hear them making good assessments,looking at options,really sticking to least restrictive,see them doing good things,then just as I think I can turn them loose,one will do something like break every pt. safety rule we have related to passing meds when I know DARN GOOD AND WELL they know the right way because I did the teaching,modeling and watched the return demo,several times 1:1. Or I can come on the unit by a back door,so I don't disrupt an activity going on in the miliue and find the RN's huddled in the nurses station sitting on their duffs grousing.

Maybe we just are picking up census too fast for them to acclimate.

Maybe we are being too protective with them and we need to cut the cord. It's not like we have 300+ pt. lol

thanks for you input

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