So... are 1:1 check-ins with patients truly "a thing of the past"?

[greenbeanio]

That's what I've been hearing recently. That it's unrealistic for patients on acute inpatient units to expect a one-to-one check in with staff each shift, or individual patient education. That these days its all done in groups.

And the depression/anxiety/SI/HI/AH/VH/paranoia assessments that we are required to chart on can be done briefly at the med room window.

That inpatient psych nurses cannot realistically do the interventions listed in the literature and the textbooks, and that at this point, on account of increased patient numbers, acuity, and liability (leading to increased documentation requirements), all we can hope to complete in a shift is passing meds, brief assessments, charting and de-escalation/crisis response as needed.

That building trust and establishing therapeutic relationships and providing patient-centered individualized care is no longer possible except on the fly, maybe squeezed in as a luxury only after the essentials (the "tasks", the charting) are completed.

And that all the therapeutic work of healing has to happen in groups, "in the milieu" and outpatient, after discharge. Not one on one with nurses any more.

Is this true? Is this a nationwide trend? Is this how we all have to work these days? Or do any of you work in places where you can still have meaningful contact with your patients?

[greenbeanio]

Like this stuff: https://en.wikipedia.org/wiki/Psychiatric_and_mental_health_nursing#Therapeutic_relationship_aspects_of_psychiatric_nursing

[elkpark]

The last time I worked as a staff nurse in psych, in 2011, I was still doing all the "old" stuff, and so were many of the RNs I worked with. An RN talked individually with every client on the unit at least once during the shift; the requirements for RN assessment q shift mandated that (and we didn't do them at the med window, we sat down and talked with people privately). How much more interaction with individual clients you did than that was up to each individual (and, yes, there were plenty of the psych RNs we all know, who focused on not having to leave the nurses' station any more times than absolutely necessary over the course of the shift ...)

It is true that most inpatient units these days are set up to function as you describe. But keep in mind that the focus of inpatient psych hospitalization these days is not to actually resolve anyone's problems, but to stabilize the immediate crisis enough to get people back into their home communities and ongoing outpatient treatment as quickly as possible, and that's where the real psychiatric treatment and "healing" happens.

Part of the problem, I think, is that there are now several "generations" of psych nurses who were educated in this model and sincerely don't realize there is (can be) more to psychiatric nursing than what you're describing.

[Barnstormin' PMHNP]

My unit still functions like the old model, although some days it just doesn't happen due to acuity and the med room assessment is all you have to go on.

[Meriwhen, ASN, BSN, MSN, RN]

Having a 1:6 ratio (and frequently having less than 6 patients) means that I can do a good 1:1 check-in on each patient I'm assigned, and I make it a point to. It's rare that I can't hit every one, though there have been some shifts that were off the chain due to patients coding left and right.

But even when I had 10, 13, 16 patients, I still tried to get some 1:1 time in with each one, though how much time I may spend with each patient varies depending on how busy it is, the patient's acuity, how much time I was able to spend with them yesterday...and yes, sometimes the 1:1 had to be confined to the med window "drive through" assessment. It's not ideal, but sometimes that's what you have to do.

[vintagemother, BSN, CNA, LVN, RN]

We had to chart daily ( so 1/3 of PTS assessed q shift) using the MSE model. Some (I think most) nurses did it based on charted observations done by techs and what the nurse observed during med pass.

This meant 5-6 assessments per shift.

As for me, I often found myself with unanswered questions about their mental status, which required me to have a sit down conversation with most PTS on most shifts (except nocs)

[thekid]

We still have 1:1 's at my facility, they are rather common. Our techs are excellent and communicate with the nurses, they also have q15 , LOS and 1:1 flow sheets that RN's sign off. Even on my most organized days, it's a challenge to spend the individualized time with each patient. Our facility is for stabilization, we don't have a residential treatment (but do have PH and OP services). There are many challenges with our frequent flyers who return to the unit soon after discharge. Some are detoxing again and many are homeless, awaiting placement. We have a lot of admissions due to SI . Our ratio is usually 6 to 9 patients . I work per diem so that is its own challenge because I am floated between adolescent and adult units. This makes it hard to build a rapport unless I return to find readmissions. You do what you can. Deescalation and an assessment can help make a patient more comfortable, give them hope, and give them a sense that someone cares. But.. yes, we are often so busy with scheduled meds , admissions, and anything that arises on the unit. And the prn's. Those are time eaters. I try to talk with each patient before their scheduled med pass so I can get a heads up if their anxiety is high or they are having somatic concerns, and then I can prepare to pass the prn that may be available.

[RN1485, BSN]

1:1 is definitely ideal but not realistic where I work. Most days I work as the only nurse on the unit where I have to chart on everyone as well as do care plans on top of the admissions I'm getting. Sometimes the only time I can talk with them is during med pass and even then I feel like I can't give them 100% of my attention because I'm constantly being interrupted in some way. Always understaffed!

[SarahMaria, MSN, RN]

1:1 is not feasible where I work. I am usually the only nurse with anywhere from 14 to 22 patients to medicate and care for. It isn't realistic to sit with them and assess their mental condition. Many of my patients have been in the facility for years, if not decades, and they do not want to talk to the nurse at length about their mental illness. I usually can observe them and determine how they are doing during a quick chat while giving medications. If I feel a thorough assessment is warranted, I will absolutely perform one.