something really freaked me out

[TerpGal02, ASN]

I just started a month ago at a small free standing psych hospital. I am coming from the community (my first job was on an ACT team-think mobile treatment but much more intensive). I was pretty independent at my old job, no CNAs or techs to manage. Last week during my last week of orientation, I spent q day with the techs on the adult unit to see how their day goes (our techs are called Mental Health Associates or MHAs, most are not CNAs but have some sort of background in psych or social work, although they still do things like getting vitals, helping with showers, etc). They mostly run groups, do 15 min checks, and monitor the unit. Our unit is quite acute right now. The MHAs chart shift notes at the end of the shift. This particular day, they were all up at the nurses station charting while the pts were having free time. The day room of the unit is down at the end of a quite long hallway, where most of the sickest and most volatile were hanging out. There was NO ONE down there. I was quite alarmed and ended up walking up and down the adult hall myself.

I know this is COMPLETELY unacceptable, but since I've never managed people before, I don't know how to tell them someone needs to be down on the unit without seeming like a witch. Thoughts?

[MrChicagoRN, RN]

Safety is everybodies job. My goal is safe staff, safe patients.

Either go to the charge nurse or ask them all, "who is supposed to be in the day room? I don't see any staff there."

Then make sure someone goes. Don't be afraid to assert yourself

[neurorn6]

Stand up, pull up your big girl panties, and instruction one of the tech's to go check the day room. If need be, just ask someone to go with you. This is what we do, we instruct, teach and help not only our patients but our co workers. It gets easier with time. Long ago, in a land far far away I was a tech. You never know, you may inspire someone to become a nurse.

[Hygiene Queen]

You politely, but firmly send them on their way down to the dayroom.

You just gotta do it.

In your situation, I might have said, "I just checked the dayroom, but I need someone to rounds. There's no one covering the rounds or checking the dayroom. I don't trust So-and So down there. Thanks."

We had a terrible incident at our hospital.

It completely changed the way we do things.

All doors locked when the pts aren't in their room, no doors shut when the pt are in their room and an MHA must be in the hall at all times.

No one allowed in our group rooms without staff.

Perhaps you can assign a specific person to the hall or the dayroom. If they need to chart, they can either use a COW in the hallway or the dayroom while also rounding, or they can switch out with someone else for a few minutes to chart at a computer if there is no COW. We rotate our staff between the hall, the dayroom and groups.

Also, there will also be some people who-- no matter how you say it-- will be sure to feel offended in epic proportions.

Don't worry about them.

Remember, you work psych... you know you can't let it get to ya...

You have to keep your unit safe.

[TerpGal02, ASN]

Thanks all. It would be soooo easy for them to just chart down there. We are still on paper charts, so they could just take one of the rolling carts for the charts and just wheel it down there and park it at the table outside. That's what the staff on the adolescent and children's unit do.

[Jayesse7]

I guess you could have brought it to everyone's attention by phrasing it into a question and saying something to the effect of; "Is it ok that the patients are unsupervised or would you like me to do that while everyone is charting?" The reality is that sooner or later something is going to happen that will cause the hospital to have to implement some new safety guidelines and I know I wouldn't want it to be on my watch. The hospital where I work has what is referred to as "milieu management". The charge nurse assigns someone to milieu at all times, usually in one or two hour increments. That person is responsible for knowing what is going on. They are supposed to be continuously walking the unit and signing off on a flow sheet every 15 minutes. In the beginning it was highly monitored by supervisors to make sure people were actually doing it properly. However, over time, it has relaxed quite a bit. It's a big problem sometimes. I've worked there long enough to have seen or known of plenty of "incidents" and that keeps me vigilant but that's my busy time too and I get tired of having to interrupt my own charting to check on things myself or fuss at staff who have seemingly stopped working an hour before their shift ends. I get really irritated sometimes which has led to me stomping into the break room and shouting at everyone; "Look around! If you are all in here, who is out THERE?! I'm trying to do an admission and chart and you guys seem to be done-for-the-day!" As you get comfortable in your new job, try to remember how important it is and don't let yourself get too comfortable or fall into the bad habits of others. Just say to yourself; "Not on my watch".

[ChelleNurse]

I have an MHA who is very difficult to ask to do things. The person has alot of experience, but are not doing all of their 15 minute checks on my shift. I am new, and don't feel comfortable reporting him to management at this time, as he is an integral part of our staff and works the schedule no one else will work. However, my license is ultimately responsible for what goes on. I, too have been uncomfortable asking the MHA's to do their job that they already know they are doing. So, when the MHA's aren't watching pt.'s or doing all the check or making beds, I just do it. I take my charting down to the day room and watch pt.'s for safety, I get up and do a round of checks anytime I want. It honestly takes me less time to get up and do stuff myself then it does to ask someone else to do it. But it is our responsibility to delegate these things so we may do our license-required nursing work. I happen to end up with enough time to do things myself....I come to work to work.

[MrChicagoRN, RN]

No, in the long run it takes more time to continue to do other peoples jobs vs getting them to do what they should be doing in the first place.

What happens on a day when you are way too busy to cover for them? Is that the time you want to start making them do what they were supposed to be doing all along?

[TerpGal02, ASN]

Well the adult unit is so acute right now that we've been saying in report that all nurses and MHAs listen to that there absolutely, positively must be someone on the unit at all times. Last night here were 3 nurses and 6 MHA for the whole hospital, including adult and c&a. We damn near needed all hands on deck with the adults they are that bad. I think with the exception of maybe 3, everyone got PRNs last night (only one by I'M though). I have never seen so many ravingly out.of control psychotics in my entire life.