Support needed for new geripsych unit job..

allnurses Guide · Apr 8, 2014

In my experience, geropsych is heavy because of all the medical issues that geros have. Some days I'm way more focused on the medical than the psych. It can be a bit stressful when you have a pt with serious medical issues and you can't get them to comply with their medical care.

Geros are also heavy on ADL's. You have one mental health tech to 14 pts? Hmmm... is the tech really a CNA/PCT or are these the folks with a bachelor's in psych? I ask because the bachelor's folks usually had no experience helping w/ ADL's and the needs of geros. Not a huge problem if they are willing to learn, but a big issue if you get one who says, "I didn't go to college for four years to wipe a butt!" :madface: Fortunately, that doesn't happen too often because it makes me angry when people consider my pts and their needs "gross" or not worthy of their time!

One tech to 14 seems like a lot because they will need help with ADL's-- not only because some of the pts actually are 2 assist to transfer, but also because you may need two techs for safety (like if they hit hit, bite and scratch!).

Of course, the nurses are there to help with this too, but I know I have a hard time always helping on the floor when I have admits, discharges, large med passes, funky labs and other nurse issues that the techs cannot help me with.

I am not trying to be negative, but that's what you may see. You just take it as it comes.

Definitely, on the good side, you keep can keep up your medical because of the medical issues. My coworkers-- techs and nurses-- work together very well and look out for each other. We know it's tough and so we know we need to be a team.

I love geriatrics and I love psych so it's win-win for me.

Good luck and welcome to our world!

HAWKIRN · Apr 8, 2014

Thanks for responding Hygiene Queen. It's nice to get some feed back. I start Monday, but the unit itself doesn't open till May 1, as it is brand new to our Hospital. Myself and all the other staff will be going through a 2 week training period, learning about various psych. meds, diagnosis' we may see and deescalation techniques. I believe the MHT's are actually CNA's but I'm not 100% positive. They will add another MHT if the census gets above 7, which is nice. The thing I found interesting was that any medical condition they have must be stable before we will accept them on our floor. Their psych needs has to surpass their need for medical treatment. Which is pretty neat. Not to say they won't have medical issues, diabetes, hypertension, etc. But they should be well controlled if what they are saying is true. I'm beyond excited at this point. Any good books to freshen up with? I worked in addictions recovery last in 2011, but haven't done much with psych since then, as this is the first psych unit we've had for years. Also, do you own your own DSM? I have always wanted one, and this may be the excuse I need to finally buy one =P.

allnurses Guide · Apr 9, 2014

I was thinking about getting some more up-to-date books, myself, so I have none to recommend. I study up online, my drug guide or from my old school books. Like any other area, you learn as you go and ask/look up what you need to on the way. I really focused on the psych meds because pts and families ask the most about those (and I love learning and teaching meds).

I do not have my own DSM. I've thought about it but just haven't gotten one yet. We used to have a copy on our unit I would just look through, but it disappeared. We should get one! :laugh:

My unit opened with 8 pts... ten years later, we hold triple that :nono: . That's waaaay too many confused geros on one unit. Your deal sounds sweet and I hope they don't get greedy and try to pack 'em all in like our hospital does. Sounds like you have good numbers... tell 'em Hygiene Queen says it doesn't work out so well if you go above 14... lol!!!

MrChicagoRN, RN · Apr 9, 2014

Congrats on the new job!

Your 2nd post answered my question about acuity.

it sounds like the unit I used to be on. That was no IV, no isolation, psych issues outweighing the medical. most were continent and ambulatory with/without devices. Even though Dementia as a primary diagnosis cant be used, you'll see a lot of psychosis NOS, dementia with psychosis/agitation. In this setting, instead of dealing with folks with chronic mental illness, you'll sometimes be dealing with people that have been independent all their lives but are now dealing with something they really don't understand.

You'll want to know a little about dementia vs delerium.

Also, with the elderly you often use redirection, & distraction, vs reality reorientation, and hard limit setting.

For example, instead of "no, your family isn't here to take you home, you are in the hospital and need to stay," you might say something like. "the doctor wants to do some tests and make sure everything is ok...your family isn't here now, but if they show up I'll be sure to let you know."

I think that the CPI website has some free Info on deescalating the elderly that may be helpful.