Transitioning to Psych / tips wanted!

Every unit is different. On my unit, most of those things would be put in a locker and rarely brought out.

We don’t have individual report sheets, either. The off-going charge nurse gives report to everyone and the report sheets are passed on to the arriving charge nurse.

congrats on your new job. i would definitely brush up on psych meds. also read up on signs and symptoms and course of tx for depression, bipolar, schizophrenia, ptsd, suicidal ideation, and addiction. those supplies you want to bring would most likely not be out in the open. you would not be walking around with a stethoscope around your neck, it could be used if needed and stored away in your bag or nurses station. clip board could be used if you want, depends on your style of writing and storing your notes. Psych is a totally different world and I am sure you will do great in your new role..

I carry a clipboard, pens, scissors. Everything else stays in my bag unless needed. I don't use a report sheet; I take notes. Be confident. If patients sense fear, they will try you. IM Zyprexa and IM benzos should not be given concomitantly. Keep a close eye on medicated patients. Some meds can keep a patient sedated for hours, masking medical conditions. Good luck. I'm sure you'll be fine!

Make sure you understand the following Federal Regulations:

State Operations Manual

Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

A-0154

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e) Standard: Restraint or seclusion. All patients have the right to be free from physical or mental abuse, and corporal punishment. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of

coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time.

A-0159

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e) (1) Definitions. (i) A restraint is—

(A) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or

A-0160

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(1)(i)(B) [A restraint is - ] A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.

A-0161

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(1)(i)(C) - A restraint does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm (this does not include a physical escort).

A-0162

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(1)(ii) - Seclusion is the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. Seclusion may only be used for the management of violent or self-destructive behavior.

A-0164

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(2) - Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the patient, a staff member, or others from harm.

A-0165

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(3) - The type or technique of restraint or seclusion used must be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm.

A-0166

§482.13(e)(4) - The use of restraint or seclusion must be --

(i) in accordance with a written modification to the patient's plan of care.

A-0167

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

[The use of restraint or seclusion must be --]

§482.13(e)(4)(ii) - implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by hospital policy in accordance with State law.

A-0168

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(5) - The use of restraint or seclusion must be in accordance with the order of a physician or other licensed independent practitioner who is responsible for the care of the patient as specified under §481.12(c) and authorized to order restraint or seclusion by hospital policy in accordance with State law.

A-0170

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(7) - The attending physician must be consulted as soon as possible if the attending physician did not order the restraint or seclusion.

Interpretive Guidelines §482.13(e)(7)

A-0171

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(8) - Unless superseded by State law that is more restrictive --

(i) Each order for restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others may only be renewed in accordance with the following limits for up to a total of 24 hours:

(A) 4 hours for adults 18 years of age or older;

(B) 2 hours for children and adolescents 9 to 17 years of age; or

(C) 1 hour for children under 9 years of age; and

A-0174

(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)

§482.13(e)(9) - Restraint or seclusion must be discontinued at the earliest possible time, regardless of the length of time identified in the order.

I keep my tiny scissors in a zippered pocket in case I need to open a packet during med pass (usually nicotine patches.) Pen light definitely needed for mouth checks. It sounds a little degrading to the patients, but many, many of them cheek their meds. It may sound strange because they are entitled to refuse meds if they so choose. If they are engaging in this behavior, they are often diverting to another patient or hoarding the meds. Both big problems.

Other than a pen and a note pad (and my unit keys), I kept all of my other supplies in the nurse station (stethoscope, bandage scissors, etc.). You will be around patients who don't think rationally, and you don't want to give them any ideas. I don't know if your unit uses restraints, but if they do, I recommend also removing your watch and your ID badge before you go into that situation. I also removed my glasses. I didn't want anything on me that could potentially injure either the patient or me.

Congratulations!

Every unit is different. Some allow office and craft supplies like scissors and colored pencils out in the open and some are in lock-up.

I rarely see stethoscopes on the floor.

Anything that can potentially be used as a weapon or to injure will be in the nurses' station. Usually we just wear our badges whenever we walk around the unit and if ever we need to perform procedures we then get what we need.

Good luck!

Congrats!

A few things I usually include in the report:

1. Diagnosis of the patient. I'd become familiar with some common psych diagnosis, their common medications, and their presentations

2. The last time they received any emergency treatment medications in case you need to give another dose.

3. Medical comorbidities and allergies

4. A brief summary of why they're here, and if they have any past incidences of aggression or violence on the unit. The strongest predictor of violence is a history of it.

5. Their legal status. There are special rules governing patients who are voluntarily versus involuntarily committed.

I'd leave the stethoscope and definitely the scissors locked up. Be mindful of anything on your person that may be used as a weapon.

Hello, I am also trying to transition into psychiatric nursing. I'm an RN who has worked Medical ICU as well as acute (inpatient) dialysis. Should I be applying for RN I positions or RN II positions for psych jobs? At a lot of places, RN I positions are for the new grads, but a lot of RN II positions say (1-2 years of behavioral health nursing preferred). Which would you apply for if you were in my position?