What does an acute psych night shift nurse do?

PsychRN45 · Dec 2, 2006

Is this a PM or NOC or 12 hour Nights?

In my facility, when I do a NOC it's mostly auditing charts and getting the paperwork ready for the next day. On occasion there is an admission but mostly just auditing.

As for DXs: maybe a manic or a psychotic pt up late at night but mainly my patients are sleeping.

The money is good for NOCs and Nights but if you really want to deal with the special diagnosis' or behaviors then look for a AM or Day shift.

CHATSDALE · Dec 2, 2006

frenzy/boredom - some nights every one is up and pacing and some [most thank heavens] nights everyone sleeps all night

nights are rough on every floor because you can't do a lot ahead of time but just remember that these pts have the same halth problems as any other group..

scorpiofish · Jan 8, 2007

Mostly solitare! It doesn't take long to get notes ready for the next morning and most of the time patients are sleeping or you are encouraging them to sleep. You never know if it is going to be quiet or not, but pays to take a good book along.

dylla · Jan 11, 2007

Depends on your clientel. We have Geri- Psych 55 and above and there are times when they are up and we only have one RN and an MHT -- So there are times when your busy and times when all your paperwork is done. We are the ones to do audits, MARs, get the charts caught up -- occassional emergency admits and you always have morning meds....

rn/writer, RN · Jan 11, 2007

Depends on the population and the size of the unit. Adults tend to be up more. I normally worked acute child and adolescent, but when I floated to the adult unit , there were usually at least a few patients who stayed up till all hours. When they'd trundle off to bed at last, the early birds would replace them.

On nights you do chart audits, MAR audits and prep, and paperwork for the next day, as others have said. You also take turns doing q15 and q30 rounds. Sometimes you have a formal 1:1 patient in their own room or in a quiet room. Or you can have an informal 1:1 with someone who feels like opening up in the wee hours or someone who needs help to deal with anger, fear, or some other emotion that is getting to them in the quiet. Once in awhile, you can have someone in a full blown rage who needs to go into restraints. This can increase the anxiety level in anyone else who is awake.

Many patients have sleep disturbances, ranging from garden variety insomnia to agitation to night terrors. A PTSD patient might have a flashback that requires you to intervene. Others with OCD, self-harm issues, or any other compulsive behavior might need help with putting their de-escalation strategies into action.

There are night admissions. And very occasionally, an early discharge.

Starting about 0600, people begin to get up. Some have early meds. Others need supervision in the shower. You could have anorexic patients who need weights (there are male anorexics, too). People going out on day passes have much to squeeze in before they leave. Day treatment patients come back to the unit and have to be processed and searched.

Yes, there are nights when the clock moves slowly. But there are other nights when the joint is jumping and you barely fit everything in.

I always enjoyed nights. That's the schedule my body likes most. And working that shift gave me some wonderful opportunities to get to know my patients individually. I didn't get to lead groups, but I felt like that was a small trade-off for the 1:1 time. Often, I was able to share information with the day shift that helped to make sense of a patient's behavior during the day.

I wish you the best. Let us know what you decide.

shrinkyrn · Jan 14, 2007

When I worked night shift on the acute psych unit even nights were busy with psychotic individuals, pacing the halls and not very redirectable because their meds hadn't kicked in yet. I've worked units where manic folks were up and about. Most of the units I've worked at night were units where we did get admits during the night and needed the necessary skills to diffuse crisis admits. I've worked intensive psych units where we had folks in seclusion during the night who needed the appropriate seclusion care. I've worked geri units where the patients had sundowners!! and were screamers who woke up the rest of the unit, and perhaps the unit above or below. :uhoh3: Don't be fooled into believing that nights in psych is a cake walk!! You have paperwork that people push off on nights because the "patients sleep".:zzzzz Nothing made me madder than a hornet,:angryfire than to hear that after a rough night with psychotic, disorganized patients or intoxicated admits!!(Yeah, you'll get those, too, even tho' you will tell the ER or doc on call that you are ill equipped to handle a detoxing pt, :nono: (who if they go into DT's is a medical emergency)!!!! :banghead: and what's even more important, they can't sign in voluntarily if they are intoxicated:nono: Probably the least eventful unit I worked on at night was child/adolescent. Guess it depends on the type of unit. When I did ER evals for psych and detox and coordinated admissions to the psych units, there were admits to psych more nights a week than not. Could be I worked big city hospitals a majority of the time, but even at the rural hospitals I worked, the RN didn't have time to play solitaire. Not enuf credit is given to night shift for doing the best you can with what you have, and I haven't worked nights in years. Hope you find what you're looking for but, if you like psych and want to really learn how to deal with people in crisis nights can give you that. Best bet to find out exactly what type of unit it is and if they accept admits at night and how much paperwork ie. chart audits, QA studies, Treatment plan revisions, reconciling MARs, cleaning fridges, which med passes, VS, treatments, discharge preps, etc. etc. etc. you will be responsible for and how many pt.s does the unit hold on the average, will you have to float to other areas of the hospital in times of low census, what are the credentials of the coworkers (do they have a psych background) Will you ever have to work alone in times of low census, (these may sound somewhat petty or improbable, but the are important)!!! Good luck.....................Shrinky:bugeyes: