What can a nurse do?

[canoehead, BSN, RN]

Hypothetically of course...

Patients with obvious hallucinations and delusions sign in to the ED and request to be admitted. They are repeatedly seen and discharged with an appt with the psychiatrist next week. They express fear at what might happen between now and then, some refusing to leave the ED until taken away by police. The psychiatrist insists they are "playing games" and not really having the symptoms they complain of. This happens at least twice a week for several months.

One of the patients that was coming regularly, and complained of suicidal thoughts, along with voices, is found dead of an overdose. Another is discharged from hospital while still insisting he needs treatment, and jumps off a bridge.

A patient is brought in after committing a violent act against a group. The police escort him to jail from the ED. He was admitted involuntarily to psych, and promised that if he took his pills they would let him go home. Evidence of hallucinactions and delusions back up the involuntary committment papers. Patient finally takes a dose of meds after 3 days of cajoling, and was released from the psych unit 30 minutes later. Amazingly- on paper all his symptoms disappeared in those 30 minutes.

As an ED nurse you know that people are dying because of decisions that have been made. You notify your supervisor, and make out the appropriate paperwork for incidents happening on your shift. What else, if anything, can be done by a nurse that wants to keep his/her job?

[piscesguy]

Find a reporter and draw public attention to the hospital :)

[Nascar nurse, ASN, RN]

Mental health sucks in this country - the whole system is broke, but mental health really suffers. Ultimately this effects those of us that are supposedly sane.

[bobarb, BSN, RN]

I agree w/Nascar nurse. Our mental health system is pathetic. Our social services system doesn't work. I guess we just keep plugging along, hoping that someday something will work out right, and just maybe that psych pt. will get better, or at least won't commit suicide....and I say this with sadness, at least not on my shift!

[Nascar nurse, ASN, RN]

And it's not just the patient that kills himself... I worry about the guy that shoots up half of McDonalds because the voices told him to (and then hearing about all the Dr's that "thought" he'd be alright).

[SharonH, RN]

Risk management needs to be aware.

[cookienay]

Find a reporter and draw public attention to the hospital :)

The OP said she wanted to keep her job.

[piscesguy]

The OP said she wanted to keep her job.

Who said anything about revealing her identity? Lots of people report and testify anonymously about issues they face.

[aura_of_laura]

This scenario sounds a little lame. You can't 302 a patient for hallucinations unless they are a threat to themselves or others. Also, you can't admit a patient for psychiatric reasons if they are intoxicated or high at the time they made the threat. While this doesn't always make us feel safer, we have a little thing called civil liberties.

It is not the purpose of a psych unit to prevent an overdose on illicit drugs (though the scenario doesn't state whether it was intentional or not) - addiction is a whole other can of worms.

In my experience, when a patient is committed to a psych unit from jail, the police are involved in his or her discharge planning. If one was arrested for a violent act on a group, certainly there would be criminal charges and more than 3 days in a psych unit would be warranted. Nobody gets discharged 30 minutes after taking a single dose of meds - there has to be some change in the criteria for which they were admitted (unless the diagnosis is Axis II instead of Axis I). Efficacy has to be established, and the patient has to have been free of PRNs usually for 24 hours. If the patient is aggressive and actively hallucinating, you can bet he or she would have gotten a hefty dose of Zydis or Ativan.

Also, realistically, what percent of mass killings are committed by psychotic people? Almost none. Usually violent criminals tend to fall under bipolar DO, antisocial personality DO, intermittent explosive DO, etc. And almost NONE of those can be treated with commitment to an acute psych unit. I say this as someone who has worked with a number of would-be terrorists or mass murderers.

Is our psych system broken? Yes. Are these scenarios at all likely to happen? One in a million, unless we're on General Hospital.

[simboka]

...Nobody gets discharged 30 minutes after taking a single dose of meds...

I think that's what the OP is saying the problem is. That this IS happening.

[canoehead, BSN, RN]

And nobody is free of all symptoms 30min after taking their meds. Except at the hospital I describe.

The police are on record with the local newspaper that they believe patients are being discharged while they are still a threat to self and others. Local officers keep bringing people in and we keep letting them go. (in this hypothetical world)

[talaxandra]

I'm so sorry for the hypothetical nursing staff and patients at this hypothetical hospital. Anonymously alerting the media is the only action I can think of, and it would need to be done vey carefully in order to remain anonymous - hospitals are infamous for blaming whistle blowers instead of attributing blame to poor practitioners.