What is a Psych Nurse's daily routine?

GeneralJinjur · Jul 23, 2012

Here are some things that my psych facility does differently than what I saw in med-surg:

We have taped report. The offgoing shift stays out on the unit while the oncoming shift listens to report.

We have a designated med nurse. For instance, today I did meds for 30 patients. Between scheduled meds, PRNs and new orders, I might have spent 20 minutes of the shift outside of the med room. One of my patients told me I was in a cage and it certainly does feel that way sometimes!

There are groups throughout the day and evening, so getting a moment to talk with your patients can be difficult sometimes. Of course if they're manic, getting them to shut up can be difficult.

Narrative charting.

Mouth checks.

Room checks.

Regarding shoelaces, paperclips and underwires as deadly weapons.

Keeping track of legal status, like 72-hour mental health holds and short-term certification is different from a typical hospital. When converting a pt to voluntary legal status, I always tell them it's the same paperwork as they sign at the emergency room if they break a leg. It helps remove some of the fear of commitment. Often they think they are agreeing to another 72 hours, so we have to clear that up as well.

I really like psych. The disease process is so dang interesting and it's great to see demeanor improve as meds kick in. I once mentioned while teaching a med education group that I like my job because it's like watching little wilted flowers come back to life (I was on a unit with mostly suicide attempts and depressed pts). The patients loved that comment and quoted me for well over a week. They clung to the idea that, they too, would be getting past the circumstances that brought them to the hospital.

Hallows_Eve · Jul 23, 2012

I am a float nurse that is often scheduled between the in-patient floors and the psych ER.

For inpatient, we too usually assign staff to specific tasks, as an LPN I am often either the med nurse or the milieu nurse (nurse on the floor with the patients, attending or even running groups and rec therapy). Med nurses have to check for signs of medication compliance, floor nurses often do the environmental and room checks- keeping patients out of rooms not their own, looking for contraband, watching visitors who might give contraband, watching meals for pocketed objects or hoarding. There are usually two RN's, one or two LPNs, and one or two HA. (Four to the unit, so the breakdown is technically 4 patients per staff for end of shift notes).

There are variances for things like adolescent units (age appropriate activities and groups, many more behavioral issues at play than psychiatric per capita), and geriatric and detox combines a lot of Mental Health with Med-Surg.

Its a bit different for our Psych ER. Again there are assigned jobs, LPNs with the milieu or meds, Charge RN, but here additional RNS to admit, discharge, and interview patients. There are also security officers posted and often special guest appearances by local law enforcement bringing in or taking out patients. It is much more fast paced, patients here are usually arriving in the middle or just post acute phase. (Also, a lot of people brought in for being under the influence and staying/doing the wrong thing while their BAC is jacked). A lot more restraints (often brought in as such), and PRN medication ordered.

For myself, I like the psych er most- You don't get sick of seeing the same faces every day (except for some frequent flyers) and you get to learn a little bit of everything. I do like the inpatient floors too, since by comparison you have a little more time to spend with patients that may respond to your nursing style. My mindset with these patients is pretty much to treat them like that one friend or friend's parent/sibling/grandparent that we all have somewhere, who somehow keeps getting in a rut and a run of bad luck, and you root for them and try your best to help them pull through. Some patients will love how you do your job, some hate you and like someone else's methods instead.

Before orientation to the floor, I had extra training on non-violent self defense, deescalation techniques, and restraint practices- four and five points. These things we review in service every year.

A lot of the main differences between psych and med-surg is that psych patients are usually not confined to bed and are instead mobile throughout the unit. The rooms do not have medical equipment, tv's or phones in them (all hazards to psych patients), and instead the phone and tv are communal in the lounge. Visiting happens in a specific room, not the patient room, and staff must watch all interaction. Lots of group activities, and of course there are some violent or grossly psychotic patients that will go after you for any reason, so there is an increased level of awareness for safety measures and locations of other staff members.

HTH!

greenbeanio · Jul 23, 2012

Yes, a psych unit is very different from a medical unit.

How much orientation will you get?

What shift will you be working? What the daily routine looks like varies from unit to unit but also shift to shift.

IKnowYouRider · Jul 23, 2012

I've only been working on a Psych unit for 4 months now, but here's how my day (well, actually I work nights) goes, in very general terms.

1) Check to make sure people are safe.

2) Check to make sure things are legal (involuntary paperwork, medication consent, restraint documentation, etc.)

3) Therapy

*4) Initial Assessments/Accepting or denying referrals

**5) PRN, ETO, and Routine med. administration

*mixed in while doing a number of 1 through 3, and also my favorite part of the job.

**also mixed in during 1 through 3, but usually an LPN is assigned this job.