What are your psych policies?

[NurseBettyRN]

I work in a rural hospital, 12 bed psych unit. One of the biggest problems we are having is inconsistencies in following rules and policy by staff. We are trying to implement some new policies. The staff have been divided on a few issues and I am supposed to find out how other psych facilities deal with certain policies.

My questions are:

1. How do you handle the patient's using your main line phone at the nurse's station?

We have a pay phone but it is frequently broken. The patient's are on our phone 24-7 and it makes it difficult for us to make/receive any phone calls. We also have an issue with the patient's making several long distance phone calls on our dime and talking forever. Several staff members want to limit patient phone usage on the main line phone to lawyers, ministers, and 1 call to family member on admit for adults and 3 phone calls a day for adolescents.

2. Do you allow cell phones to be used by your patient's? Why or why not?

The doctor is allowing patient's to use their cell phones with a doctors order. We have had MANY problems with this and several staff are against it, but we need proof of what other facilities are doing.

3. How many visitors do you allow at one time? Do you allow patient's to have visitors in their rooms?

Also, many problems here including exchange of drugs, cigarettes, alcohol, and numerous other contraband. Also problems of inappropriate sexual behavior. Several staff want visits limited to activity room but we only have 12 chairs so many staff complain that it will be too small and unfair to patients. Expanding unit is NOT an option.

4. Do you allow patient's to use headphones? Do you allow patient's to use boom boxes, CD players, cassette players/recorders?

Any help is much appreciated,

Thanks

NurseBettyRN

[elkpark]

1) I've been a psych nurse for many years, a psych CS for about 10 years, and have surveyed/inspected inpatient psych settings for my state and the Feds for the last few years, so I have experience in a wide variety of settings. I've never been in any situation where clients were allowed to use the hospital/nsg. station phone. There needs to be a separate phone with a direct, outside line, in a location that allows some privacy for the clients using it. If family members, etc., call in to the nursing station, trying to reach a client, they are transferred to the client line or given the client phone number (following whatever your established procedure is for maintaining client confidentiality). It is inconvenient and, at times, dangerous to allow clients to tie up a phone line at the nurses' station; plus, you don't want to encourage clients to hang around the nurses' station, where they may overhear protected information about another client in a conversation between staff members, and clients shouldn't have to conduct all their phone coversations in the presence of staff (unless there is a specific clinical reason why a particular client's calls need to be monitored by staff).

The client telephone needs to be kept in working order so that there is no need for clients to use the hospital's lines. There is no reason on earth why a client should be making long distance calls on the hospital's bill! Also, you can set some practical limits on telephone usage, e.g., no calls between 10 PM and 8 AM (or 11-7, or whatever), time limit on length of calls (10 or 15 minutes is common) to allow all clients an opportunity to make and receive calls, phone off the hook during groups/therapies. It would be important to check and make sure that any limits you set on phone usage don't conflict with any state rules that may apply to your unit regarding client rights, however.

2) Everywhere that I have worked, client cell phones have been kept locked at the nurses' station for security, and clients have been allowed to use them only when there's a particular, good reason and with a doc's order. In that case, they were given the cell phone to make a specific call, and then the phone was locked up again after they were done. I've never seen a situation where clients were allowed to walk around the unit with a cell phone and use it ad lib.

3) Policies on visitation vary greatly among facilities. It is not at all uncommon to limit the number of visitors allowed per client at a time, esp. on small units such as yours, where it is just impractical to have large crowds. Also, remember that, anytime a visitor(s) is causing problems on the unit, you can ask him/her to leave. The state client rights rules in my state require that, in order to limit a client's visitors, there must be a written doctor's order and specific documentation of the reason(s) why limiting visitors is necessary. Be sure that whatever you decide for your unit is in compliance with any state rules in your state ... If you decide to allow visitation in client rooms, it is certainly reasonable to require that doors be kept open all the way while visitors are in the room, so that staff can glance in as they walk by (staff should certainly be out in the hall(s) during visitation, alert for any problems).

Contraband is always an issue on psych units. It is v. common now to not allow any kind of purses, bags, etc. on psych units (many units now have lockers outside the unit available for visitors to secure their personal belongings before they come on the unit). Staff must be alert and observant (as always). However, some folks are going to slip stuff past you anyway, no matter how careful you are. If you have a particular reason to suspect that a client has obtained something contraband during a visit, you can always do a search (again, in my state, the rules require that clients be informed on admission when and how searches can be done -- you need to know what your own state rules require).

4) Every place I've ever worked has had a policy that boomboxes, etc. with recording capability cannot be used unless/until the hospital maintenance dept. has checked it out electrically (for safety, like any other electrical appliance brought into the hospital) and disabled the recording capability -- this is a big confidentiality issue. In my experience on acute units, when you explain to people that this is necessary in order to be able to use the device on the unit, they usually decide not to bother. However, I have worked in long-term residential adolescent programs where all the kids had their own boomboxes with disabled "record" features -- but they were living there for some length of time, and we all know how kids are about their music ... :) In my experience on adult acute (short length of stay) units, clients have needed a doc's order to have a radio/boombox in their rooms, and, of course, they are required to sign a waiver releasing the hospital from any responsibility if it is damaged or broken, the same as any other personal items they choose to keep with them on the unit.

BTW, you mentioned in your question about phone calls both adults and adolescents -- are you admitting both adults and adolescents to a single, 12-bed unit? Is there some way that you are physically separating the adults and the adolescents? I ask because that's generally considered a really bad idea within the larger psych community ...

Hope this (and whatever answers you get from others) is helpful. Best wishes with your project and your unit. My first psych job out of school was on a small unit in a small, rural hospital, and it was a whole 'nother world from the large urban teaching hospital in which I had trained. It was a great experience, though, and I really enjoyed it!