What does a Psych RN do exactly?

OLD NURSE · May 8, 2004

:nurse:I also take referrals, deal with staffing problems, act as a social worker, and deal with any thing else that happens, (and something usually does), do inservices, orient new hires, etc.

WHAT AN RN DOES
1. Assess and admit pt to acute inpt psychiatric unit.This task will take about 2 hours including documentation(...And remember not all pts are visiting on a voluntary basis.)
2. Obtain appropriate orders from MD. Many units have standing orders for things like blood and urine specimens to be obtained ECG ,detox protocols etc. Most units admit 24/7. Each patient will need individual care. Many will be admitted with chronic illness such as DM, lupus,or HIV. Orders will need to be obtained to continue pt. on any med already prescribed. Often these orders will be obtained by phone and the MD will not see this person for 24 hrs. ASSSESSMENT SKILLS ARE CRUCIAL.You will see plenty of pts that need total care, at least until they are stabilized.
3.Delegate tasks to the rest of the team- meds to pass safety checks to do on all pts as often as q15 minutes,groups to run,(2-3 a shift except on NOCS
4.Co- ordinate care with other team members- Social workers to start discharge planning, physician to do H&P.(The MD that you call for orders will be the attending psychaitrist;however every one wil need to see a physician for history and physical),lab techs to draw blood(may have to draw your own, however) housekeepers to make the beds for new admit, order tray from the kitchen...
5.Obtain consent (or not) to speak with the patients signifigant other. (We in psych have always been very careful with confidentiality, prior to HIPPA.) Often one will find that the identified pt. is not the sick one
6.Keep the unit SAFE and running. "Safe" means no drugs, no weapons, no sexual activty, no gambling ,no pill cheeking, no fighting, limited verbal abuse, limits on demanding pathological behavior, somewhat like a cop with a heart of gold.
7.1:1 with assigned pts. A good way to achieve this is divide the number of clients by number of staff. Each staff will be assigned to spent quality time talking one on one with each patient assigned and documenting said conversation. The RN/ charge nurse will be assigned the most acute individuals. This can be a most therapeutic intervention, even at 3am.
8.Give report to the oncoming shift.
9.Complete an acuity assessment tool of some type, often thought of as a cruel joke.
10.Try to relax- it will all start again tomorrow.
WHAT DID I LEAVE OUT LADIES AND GENTLEMAN?

OLD NURSE · May 8, 2004

I love my job! I have worked in many areas of nursing, and I have enjoyed everything I've ever done. The satisfaction of knowing I made a difference, far outweighs the negatives.

I love being a psych nurse!!!!!! I have never worked in any area of nursing except psych and I have been doing this for 20 years! I have no desire to do anything else but psych nursing. My pay is the same as nurses who work in other areas.

OLD NURSE · May 8, 2004

That RN you observed really made a difficult job look easy!!!!!!!!!!!!!!!:chuckle

From what I have seen(little), all I really saw the RN do was pass meds and make small talk with patients.
I am sure this is not the case... So what exactly do you Psych RN's do?

Commander Vimes · May 8, 2004

That RN you observed really made a difficult job look easy!!!!!!!!!!!!!!!:chuckle

He must have been damned good at his job.

Great nurses make it look easy. The ward was obviously settled, he/she was reaping the reward. :)

Eviene · May 16, 2004

I have often found myself acting as a catalyst for a patient bubbling away (a very dangerous thing) By pushing buttons and getting them to respond, I can manage them more safely.

Louisepug · May 19, 2004

Hi everyone,

I actually posted a similar question a few weeks back and didn't get many replies, so it really helps to read these. Thanks! :) I myself would love to possibly go into psych nursing eventually. Can someone give me a little info. on Geriatric psych nursing? I've been told by people who know me that I should look into this? Does this area of psych deal with alzheimers patiets as well? Thanks!! Louisepug

lucianne · May 19, 2004

Louise, I bumped this thread to the front page because you weren't getting responses to your other thread.

I don't work geropsych, but I do know that community-dwelling dementia patients often have inpatient admissions to geropsych units when their behavior deteriorates for some reason (often an infection worsens their symptoms).

good luck,

luci

Louisepug · May 19, 2004

Thanks Lucianne! I appriciate it. :)

Crazy Mama · May 20, 2004

Hi everyone,
I actually posted a similar question a few weeks back and didn't get many replies, so it really helps to read these. Thanks! :) I myself would love to possibly go into psych nursing eventually. Can someone give me a little info. on Geriatric psych nursing? I've been told by people who know me that I should look into this? Does this area of psych deal with alzheimers patiets as well? Thanks!! Louisepug

Our hospital takes patients from 45 and up. Yes we do take Alz pt's. Most of the time they are here due to combative behavior or just dx. and forgetfulness is there problem. i always tell the family that we can help control the behavior, but we can not cure alz. As far as forgetfulness, with the some of the new meds out, Namenda, we are able to help a few with memory. But this isn't a cure either. We currently have a pt. on the unit that has just been dx w/ alz. She knows she is forgetful and this petrafies her. no matter what i say or do relieves that fear. On the other hand i am dealing with a husband that is totally lost and afraid. He is lossing the only thing that has mattered to him for 33 yrs. He himself is in rehab for a broken hib and ulcers to heels that he received while there. I spoke to this gentleman for over an hour x2 this weekend. My heart goes out to him, for there is not much we can do, but find her a safe place to live were he can stay w/her until the time comes for her to be in a locked down unit. I have said before, I love my job. But there are trying times. Since we are a locked unit the RN can not leave the unit unless there is another RN in place. So this means that eating is done at the front desk and we do not get 15 min breaks. We are the only RN on the unit. At the present time we do not have a nurse manager, but even when we did, that person would never releave us. For one thing, none of the managers that we have had know how to do a DC or an Admit, let alone the regulations.

Louisepug · May 20, 2004

Crazymama,

Thanks for the reply! Psych nursing definately does sound like the field I'd like to go into, but I need to try to keep an open mind during nursing school :) . The only thing that I would be slightly hesitant about is the danger factor. I mean, I know that there is danger involved in any area of nursing, but do you get afraid of being attacked by patients? How often do serious attacks occur to psych nurses? Thanks again for all your help! Louisepug

Crazy Mama · May 23, 2004

Crazymama,
Thanks for the reply! Psych nursing definately does sound like the field I'd like to go into, but I need to try to keep an open mind during nursing school :) . The only thing that I would be slightly hesitant about is the danger factor. I mean, I know that there is danger involved in any area of nursing, but do you get afraid of being attacked by patients? How often do serious attacks occur to psych nurses? Thanks again for all your help! Louisepug

Sorry it took so long to answer, I did my 2 16 hour shifts and slept for 3 hours this morning, now I'm ready to go. I can understand why you may be hesitant. When you are employeed on a psych unit, you will be trained to do take downs the proper way. Our unit is part of horizon out of TN i believe. Anyway when i was first taught we learned PMAB training, this is where you take the patient down in the safest way so that you and the pt are not harmed. Then they went to Secure training. the difference is with PMAB its a take down. Secure you have to show where you tried different things to calm the pt prior to the take down. IE: dec. stimulation, 1:1, offer food and hydration etc... It is very hard for me to say what the units that take younger units do, but usually we experience 1 or 2 per week. I've learned that you can not show fear. Usually the person will back down, of course there have been times that I was caught off guard. I have been slapped, almost had the addressograft thrown at me(if it hadn't of been plug in I would have been hit). some people think just because you take care of the elderly that they aren't strong. They haven't been on my unit! I have heard stories from the other unit that we have across town. They take the child to adult. One staff member broke his leg and arm by a pt. and not enough staff on hand to help him. People believe that all we do is read and watch the patients. We have been called "glorified babysitters". But when another nurse has to come to our unit because someone didn't show up they learn fast. Also, when our pt has med. problems and is sent to their unit they have a fit and we have to go down to give the inj. because they are afraid to get close to the pt. Sorry, I have a tendency to get carried away.

marymary · May 28, 2004

Sorry it took so long to answer, I did my 2 16 hour shifts and slept for 3 hours this morning, now I'm ready to go. I can understand why you may be hesitant. When you are employeed on a psych unit, you will be trained to do take downs the proper way. Our unit is part of horizon out of TN i believe. Anyway when i was first taught we learned PMAB training, this is where you take the patient down in the safest way so that you and the pt are not harmed. Then they went to Secure training. the difference is with PMAB its a take down. Secure you have to show where you tried different things to calm the pt prior to the take down. IE: dec. stimulation, 1:1, offer food and hydration etc... It is very hard for me to say what the units that take younger units do, but usually we experience 1 or 2 per week. I've learned that you can not show fear. Usually the person will back down, of course there have been times that I was caught off guard. I have been slapped, almost had the addressograft thrown at me(if it hadn't of been plug in I would have been hit). some people think just because you take care of the elderly that they aren't strong. They haven't been on my unit! I have heard stories from the other unit that we have across town. They take the child to adult. One staff member broke his leg and arm by a pt. and not enough staff on hand to help him. People believe that all we do is read and watch the patients. We have been called "glorified babysitters". But when another nurse has to come to our unit because someone didn't show up they learn fast. Also, when our pt has med. problems and is sent to their unit they have a fit and we have to go down to give the inj. because they are afraid to get close to the pt. Sorry, I have a tendency to get carried away.

I think the nursing shortage is greater in psychiatric settings because of the fear factor. People are terrified of the mentally ill. They do not realize that they are not exclusively in mental hospitals, they are everywhere, they may even be in our homes.I am going to go and check it out.

:rotfl: