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What’s it like working in the psych emergency department?

Psychiatric   (512 Views 6 Comments)
by SparklingRN SparklingRN (New Member) New Member

430 Visitors; 6 Posts

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Hi! For about a year an a half, I have been working on a chemical dependency unit which specializes in dual diagnosis. This is for an inpatient rehab program.  This is a voluntary unit and for the most part our patients are stable but do have other psych diagnosis. At times they can get a little amped up and occasionally we have to transfer them to the acute psych department to stabilize them. I spend many shifts just passing meds/PRN’s and scheduled meds. As well as sitting an answering phones while the patients are in group therapy. Sometimes the sitting can be for a couple hours or more with the exception of sitting and charting, Walking to the Pyxis which is 5 feet behind me or answering the phone. I have an opportunity to work in the psych pod in a level 2 trauma emergency department. 

I am curious what it is like, I really need some more challenges and intensity. Sometimes in my current job I feel like I sit and watch paint peel when the patients are gone for an hour here and there. How many patients do those psych ED nurses have at a time? is there usually only 1 nurse working the pod? Do they cross train to work in the medical side of the ED when things are fairly slow that shift? Do you get psych patients that also have medical emergencies?

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Nature_walker has 3 years experience as a ASN, RN.

4,044 Visitors; 200 Posts

In my hospital our psych ED is a separate locked unit. Once they are medically cleared, they are sent up to us. We do not have a cap on how many pts we can have on the floor, so it can be feast or famine.  I have seen as many as 48 pts one night and one time we had 0 pts for a few hours. That being said we never send staff home early because we can go from 0 to 50 in a heartbeat. 

If our pt's have medical issues they must be cleared in the ED first before we can bring them up. If not, our docs can go down to do a psych consult if needed. 

We do not cross train to work in ED. ED nurses are always nervous when they get called up to help us with medical issues. 🙂

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7,984 Visitors; 737 Posts

Everything NatureWalker said, although on “slow” nights I’ll run over to the medical side to help them out (so yes, I’m cross trained as are the nurses from medical, but I already had medical experience; others who have only worked in psych are not).

It can go from crickets to fireworks in mere minutes, when our 10 rooms go from open to full with the hallways crammed. Anywhere from 1-50+ - we cannot divert (though we’ve tried), we cannot send people away. This makes it challenging when acuity is high. Some patients stay for days and these are tough - usually the frequent flyers who have already been everywhere and placement is challenging. 

I have had medical clear my patients way too quickly to get them to my section ... only to have them go right back to medical again (the uncontrolled diabetics, poisonings that weren’t mentioned). I don’t enjoy this.

You won’t be watching paint peel in this environment (I’m in a peds ED).

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kingvonnBSN2017 has 1 years experience as a BSN and works as a Psychiatric Nurse.

6,035 Visitors; 210 Posts

I am glad this was posted. I have been working inpatient adult psych and working in a mental health unit in a jail environment. I have an interview for an 8-bed Psych ED position in a community hospital (looking for a change). Always 2 nurses on staff, so no more than 4 pts. each I am assuming. I am looking forward to it. 

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B52 has 8 years experience as a ADN, BSN, RN and works as a RN-BC.

4,965 Visitors; 156 Posts

Our psych E.D. is a locked unit inside the medical E.D. It holds seven patients, but sometimes the census tops seven and we have patients lining the halls in the medical E.D. On night shift we have one nurse and two techs; day shift has two nurses and one tech. We also have a security guard in the psych E.D. 24/7. Patients are medically cleared on paper only. Really. After they enter the psych E.D. blood and urine samples are collected, and CT scans and X-rays are done. Then, they have to return to the medical E.D. if labs or imaging tests are abnormal. Some of our E.D. physicians frequently downplay the ailments of psych patients. We have to make multiple requests for BP meds, insulin, or Librium, and too often those requests are denied. It can get frustrating. Some patients have limited insight and don't want to be held involuntarily, and they will put up a fight. We also have to do insurance authorizations, which is sedentary and very time-consuming. Another time-consuming task is reviewing charts and accepting patients from other hospitals that don't have a psych E.D. 

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kingvonnBSN2017 has 1 years experience as a BSN and works as a Psychiatric Nurse.

6,035 Visitors; 210 Posts

BUMP 👀

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