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

[DaisyRN, BSN]

I have experience in a low acuity behavioral health unit”. 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?

[Nature_walker, ASN, BSN, RN]

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. ?

[pixierose, BSN, RN]

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).

[kingvonnBSN2017, BSN]

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.

[B52, ADN, BSN, MSN, RN]

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.

[kingvonnBSN2017, BSN]

BUMP ?

[ItalianRN, BSN, RN]

I've been searching for Florida ER's that have a psych / behavioral health unit in them. I was a Cardiac stepdown nurse for 12 yrs, CCU for 2 years, traveler in cardio for 2, & my last 2 years have been in psych. I worked in an ER in North Carolina in their "psych pod" for 6 months. They didn't have a need for a full time nurse so I transferred to their inpatient beh health at that time. I've left that hospital & have been working in a psych hospital since then. I really loved working in the psych er area & want to go back to it in Florida.

All replies will be greatly appreciated!! Thank you!!!

[B52, ADN, BSN, MSN, RN]

ItalianRN,

In South Florida: Broward Health Medical Center, Broward Health Imperial Point, Florida Medical Center, Delray Medical Center, Plantation General Hospital, Memorial Hollywood, Aventura Hospital, Larkin, University Pavilion.

[ItalianRN, BSN, RN]

Thank you so much B52. I was actually looking for hospitals in Northern Florida. I lived in Ft. Lauderdale for 10 years before moving to North Carolina.

I would really prefer Northern Florida or Eastern Tennessee. Thanks again!