Why is everyone so tight lipped???

DutchgirlRN, ASN, RN · Nov 6, 2006

I've read alot of posts here regarding how hard it is to be a nurse and what their days is like. There is a thread: describe your day in 50 words or less. It speaks volumes with few words. I was a floor nurse for 31 years. Working med/surg is HARD, it is TIRING, it is EMOTIONALLY and PHYSICALLY draining. You have to love being a nurse or you'll never survive.

https://allnurses.com/forums/f31/describe-your-last-day-work-50-words-less-117912.html

RN1263 · Nov 6, 2006

I've read alot of posts here regarding how hard it is to be a nurse and what their days is like. There is a thread: describe your day in 50 words or less. It speaks volumes with few words. I was a floor nurse for 31 years. Working med/surg is HARD, it is TIRING, it is EMOTIONALLY and PHYSICALLY draining. You have to love being a nurse or you'll never survive.
https://allnurses.com/forums/f31/describe-your-last-day-work-50-words-less-117912.html

I'm referring to "psych" nursing!

maryloufu · Nov 6, 2006

I worked as a tech in psych for 7 years. I hate to say this but pretty much what I saw was this. The LPNs were responsible for passing all the meds- and that usually meant at least 5-10 meds each for around 60 patients.

The RNs did a lot of charting and sitting on treatment team. They were also responsible for management duties like writing up evaluations on techs. Very little patient contact. In fact as I was going through nursing school I would be shocked over and over again when I realized different aspects of jobs that RNs would delegate to the techs (example- initial vital signs, assessment of the body for bruises and or breakdown). I am sure this is not how it is at all psych facilities- but honestly I have heard of several RNs that would sleep in their offices on the job on a regular basis.

I enjoyed the patients in psych- but I could not see myself in either of those nursing roles.

RN1263 · Nov 6, 2006

maryloufu,

thanks for your honest answer!

what a breath of fresh air for a change, at least you're not blowing smoke up my a**!

bookwormom · Nov 6, 2006

I have worked as a PRN nurse in a psych facility, mostly on evenings and weekends. I wouldn't underestimate the role of the RN (or the LPN). In my opinion, she (or he) sets the tone for how the unit is functioning. Sure there is paperwork, but the nurse really needs to be completely on top of all the little undercurrents between patients as well as issues developing with individual patients. She also needs to project to the staff what she expects in terms of interventions. Example: two patients start to exchange verbal insults. Nurse needs to quickly assess what is gioing on, decide if she or someone else can deescalate it, or if crisis team is needed. Nurse needs to decide if PRN meds are needed after trying behavioral interventions. Nurse needs to make sure other patients are safe. Then after the dust settles there is a bucket of paperwork.

Also on a psych unit, there is plenty of med-surg type decision making, too. Example: 400 pound patient with borderline blood glucose readings begs for a snack. Is this a behavior issue? a hypoglycemic episode? etc. And of course patients with severe CHF and COPD, even pregnant women, are hospitalized with psych problems, too.

I find the aides on the unit have a limited picture of what the nurse does. But I truly believe that LPNs and RNs are really important for patient care in psych.

njmonsterboi80, BSN · Nov 6, 2006

I'm a recent grad and have been working on a busy Psych floor for 3 months ago. To answer some of your questions... Sometimes I do run around like a chicken without my head, it is nursing after all. My typical day starts with report and organization for about an hour. We have a team nursing concept and have to know what is going on will all the patients on the floor even if its not our assignment. That includes knowing who is going to the medical hospital for medical tests such as MRI or doppler studies. We're heavy on ppd and CXR so we need to schedule that as well so MHWs can go with patients, we do happen to have xray on site. We do the assignment, split of MAR books, go through the Kardex. That's hour one.

Then we go and meet our patients while the charge nurse meets all the patients, I usually go with the charge when I'm not in charge to make sure I know who everyone is especially since nurses do SO's (we check to see where patients are on a list periodically) when we don't have 2 MHWs, which is common. Then the charge nurse starts to get her meds. She/he goes first as they go to Team meeting with the multidisciplinary team (2 Psychiatrists, OTs, Art Therapists, Social Workers) and gives report on the status of the patients on our unit including mental/psychiatric status, medical conditions, issues involving transfer (we're a Short Term Commitment Facility STCF).

We give our meds to our own patients, then start moving to do the assignment of the day. Its usually either treatment planning where we go over the patient's treatment/care plan with them or on alternate days go over their medications and do that education either as a group or with individual patients.

On days where I don't have all my patients meds I'll be calling pharmacy and harassing them to approve things in our pixsys. We do do extensive charting, after all we're talking about psychiatry but it doesn't mean we're not working.

On days or weeks when we have aggressive patients we need to tackle them, put them in restraints, or call security to assist us. We restrain, medicate, and allow patients to calm down before taking them out of restraints..Then we debrief them about why they entered restraints and ways to avoid it in the future. While we're charting patients are constantly interrupting us for socks, towels, problems they're having.. Many of them are very disorganized and can have a hard time verbalizing what they need. It often takes a few minutes of conversation each to figure out what they want.

On the non committed side of the building we're geriatric/non committed. The geri population have medical problems including DM, massive HTN, etc. Last week we had a rectum and a uterus prolapse. I've had one patient with ESRD, rectal prolapse, massive constipation, dialysis 3x a week.. Other patients that need to be straight catheterized. Wrist wounds that need to be rinsed with betadine and covered with DSDs.

Basically I feel psych nursing is just as much running around without all the bending. I don't come home with that aweful back pain from bending improperly. I have strained a muscle holding back a patient from hitting another and have had to sit on a patient to keep him from ripping the stiches out of his jugular (highly suicidal). I risk getting punched regularly and losing teeth. So, its either bending or getting hit. Choose your poison.

Did I forget days during constant discharges and admissions?

I hope this helps you a little. I like what I do, but it is nursing and its a demanding profession on any floor.

Marc

I find that most posts in this area of "psych" nursing are so vague or if a student or new grad asks a question, their posts many times don't get answered?... WHY???
Does ANYONE want to say what their day is like? Do you run around like a chicken w/ your head cut off like on med/surg? Do you like your job? Are you glad you choose psych?
I like psych & I liked my clinical, but we were never given a time to ask the nurses any questions since we had a mound of paperwork, had to assess our client and go to group for the rest of the day, then finish are paperwork and go home. So, I haven't a clue what the nurses do or don't do all day???

lovinghands · Nov 7, 2006

I posted this message quite awhile back under "What's your day like?" and "Typical Day in Psych Nursing." Btw, I'm not blowing smoke anywhere ... :lol2:

I am a psych nurse on an inpatient acute unit. I work 8 and 12 hour shifts. Generally I am the only RN on the unit - if I need backup, I call neighboring units or the supervisor (if he/she isn't too busy). My unit is usually full, 15 pts, and we run with 3 aides depending, of course, on acuity and staff availability.

I count and get report at 2:30 and am on the floor by 3:00. The beginning of my day is usually busy - orders and finishing up tasks leftover from dayshift. The Dr and PA-C have a tendency to write orders late in the day, so I may be working on admissions, discharges, med changes, referrals, following up on abnormal labs, etc. I deal with all medical and acute psych issues - everything from a scrape to chest pain to suicidal thoughts or aggression. I am the med/treatment nurse. I am also the team leader, so I deal with delegation and personnel issues on my unit. Somedays run smoothly and other days it seems all I do is set out fires and race the clock.

We are an admission unit and most of our admits come in the evening, usually I have one but I have had up to three in an 8 hour time span. If I have an admit, I complete a nursing assessment with the patient, deal with immediate medical/psychiatric concerns, take off admission orders, contact their family, and of course document every intervention and write up an initial treatment plan. I am engulfed by paperwork my entire shift - it seems for every intervention there is triplicate paperwork to complete. I love patient care, hate the paperwork - it's a necessary evil though.

There is a high level of unpredictability when dealing with psych admissions - I deal with patients with varying diagnoses, including medical, and crises (s/p suicde attempts, mood disorders, psychosis, homicidal ideation, dementia, etoh/drug withdrawal and personality disorders). I have worked with some awe-inspiring patients over the years and a few that I'd prefer not to meet again (to put it nicely Copy%20of%20wink.gif ).

Some of our patients can't communicate their needs so assessment is critical. I don't think this can be emphasized enough with this population. It's easy to pass things off as a "psych issue" and then have it blow up in your face a few hours/days later. I follow my gut instinct if I can't pinpoint a specific problem - fortunately we have a great medical team who listen to staff concerns.

Somedays I am assigned the defib nurse if there is code in the hospital and other days I handle scheduling conerns for my department. There are many small tasks that I complete throughout my shift - I try to help the aides out as much as I can and vice versa. We work as a team and we depend on one another - I could not do my job without their help.

The last hour of my shift is usually the calmest, most of the patients are in their beds and the staff seem to unwind at this time. I finish up on my last minute tasks and try to spend a little time with staff in between doing things. It's my favorite time of the day, sort of a debriefing for us. Then the oncoming nurse shows up and I count/give report and try to let things go as I leave for the day.

EricJRN, MSN, RN · Nov 7, 2006

I'm referring to "psych" nursing!

I think, in the spirit of not being tight-lipped, she was just trying to help. From the wording of the original post, it would have been easy to misread it as seeking a comparison of med/surg vs psych.

Looks like the responses are starting to roll in. Good luck to you.

RN1263 · Nov 7, 2006

thanks for the responses thus far! They DO help alot!!!

also, DutchgirlRN i ment no disrespect when i posted back that i was referring to "psych" nursing, i was just clarifying, but thanks for posting!

kadokin, ASN, RN · Nov 29, 2006

maryloufu,
thanks for your honest answer!
what a breath of fresh air for a change, at least you're not blowing smoke up my a**!

Remember, she worked as a tech, not an RN. And, btw, the ones that sleep on the job dont' last very long. I can't imagine even finding the TIME to sleep on the job. But then, I work days, that might make a difference.:uhoh21:

kadokin, ASN, RN · Nov 29, 2006

I'm a recent grad and have been working on a busy Psych floor for 3 months ago. To answer some of your questions... Sometimes I do run around like a chicken without my head, it is nursing after all. My typical day starts with report and organization for about an hour. We have a team nursing concept and have to know what is going on will all the patients on the floor even if its not our assignment. That includes knowing who is going to the medical hospital for medical tests such as MRI or doppler studies. We're heavy on ppd and CXR so we need to schedule that as well so MHWs can go with patients, we do happen to have xray on site. We do the assignment, split of MAR books, go through the Kardex. That's hour one.
Then we go and meet our patients while the charge nurse meets all the patients, I usually go with the charge when I'm not in charge to make sure I know who everyone is especially since nurses do SO's (we check to see where patients are on a list periodically) when we don't have 2 MHWs, which is common. Then the charge nurse starts to get her meds. She/he goes first as they go to Team meeting with the multidisciplinary team (2 Psychiatrists, OTs, Art Therapists, Social Workers) and gives report on the status of the patients on our unit including mental/psychiatric status, medical conditions, issues involving transfer (we're a Short Term Commitment Facility STCF).
We give our meds to our own patients, then start moving to do the assignment of the day. Its usually either treatment planning where we go over the patient's treatment/care plan with them or on alternate days go over their medications and do that education either as a group or with individual patients.
On days where I don't have all my patients meds I'll be calling pharmacy and harassing them to approve things in our pixsys. We do do extensive charting, after all we're talking about psychiatry but it doesn't mean we're not working.
On days or weeks when we have aggressive patients we need to tackle them, put them in restraints, or call security to assist us. We restrain, medicate, and allow patients to calm down before taking them out of restraints..Then we debrief them about why they entered restraints and ways to avoid it in the future. While we're charting patients are constantly interrupting us for socks, towels, problems they're having.. Many of them are very disorganized and can have a hard time verbalizing what they need. It often takes a few minutes of conversation each to figure out what they want.
On the non committed side of the building we're geriatric/non committed. The geri population have medical problems including DM, massive HTN, etc. Last week we had a rectum and a uterus prolapse. I've had one patient with ESRD, rectal prolapse, massive constipation, dialysis 3x a week.. Other patients that need to be straight catheterized. Wrist wounds that need to be rinsed with betadine and covered with DSDs.
Basically I feel psych nursing is just as much running around without all the bending. I don't come home with that aweful back pain from bending improperly. I have strained a muscle holding back a patient from hitting another and have had to sit on a patient to keep him from ripping the stiches out of his jugular (highly suicidal). I risk getting punched regularly and losing teeth. So, its either bending or getting hit. Choose your poison.
Did I forget days during constant discharges and admissions?
I hope this helps you a little. I like what I do, but it is nursing and its a demanding profession on any floor.
Marc

Thank you Marc

A fellow psych nurse. It's not easy is it?:uhoh21: